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The term 'Invalidating Environment' refers essentially to a situation in which the personal experiences and responses of the growing child are disqualified or "invalidated" by the significant others in her life.

The child's personal communications are not accepted as an accurate indication of her true feelings and it is implied that, if they were accurate, then such feelings would not be a valid response to circumstances.

The discovery that an increase in exercise tolerance did not lead to an increase in fitness means that an underlying physical problem prevented this; validates that ME/CFS is a physical disease and that none of the treatments studied addressed this issue.

Chronic Fatigue Syndrome; CBT; Cognitive Behavioral Therapy; GET; Graded Exercise Therapy; Myalgic Encephalomyelitis; PACE Trial; Pacing 6MWT: 6 Minute Walk Test; APT: Adaptive Pacing Therapy; ATS: American Thoracic Society; BMJ: British Medical Journal; CBT: Cognitive Behavioral Therapy; CDC: Centers for Disease Control and Prevention; CFS: Chronic Fatigue Syndrome; CGI: Clinical Global Impression; CMO: Chief Medical Officer, the UK government’s principal medical adviser; GET: Graded Exercise Therapy; IOM Institute of Medicine; ME: Myalgic Encephalomyelitis; ME/CFS: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome; SD: Standard Deviation; SF-36: Short Form-36; SMC: Specialist Medical Care; VO Following an extensive review of the literature, the American Institute of Medicine (IOM) concluded that “myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) are serious, debilitating conditions that affect millions of people in the United States and around the world”; that it is a “medical - not a psychiatric or psychological - illness” without a “known cause or effective treatment” which “can cause significant impairment and disability” [1] rendering 25% of patients homebound or bedridden [2] yet “the term chronic fatigue syndrome can result in trivialization and stigmatization” of this “complex, multisystem, and often devastating disorder” [1] .

As a doctor who has been bedridden with severe ME for a long period, I analyzed the PACE trial and its follow-up articles from the perspectives of a doctor and a patient.

During the PACE trial the eligibility criteria, both subjective primary outcomes, and most of the recovery criteria were altered, creating an overlap of the eligibility and recovery criteria; consequently, 13% of patients were considered “recovered,” with respect to 1 or 2 primary outcomes, as soon as they entered the trial.

Holding emotions and fears inside all the time can lead to feelings of tension in the body, sleep problems, or feeling like you’re going to explode.You might wish that you could just forget about the past and put the pain behind you and perhaps you’ve even tried to do this on your own.It’s normal to have questions and fears about seeking help when you’ve been hurt, manipulated, or betrayed in the past.Dialectical Behaviour Therapy is based on a bio-social theory of borderline personality disorder.Linehan hypothesises that the disorder is a consequence of an emotionally vulnerable individual growing up within a particular set of environmental circumstances which she refers to as the 'Invalidating Environment'.

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