Chronisches Fatigue-Syndrom, 2026, Alexa Alica Kupferschmitt & Volker Köllner

[Chandelier]

Chronisches Fatigue-Syndrom

Kupferschmitt, Alexa Alica; Köllner, Volker

Spoiler: Zusammenfassung

Zusammenfassung​

Das Chronische Fatigue-Syndrom (CFS) ist durch eine anhaltende, körperlich und kognitiv stark beeinträchtigende Fatigue gekennzeichnet, die durch Belastung verstärkt werden kann (Post-Exertional Malaise, PEM).
Das Krankheitsbild hat durch das Post COVID-Syndrom (PCS) sowohl eine Zunahme der Häufigkeit als auch der öffentlichen Aufmerksamkeit erhalten.
Empirische Wirksamkeitsnachweise zur Besserung der Fatigue-Symptomatik liegen bisher nur für die KVT und eine vorsichtig aktivierende Bewegungstherapie bei leichten und mittelschweren Formen vor, während es für ein schweres CFS bisher keine ausreichende Datenlage gibt.
Zudem muss hier auf eine Verschlechterung durch PEM geachtet werden, obwohl die Datenlage auch hierzu inkonsistent ist.
Zur Unterstützung der Krankheitsverarbeitung sind ACT-basierte Ansätze und beim PCS das aus der Schmerztherapie adaptierte Avoidance-Endurance-Konzept hilfreich.

Abstract (machine translation)
Chronic Fatigue Syndrome (CFS) is characterized by persistent, severe fatigue that substantially impairs physical and cognitive functioning and may be exacerbated by exertion (post-exertional malaise, PEM).
The condition has received increased attention, both due to its higher prevalence and its growing public awareness, in the context of post-COVID syndrome (PCS).
To date, empirical evidence for the efficacy of interventions aimed at improving fatigue symptoms is available only for cognitive behavioral therapy (CBT) and cautiously activating exercise therapy in mild to moderate forms of CFS, whereas the evidence base for severe CFS remains insufficient.
In addition, potential worsening due to PEM must be taken into account, although the evidence regarding this issue is also inconsistent.
To support patients in coping with the illness, acceptance and commitment therapy (ACT)-based approaches may be beneficial. In patients with PCS, the Avoidance-Endurance Model, adapted from pain therapy, may also be helpful.


Web | DOI | Psychotherapie: Praxis | Paywall

 

[Utsikt]

To date, empirical evidence for the efficacy of interventions aimed at improving fatigue symptoms is available only for cognitive behavioral therapy (CBT) and cautiously activating exercise therapy in mild to moderate forms of CFS, whereas the evidence base for severe CFS remains insufficient.

That tells you all you need to know about their ability to assess evidence.

In addition, potential worsening due to PEM must be taken into account, although the evidence regarding this issue is also inconsistent.

So the standards for harm are higher than for benefit. Gotcha.

To support patients in coping with the illness, acceptance and commitment therapy (ACT)-based approaches may be beneficial. In patients with PCS, the Avoidance-Endurance Model, adapted from pain therapy, may also be helpful.

I have no idea what that is, but it sounds like the usual BPS babble. Obviously hypothetical niche «model» can be applied to all conditions if you just believe enough.

 

[Chandelier]

Bluesky post with screenshots from the book chapter (machine translation):

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Dr. Daniel Loy​

@drdanielloy.bsky.social​

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1. A particularly toxic, powerful, and therefore dangerous narrative in the context of #MECFS is that of patients being difficult and aggressive.​

This is precisely why it is essential to choose one’s words carefully when writing or speaking about this patient population.​

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OCR of the screenshot and machine translation:​

A striking characteristic of some patients with fatigue is a combative and reproachful attitude toward healthcare providers who do not share the patient’s own diagnostic assumptions.​

Another feature may be dysfunctional illness behavior, characterized by self-harming patterns of rest and avoidance, increased self-monitoring, and involvement of the patient’s social environment, which, irrespective of the primary etiology, may fulfill the criteria for a hypochondriacal disorder.​

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2. Basic research, including studies investigating biomarkers and objectively measurable pathophysiological changes, is essential for definitively resolving certain claims about #MECFS on an empirical basis.​

A one-sided focus on treatment studies is therefore insufficient.​

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OCR of the screenshot and machine translation:​

Chronic fatigue syndrome (CFS) is also referred to as myalgic encephalomyelitis (ME), chronic fatigue or exhaustion syndrome, systemic exertion intolerance disease (SEID), neurasthenia (ICD-10 F48.0), somatoform disorder (ICD-10 F45), or fibromyalgia.​

To date, there is insufficient empirical evidence to support the various etiological concepts associated with ME/CFS.​

CFS frequently occurs following viral infections, but may also develop following traumatic brain injury or arise spontaneously.​

The diagnosis is based on clinical criteria, with the Canadian Consensus Criteria being the most commonly used.​

In general, however, it should be noted that “chronic fatigue syndromes” occur very frequently in a wide variety of contexts.​

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3. Anyone who still treats #MECFS in 2026 as if it were nonspecific fatigue is obscuring or denying the crucial distinction: #PEM.​

There may be scientific debate about many details of the disease.​

But the fact that PEM is central to both diagnosis and treatment is no longer up for debate.​

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OCR of the screenshot and machine translation:
The condition has received considerable media attention in the wake of the COVID-19 pandemic, so it is understandable that patients not infrequently attribute their symptoms to it.
However, post-viral fatigue has long been recognized in medicine independently of COVID-19.
It is important to rule out both psychological differential diagnoses (e.g., depression, burnout) and somatic ones (e.g., multiple sclerosis, anemia, hypothyroidism).
A notable characteristic of some patients with fatigue is their combative and accusatory attitude toward healthcare providers who do not share or follow their own diagnostic assumptions.​

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[NelliePledge]

Avoidance-endurance model yet another term to add to the Catastrophising list of patient blame and stigmatisation

 

[Chandelier]

The two authors already made multiple appearances on the forum:

“Conflict of interest: The author (i.e. Prof. Dr. med. Volker Köllner) states that he has received royalties and an author's fee from Elsevier Publishing, fees for expert opinions in court, lecture fees from Synaptikon, SRH Vocational Training Center and the University of Würzburg, as well as funds for studies from the German Pension Insurance (DRV).”

I think his stance is well expected for a scientist payed by the National Pension Insurance Agency. However that really looks utterly ugly and pessimistic. At least lets hope that the hardcore pro-ME team in Charite Berlin will achieve to secure a part of the Funds.

Satisfaction of post-COVID patients with rehabilitation

Alexa Alica Kupferschmitt, Thilo Hinterberger, Sebastian Indin, Christoph Hermann, Jöbges Michael, Stefan Kelm, Gerhard Sütfels, Thomas H Löw, Volker Köllner

Bedeutung von „avoidance“ und „endurance“ beim Post-COVID-Syndrom
Kupferschmitt, Alexa; Herrmann, Christoph; Jöbges, Michael; Kelm, Stefan; Sütfels, Gerhard; Loew, Thomas H.; Hasenbring, Monika; Köllner, Volker

After yesterday's positive news, here's why many pwME aren't overly optimistic because the money could be used to fund more BPS nonsense.

All three recommend GET or even inpatient rehab facilities for pwME.

From comments by German users on bsky, this is a podcast for physicians and this episode features a lot of disinformation about LC and ME/CFS:

 

[wallfish]

If I have it right, this is the earliest of Wessely's papers about CFS. Published in 1989.

He introduces an early Cognitive Behavioural model of CFS, hypothesizing a vicious cycle of avoidance and inactivity maintains symptoms. He says:

This model has been successfully applied to chronic pain

And recommends CBT and graded exercise therapy.

Now, 37 years, 1 PACE scandal, 1 pandemic and who knows what amount of avoidable suffering later, the authors in the present study write:

In patients with PCS, the Avoidance-Endurance Model, adapted from pain therapy, may also be helpful.

and recommends CBT and cautiously activating exercise therapy.

 

[Chandelier]

He introduces an early Cognitive Behavioural model of CFS, hypothesizing a vicious cycle of avoidance and inactivity maintains symptoms.

Also see this thread for more on the Avoidance-Endurance model:
Importance of avoidance and endurance in post-COVID syndrome Can dysfunctional patterns be changed?

Trish has written a post in there that goes into more detail as well.