Table 1.

Structure and content of therapies

	Pragmatic rehabilitation	Supportive listening
Overview of treatment	Provides a physiological dysregulation model of CFS/ME, supported by a referenced manual, which underpins the rationale for a programme of graded return to activity, designed collaboratively by patient and therapist. The rehabilitation programme encourages patients to regularise their sleep patterns and includes relaxation exercises to address the somatic symptoms of anxiety and the concentration and memory problems that many patients experience.	A form of nondirective counselling, based on person-centred counselling techniques. The therapist aims to provide an empathic and validating environment in which the patient can discuss his or her concerns and work towards resolution of whichever problems the patient wishes to prioritise.
Structure of treatment	Session 1: 90-minute home visit. One-hour home visits on weeks 2, 4, 10, and 18. Thirty-minute telephone calls on weeks 3, 6, 8, 12, and 15.	Session 1: 90-minute home visit. One-hour home visits on weeks 2, 4, 10, and 18. Thirty-minute telephone calls on weeks 3, 6, 8, 12, and 15.
Content of treatment	Session 1: Patients are presented with a detailed explanation of their symptoms, supported by a referenced manual, with diary pages, reinforcing the model and outlining a rehabilitative programme. Session 2: The manual is reviewed, patient priorities are determined, and goals for rehabilitation are set collaboratively by the patient and therapist. Care is taken to set goals at a level easily manageable by the patient. Sessions 3-10: At subsequent sessions, progress is reviewed, and the rehabilitative programme adjusted if necessary. Sessions 5-10: Relapse prevention is discussed in the fifth to tenth sessions. In all sessions, the model of CFS/ME contained in the manual is reinforced.	Session 1: The basis of the therapeutic approach is explained and a short booklet with diary pages is given to patients. Issues for discussion in subsequent sessions are elicited, and the therapists use standard counselling techniques of active listening, reflection, and summarizing to ensure that patients feel understood. Sessions 2-10: The therapist summarises the previous session's work and invites the patient to set the agenda for that session's discussion. The therapists do not provide any explanation for patients' symptoms. Throughout, the content of sessions is determined by patients; therapists avoid giving advice or leading patients and concentrate on providing an empathic, validating environment in which patients can discuss their concerns, are encouraged to explore their difficulties, take responsibility for decisions, and identify and use their own resources to manage their health.

CFS/ME = chronic fatigue syndrome/myalgic encephalomyelitis.