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Boudewijn Van Houdenhove
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=== Adaptation instead of recovery === When analyzing the results of the multidisciplinary center for CFS at the University of Leuven, Van Houdenhove and colleagues found that among all factors of the cognitive-behavioral model, only severity of [[depression]] before treatment was significantly associated with post-treatment fatigue.<ref>Kempke S, Goossens L, Luyten P, Bekaert P, Van Houdenhove B, Van Wambeke P. Predictors of outcome in a multi-component treatment program for chronic fatigue syndrome. J Affect Disord. 2010 Oct;126(1-2):174-9. [[doi:]][https://www.jad-journal.com/article/S0165-0327(10)00099-6/fulltext 10.1016/j.jad.2010.01.073] [[PubMed Identifier|PMID]] [[pubmed:20167377|20167377]]</ref> As Van Houdenhove noticed, this wasn’t the only time findings contradicted the [[cognitive behavioral therapy]] (CBT) paradigm: <blockquote> "[…] in [[Cognitive behavioral therapy|CBT]]-oriented literature concerned with CFS, different treatment goals can be discerned. Some authors suggest that the therapist should mainly incite patients to diminish their somatic focus and correct inappropriate physical attributions. However, the usefulness of this goal is doubtful since the majority of patients with CFS and the largely overlapping fibromyalgia syndrome (FM) seems to accept a combined psychological/somatic causation of their illness. According to other authors, the therapist should in the first place tackle the patients’ activity avoidance or irregular activity patterns (outburst of activity followed by prolonged periods of rest), and stimulate them to engage in a graded exercise program in order to fight physical deconditioning. However, most CFS patients do not show kinesiophobia and loss of exercise capacity does not seem to play a major role in the pathophysiology of CFS."<ref name=":21">Van Houdenhove B. What is the aim of cognitive behaviour therapy in patients with chronic fatigue syndrome? Psychother Psychosom. 2006;75(6):396-7. [[doi:]][https://doi.org/10.1159/000095448 10.1159/000095448] [[PubMed Identifier|PMID]] [[pubmed:17053343|17053343]] </ref> </blockquote> Van Houdenhove criticizes his Dutch colleague [[Gijs Bleijenberg]] for arguing that full recovery should be the main goal of CBT. Based on years of experience working in ME/CFS clinic, Van Houdenhove does not see this as a realistic objective.<ref name=":21" /> Instead he suggests clinicians should recognize the lasting vulnerability of ME/CFS patients. He advises ME/CFS patients that: <blockquote>"…they should accept their ailment and functional limitations and work through the painful grieving process resulting from the fact that CFS means giving up many important things in life. Second, they should realistically adapt to their effort intolerance by learning to carefully pace activities in order to avoid post-exertional malaise reflecting abnormal immune activation. In many patients, this implies abandoning their previous ‘overactive’ lifestyles, which may be rooted in [[personality traits and patient attitudes in ME/CFS|narcissistic, perfectionistic or counter-dependent tendencies]]."<ref name=":21" /> </blockquote> Despite these criticisms, Van Houdenhove continues to promote [[graded exercise therapy]] (GET) and CBT as an essential part of the treatment of ME/CFS patients.<ref>Finoulst M, Vankrunkelsven P, Van Houdenhove B. [https://www.tvg.be/article/cvs-me-en-fibromyalgie-waar-staan-we CVS, ME en fibromyalgie: waar staan we?] Tijdschrift voor Geneeskunde. 2018; 74: 666.</ref>
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