Dr Bill Reeves (CDC CFS program) and CBT | ProHealth Fibromyalgia, ME/CFS and Lyme Disease Forums

Dr Bill Reeves (CDC CFS program) and CBT

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(From Co-Cure)

I thought I would draw attention to the following quote by Dr. Bill Reeves
from the minutes of the CFSAC meeting, May 2009 (pp.60)

"The other problem is that in studies that we've recently published, a large
proportion of
people who have CFS have serious psychiatric overlays. Those need to be
as well. But that isn't saying that that is the cause of your illness; that
is saying that that
is something that needs to be taken care of because it's there with your
illness. You
cannot ignore it. There is unhappiness with CBT because CBT is "all in your
Many of you knew me when I was walking on a crutch with a ruptured
tendon and a year's worth of surgery. A huge part of the rehabilitation
therapy was CBT
to help me understand what was happening, understand how I could cope, and
understand what was expected."

The first point is that the empirical definition has increased the
percentage of people with psychiatric issues (many of them may not have CFS
as normally defined at all).

But the main issue I want to point is that I do not believe Dr Bill Reeves
had CBT for his ruptured quadriceps tendon.

CBT is not something that is normally offered for a problem like that.

And I'm not sure Dr Reeves would have gone to regular sessions with a
psychologist (on top of time spent with a physical

If it is the case that he has not gone for CBT, he is either being
misleading or, and I think this is more likely, he does not understand what
CBT is.

CBT is designed for maladaptive beliefs and behaviours. It if involves a
lot of homework where you have to keep diaries. Other psychologists can
probably describe it better than me but one can give coping skills training
and education on the condition without giving CBT.

Dr Reeves' understanding of CBT is important given the CBT want to draw up
management and treatment guidelines including guidelines which have an
international consensus (getting a consensus on management guideliens would
seem very hard to do unless you don't pay attention to the people who
propose a pacing model or an envelope theory model for how to manage CFS -
these are very different from the graded exercise model (which is the basis
of the CBT model for the illness).

As I pointed out before, at this meeting, Dr Reeves said:

"CBT GET. We are in the process of planning a cognitive behavioral therapy
(CBT) and graded exercise (GET) trial as part of the provider registry
in Macon. We're going to do that in collaboration with the providers in
with Mercer Medical School, with the U.K. group, and with Mayo Clinic.
Obviously, CBT GET is not the cure for everybody. Nobody knows for how many
it is. It probably applies to a subset."

What he is saying is that CBT GET is a cure for some people with CFS. Most
people in the field don't talk as if CBT is a cure for some percentage of
people with CFS. Two of the few that do are Peter White and Gijs

I'm appending a selection of other quotes from the meeting by Dr Bill Reeves
on the issue of CBT, GET, Peter White and the situation in the UK.


CFS Program Five-Year Goals


"International Workshop - Research, Clinical, and Pediatric Definitions of
would like to try to get together by the winter of 2009. I know the IACFS/ME
interested in this. We want to include countries such as UK that have CFS
completely integrated into their healthcare system."
(TK: that's CBT/GET and very little else (the NICE guidelines recommend
against other treatments and against most testing (except basic testing to
rule out other conditions))


Dr. Oleske (Chair of the CFSAC): I'm going to open it up to questions from
the group. The only thing I want to say, Bill, is I was interested in your
comments about the international community and how much
effort will be put into that. While I have no problem with international
collaborations, I
have to say that I think there are times when the domestic agenda suffers at
the behest
of an international agenda. I just hope that we don't dilute the
concentration on the US.
I want to ask you to comment about that.

Dr. Reeves: An excellent comment. Our focus is obviously on the United
There are three important reasons for international collaboration. One of
them I alluded
to. There are countries that have put CFS evaluation, diagnosis, and
management into
their national health systems. The UK is one of those. An international
provides the chance to learn from another government that has embraced this
perhaps not to the extent that everybody would like-but is trying to work
with it as a
national health service.


Ms. Artman (member of CFSAC committee): I want to stay on the international
theme. Before this meeting, I sent out
a query to those who participated in the CDC stakeholder meeting to find out
what they
had to say, because I was ill and couldn't attend. Just about everyone came
back with
comments about either Simon Wesley or Peter White treating this as a purely
psychiatric disorder and not as a multi-system complex disorder. There's a
that in working with the UK, we are adopting that this is a purely
psychiatric disorder.

This is a big patient perception issue with the CDC. It's not what you're
actually doing;
it's what we perceive that you're doing. You need to really place an
emphasis on how
you want the patient community to view what the CDC is doing.

Japan is doing such remarkable research, I would hope that whatever you do,
you pull
the Japanese in. I love what they call it: burnout syndrome. Their whole
concept is that
you do too much and get sick, not as the US tends to think, that we're
malingerers. I
just want to ask you so it's on the record out there for everyone-what is
the CDC's take
on this? Do you see it as a purely psychiatric illness?

Dr. Reeves: Of course it is not. One of the very first things that I
highlighted out of the
stakeholder meeting is that communication has not been optimal. Peter White,
psychiatrist that we work with at Emory, does not look upon CFS as a
illness. What they are extremely interested in at Emory are the neurologic
and brain
pathways that mediate this. That is one of the things that Peter White
really added to
the peer review-he is an expert on autonomic nervous system function. The
fact that
certain investigators have a reputation in a certain component of the
community for
thinking that CFS is all in the patient's head is a result of the CDC's
problems with

(TK: I believe most people would question why a major body like the CDC, if
it needed a person who was an expert in the autonomic nervous system for a
peer review, would bring in Peter White to do it! And regarding the last
sentence, people like Peter White have a "reputation" for what they say and
do - it's not simply because people picked them up incorrectly)


Dr Bill Reeves: "The collaboration with Peter White is largely because Peter
White came to us when the
national health service in the UK was trying to design its program and
recommendations about what the health service in the UK should do. We've
with them as far as our ideas and our expertise, and we collaborate with Dr.
White on
the PACE trial. He's an unusually intelligent individual-you've read some of
comments on some of our articles-whom we enjoy sparring with. He is an
expert on
autonomic nervous system function and he's highly instrumental in all of the
both with patients with the government and with physicians, in trying to put
given the current state of knowledge, a national program."

--Another quote--

"Dr. Miller (from the CDC): I think that my goal in terms of intervention is
that we get to a point
sometime during the five-year plan where we're ready with the defined study
we implement some intervention that shows promise, and we're to measure the
of that intervention.

Dr. Reeves: We talked about a collaboration with Mayo on a CBT/GEBM
That's two years out, maybe more."


New Member
In regards to CBT, again, Reeves is mixing up apples and oranges – and he probably well knows it. You ask him about a rotten apple, and he shows you a shiny fresh orange.

Traditional cognitive behavioral therapy has been shown to be of value in helping people cope with physical illness and injury. It never claims to be a substitute for medical treatment.

In the case of ME/CFS (Canadian definition - CFS is now meaningless thanks to the CDC), appropriate CBT would involve learning how to cope with a serious chronic physical disease, which is widely disbelieved and dismissed as psychological. Techniques, such as pacing, that have been shown to be effective and can cause no harm, would be stressed.

The therapist or counsellor would emphasize the physical nature of the disease and confirm it is not the patient, or his/her "illness beliefs," that is at fault.

UK-style CBT/GET is a different kettle of fish entirely. It is offered in lieu of appropriate medical treatment and places the burden on the patient to correct his/her thinking that ME/CFS is primarily a physical problem.

It encourages patients to embark on an exercise program which is likely to make them sicker.

I doubt very much if Dr. Reeves would have accepted UK-style CBT is place of surgery for his torn tendon.

[This Message was Edited on 10/03/2009]



thank you very much. is Reeves softening his rhetoric, trying to portray himself as a kinder, gentler controller of CDC research on cfids?? so he is listening to criticism from PWCs, it seems to some extent. at least in terms of defending himself

he, and Wesseley (sp?) in England, do need to incorporate actual physiological findings from people like Cheney and Montoya,and i know there are others. we need an inclusive approach to uncovering all the dynamics at work here, is my opinion.

again, thank you so much for what you contribute to the dialogue- Sascha



RE: "UK-style CBT/GET is a different kettle of fish entirely."

When people talk about evidence-based CBT, this is what they are talking about.

And it's not just in the UK where studies have been produced using CBT based on GET.

If you look at the last International CFS Study group that the CDC put together, all or virtually all of the authors would have recommend "UK-style CBT/GET"

Without action, these will be appearing at the treatment on the CDC website soon.

And they will use them for their education programmes to doctors and other professionals.

And when they are advising the TV/Movie industry on CFS (they say they are starting to do this), this will be what they'll be recommending.


New Member
Wessely will never change his stance. His whole career has been predicated on 'treating' M.E with his belief that, although an organic basis is responsible for initiating the illness, we as patients, are responsible for perpetuating it.

There can be few in the medical profession that have done so much harm, to so many, over such a long period of time, with a well rewarded career, and would you believe, a gold medal for his 'success in treating this illness'.

Don't bother passing me the vomit bag, my gut related issues have already beaten you to it.....

Kind regards, Mark
says, "The other problem is that in studies that we've recently published, a large
proportion of
people who have CFS have serious psychiatric overlays. Those need to be
as well. But that isn't saying that that is the cause of your illness; that
is saying that that
is something that needs to be taken care of because it's there with your
illness. You
cannot ignore it."

Oh really Dr. Reeves? Is that the same kind of recommendation you also give to people who have AIDS or cancer? I highly doubt it~

If anyone knows of any quotes from Dr. Reeves or any other Dr. that states that there are "serious psychiatric overlays" in other illnesses that interfere with healing, please post them here - I wanna see 'em.

So do these "serious psychiatric overlays" get in the way of people getting better? Is that what he's saying?? Puhleeze.

[This Message was Edited on 10/03/2009]


New Member
nice explanation of the differences between real CBT and the UK version....I absolutely agree with you

I have read case notes that were written by a UK therapist about several sessions done with a CFS patient, and the notes included some transcripts of what was said by the therapist and patient...... the therapist just kept pushing the patient to change his "abnormal illness beliefs" and accept that his CFS was completely psychological....it was a horrible, horrible exp of counseling

even if the person really did have a mental illness (which obviously CFS is NOT), the counseling he was given would have absolutely appalled me - it was so completely in violation of what I was trained to do as a counselor- he was not working with the client, was not gaining his trust, was not doing anything at all helpful and was in fact quite harmful in a lot of ways


New Member
thanks for posting this....nice job of really picking out some of the stuff that clearly shows how bad the CDC's plan and Reeves are.....I listened to much of the mtg, but was getting so upset I had to shut it off or leave the room for awhile, so although I got the gist of it, I am glad to read this, too (well, glad might be the wrong word, considering how disturbing it is.....appreciative of your efforts to keep us informed would be a better way to say it, I guess)

the efforts to inc the UK and to say that they have done such a great job of integrating CFS into their health care system is so scary.....the only way that things could be worse for ME/CFS patients in the US is if we adapt the UK's ideas into our system even more so than they already are....I swear I am about ready to move to japan : )


"I have read case notes that were written by a UK therapist about several sessions done with a CFS patient, and the notes included some transcripts of what was said by the therapist and patient...... the therapist just kept pushing the patient to change his "abnormal illness beliefs" and accept that his CFS was completely psychological....it was a horrible, horrible exp of counseling"

This is interesting, could I ask if you happen to remember where you read it?



New Member
I will try to find it again for you....unfortunately I have so many things saved and am so bad at organization (another thing that I was great at pre-ME and am no longer) that I am not entirely sure if I will be able to find it.....if I do, I'll start another thread with it for you
I'm not disputing that illness can cause psychiatric problems. I'm against psychologizing CFS as Dr. Reeves is constantly doing. Are you aware of who Dr. Reeves is?

Also, thanks for your reply posts but what I'm asking for is quotes from doctors stating that patients with AIDS or Cancer or Epilepsy etc... need CBT or else their psychiatric illnesses will interfere with their healing.


[This Message was Edited on 10/06/2009]


(From Co-Cure)

From: http://www.nature.com/news/2009/091008/full/news.2009.983.html

William Reeves, principal investigator for the Centers for Disease Control
and Prevention (CDC)'s CFS public health research programme, says the
findings are "unexpected and surprising" and that it is "almost unheard of
to find an association of this magnitude between an infectious agent and a
well-defined chronic disease, much less an illness like CFS"

What does he mean "much less an illness like CFS". CFS is much more like a
chronic viral disease than most chronic diseases - it is often clearly
triggered by an infection and 'flu-like symptoms are part of the complex.

Why is he heading a program based in the viral section of the CDC if he has
this attitude?

Quote:"But Reeves is cautious. "Until the work is independently verified,
the report represents a single pilot study," he says. According to Reeves,
the CDC is already trying to replicate these findings. He also notes that
CFS is a heterogeneous disease and likely arises from a combination of many

Normally, I would be pleased to hear that the CDC was doing viral research
on the illness.

However, if they use the "empirical" definition, I believe the percentage of
patients with CFS will be much lower than the percentage of patients who
satisfy a "proper" defintion for CFS.

Tom Kindlon

Don't support the Reeves/empirical definition/criteria for CFS?
Sign the petition at: http://CFSdefinitionpetition.notlong.com
Thanks for posting that. I was wondering the same thing and no, I do not support the Reeves empirical definition criteria for CFS.


Response to Reeves and Jones - Gurli Bagnall - October 9th, 2009

Gurli Bagnall

Oh that is rich! Oh I love it! That was so funny and so true and dang if I didn't have to look up "allostatic" for myself just now in Webster's and it is not a real word. All this time I thought it was as I've either read that very paragraph before or they've used it elsewhere. OMG! lol

Thanks so much for the link Quayman.
[This Message was Edited on 10/09/2009]


(From Co-Cure)

Another Bill Reeves quote:



"It is almost unheard of to find an association of this magnitude in any
study of an infectious agent and a well-defined disease, much less an
[ill-defined] illness like chronic fatigue syndrome," he said in an e-mail.
It is extremely difficult to prove causation with a ubiquitous virus like
XMRV, and it "is even more difficult in the case of CFS, which represents a
clinically and epidemiologically complex illness," he said.


This quote is similar to the last quote so the same points apply except that
he is now saying that XMRV is a "ubiquitous virus".

Some viruses could be said to be "ubiquitous" e.g. most of the adult
population will have some sort of antibodies to EBV.

However, the XMRV virus was only identified in 8 of 218 (3.7%) healthy
controls (compared to 68 of 101 patients (67%) of the patients).

The researchers also did some extra experiments, summarised in plain English

"Testing the white blood cells from thirty CFS patients showed that 63% (19
people) of the samples tested showed viral proteins. Tests on samples from
five healthy controls did not show any viral proteins.

"Overall, samples from people with CFS were 54 times as likely to contain
viral sequences as samples from healthy controls.

"The researchers found that XMRV found in the white blood cells of CFS
patients could be transmitted to prostate cancer cells when grown together
in the laboratory. In 10 out of 12 people with CFS (83%), fluid taken from
their blood samples could also infect the prostate cancer cells in the
laboratory. Similar results were found when uninfected white blood cells
were exposed to this fluid. Fluid from the blood samples of twelve healthy
controls did not infect the prostate cancer cells.

"The researchers found that half (nine out of 18) of CFS patients carrying
XMRV DNA had antibodies against a similar virus, while none of the seven
healthy controls tested showed an antibody response. This suggested that
half of the CFS patients had had an immune response to the XMRV."


To summarise, these experiments (admittedly using smaller sample sizes)
again don't show XMRV to be ubiquitous like Bill Reeves claims.

Tom Kindlon


I claim that Reeves had better keep his mouth shut, or he's going
to find himself out of that job at Emory!