Chronic fatigue syndrome is a disabling condition characterized by persistent mental and physical fatigue. Its aetiology is controversial, and it has been attributed to both physical and psychological causes. Previous controlled trials with ambulatory patients have shown that a proportion of CFS patients respond to cognitive-behaviour therapy. In this paper, we report two case studies of patients who are wheelchair-bound, who have been treated by a pragmatic intervention designed to increase activity and challenge dysfunctional illness beliefs. The patients received 60 and 55 contacts with the therapist, some of which were face-to-face and some of which were by telephone. At the end of treatment, the patients experienced clinically significant reductions in fatigue, were not using wheelchairs, showed an increase in occupational and social functioning and were leading relatively independent existences.