Innovations Medication Management

by Katrin Olavessen-Holt, BA Psych, PharmD, CPGx, CMTM

If you’re living with chronic fatigue or ME/CFS, you’ve probably been told that graded exercise therapy and CBT are the go-to treatments. But what if these popular approaches are actually doing more harm than good?

In the latest episode of The Wellness Pharmacist podcast, Dr. Kat dives into the controversial world of these therapies. Graded exercise therapy and CBT were originally designed to gradually recondition patients with persistent fatigue. And for some, they may provide small improvements. But for many others, especially those with ME/CFS, they can be dangerous.

Research

Research is conflicted. Some studies, like the Cochrane Review and findings from the Scandinavian Journal of Primary Health Care, show modest benefits. However, newer research from Work (2020), Diseases (2023), and the Journal of Health Psychology (2022) report the opposite: patients often worsen when pushed into structured activity or told their symptoms stem from psychological issues.

Personal Story

Dr. Kat shares her personal story of repeated flare-ups and crashes when she tried to follow these treatments. Like many others with ME/CFS, her body simply could not recover from even small increases in activity. This common response is called post-exertional malaise (PEM), and it’s a defining feature of chronic fatigue that graded exercise therapy and CBT often overlook.

We need a shift toward listening to patients, validating their symptoms, and designing treatment plans based on biology, not outdated behavioral models.

If you or someone you love lives with chronic fatigue, this episode is essential listening. You are not lazy. You are not making it up. And there are better, safer paths forward.

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