text: Could Cognitive Behavioural Therapy Be an Effective Treatment for Long COVID and Post COVID 19 Fatigue Syndrome Lessons from the Qure Study for Q Fever Fatigue Syndrome An increasing number of young and previously fit and healthy people who did not require hospitalisation continue to have symptoms months after mild cases of COVID 19 Rehabilitation clinics are already offering cognitive behavioural therapy CBT as an effective treatment for long COVID and post COVID 19 fatigue syndrome based on the claims that it is effective for myalgic encephalomyelitis chronic fatigue syndrome ME CFS the most common post infectious syndrome as no study into the efficacy of CBT for post COVID 19 fatigue syndrome has been published Re analyses of these studies however showed that CBT did not lead to objective improvements in heterogeneous groups of ME CFS patients nor did it restore the ability to work The group of patients with long COVID and post COVID 19 fatigue syndrome on the other hand is homogeneous We therefore analysed the Dutch Qure study as it studied the efficacy of CBT in a homogeneous group of patients who developed Q fever fatigue syndrome which affects up to 30 of patients after the largest reported outbreak of Q fever to see if CBT might potentially be an effective treatment for long haulers after COVID 19 infection Our reanalysis found that the Qure study suffered from many serious methodological problems which included relying on one subjective primary outcome in a study without a control group for the non blinded CBT treatment group using a post hoc definition of improvement waiting 2 years before publishing their objective actometer results and ignoring the null effect of said results Moreover only 10 of participants achieved a clinically meaningful subjective improvement in fatigue as a result of CBT according to the studys own figures Consequently CBT has no subjective clinically meaningful effect in nine out of every ten patients that are treated with it Additionally the subjective improvement in fatigue was not matched by an improvement in disability even though the disability was fatigue related according to the researchers On top of this CBT did not lead to an objective improvement in physical performance Therefore it cannot be said that CBT is an effective treatment for Q fever fatigue syndrome either It seems therefore unlikely that CBT will reduce disability or lead to objective improvement in long COVID or in post COVID 19 fatigue syndrome 