Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trial.
Open accessAbstract
Background Cognitive behaviour therapy (CBT) added to specialist medical care (SMC), or graded exercise therapy (GET) added to SMC, are more effective in reducing fatigue and improving physical function than both adaptive pacing therapy (APT) plus SMC and SMC alone for chronic fatigue syndrome. We investigate putative treatment mechanisms.Methods We did a planned secondary mediation analysis of the PACE trial comparing SMC alone or SMC plus APT with SMC plus CBT and SMC plus GET for patients with chronic fatigue syndrome. 641 participants were recruited from six specialist chronic fatigue syndrome clinics in the UK National Health Service between March 18, 2005, and Nov 28, 2008. We assessed mediation using the product of coefficients method with the 12 week measure of the mediators and the 52 week measure of the outcomes. The primary outcomes were fatigue measured by the Chalder fatigue scale and physical function measured by the physical function subscale of the SF-36. We included confounder covariates and used treatment by mediator interaction terms to examine differences in mediator-outcome relations by treatment group.Findings The largest mediated effect for both CBT and GET and both primary outcomes was through fear avoidance beliefs with an effect of larger magnitude for GET (standardised effects ×10, CBT vs APT, fatigue -1.22, 95% CI -0.52 to -1.97, physical function 1.54, 0.86 to 2.31; GET vs APT, fatigue -1.86, -0.80 to -2.89, physical function 2.35, 1.35 to 3.39). Increase in exercise tolerance (6 min walk distance) was a potent mediator of the effect of GET (vs APT, fatigue -1.37, 95% CI -0.76 to -2.21, physical function 1.90, 1.10 to 2.91), but not CBT.Interpretation Our main finding was that fear avoidance beliefs were the strongest mediator for both CBT and GET. Changes in both beliefs and behaviour mediated the effects of both CBT and GET, but more so for GET. The results support a treatment model in which both beliefs and behaviour play a part in perpetuating fatigue and disability in chronic fatigue syndrome.Funding UK Medical Research Council, Department of Health for England, Scottish Chief Scientist Office, Department for Work and Pensions, National Institute for Health Research (NIHR), NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust, and Institute of Psychiatry, Psychology, and Neuroscience, King's College London.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the same treatment study, sleep problems measured at 12 weeks were also found to mediate part of the effect of CBT and GET on fatigue at 1-year follow-up, when compared to standard medical care.
“In the same treatment study, sleep problems measured at 12 weeks were also found to mediate part of the effect of CBT and GET on fatigue at 1-year follow-up, when compared to standard medical care (Chalder et al., 2015).”
From The relationship between improvement in insomnia severity and long-term outcomes in the treatment of chronic fatigue (2018) · cites this paper as Chalder et al., 2015
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Baron, R. M., & Kenny, D. A. (1986) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.51.6.1173 · Cited by 91,542 · see citing works
Baron, R. M., & Kenny, D. A. (1986) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.51.6.1173 · Cited by 91,532 · see citing works
An Introduction to the Bootstrap
Efron, B., & Tibshirani, R. J. (1994) · doi:10.1201/9780429246593 · Cited by 40,500 · see citing works
An Introduction to the Bootstrap
Efron, B., & Tibshirani, R. J. (1993) · doi:10.1007/978-1-4899-4541-9 · Cited by 21,230 · see citing works
The american college of rheumatology 1990 criteria for the classification of fibromyalgia
Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., Tugwell, P., Campbell, S. M., Abeles, M., Clark, P., et al. (1990) · Arthritis & Rheumatism · doi:10.1002/art.1780330203 · Cited by 9,563 · see citing works
Introduction to Statistical Mediation Analysis
MacKinnon, D. P. (2012) · doi:10.4324/9780203809556 · Cited by 5,618 · see citing works
Enders, C., & Bandalos, D. (2001) · Structural Equation Modeling: A Multidisciplinary Journal · doi:10.1207/s15328007sem0803_5 · Cited by 4,978 · see citing works
The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2002) · Psychosomatic Medicine · doi:10.1097/00006842-200203000-00008 · Cited by 3,305 · see citing works
The Work and Social Adjustment Scale: a simple measure of impairment in functioning
Mundt, J. C., Marks, I. M., Shear, M. K., & Greist, J. M. (2002) · British Journal of Psychiatry · doi:10.1192/bjp.180.5.461 · Cited by 2,515 · see citing works
Process Analysis: Estimating Mediation in Treatment Evaluations
Judd, C. M., & Kenny, D. A. (1981) · Evaluation Review · doi:10.1177/0193841x8100500502 · Cited by 2,442 · see citing works
A report—Chronic fatigue syndrome: Guidelines for research
Sharpe, M. C. (1991) · Journal of the Royal Society of Medicine · doi:10.1177/014107689108400224 · Cited by 1,026 · see citing works
Self-citationWhite, P., Goldsmith, K., Johnson, A., Potts, L., Walwyn, R., DeCesare, J., Baber, H., Burgess, M., Clark, L., Cox, D., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60096-2 · Cited by 897 · see citing works
Self-citationTurner, J. A., Holtzman, S., & Mancl, L. (2007) · Pain · doi:10.1016/j.pain.2006.09.005 · Cited by 530 · see citing works
Reeves, W. C., Lloyd, A. R., Vernon, S. D., Klimas, N. G., Jason, L. A., Bleijenberg, G., Evengård, B., White, P. D., Nisenbaum, R. A., Unger, E. R., et al. (2003) · BMC Health Services Research · doi:10.1186/1472-6963-3-25 · Cited by 475 · see citing works
Self-citationRandomised controlled trial of graded exercise in patients with the chronic fatigue syndrome
Fulcher, K. Y., & White, P. D. (1997) · BMJ · doi:10.1136/bmj.314.7095.1647 · Cited by 431 · see citing works
Self-citationEmsley, R., Dunn, G., & White, I. R. (2010) · Statistical Methods in Medical Research · doi:10.1177/0962280209105014 · Cited by 356 · see citing works
The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis
Vercoulen, J. H. M. M., Swanink, C. M. A., Galama, J. M. D., Fennis, J. F. M., Jongen, P. J., Hommes, O. R., van der Meer, J. W. M., & Bleijenberg, G. (1998) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(98)00023-3 · Cited by 248 · see citing works
Moss-Morris, R. E., Sharon, C., Tobin, R., & Baldi, J. C. (2005) · Journal of Health Psychology · doi:10.1177/1359105305049774 · Cited by 242 · see citing works
Mania and Recovery from Chronic Fatigue Syndrome
Sharpe, M., Johnson, B. A., & McCann, J. (1991) · Journal of the Royal Society of Medicine · doi:10.1177/014107689108400123 · Cited by 235 · see citing works
Self-citationNijs, J., Roussel, N. A., Oosterwijck, J. V., Kooning, M. D., Ickmans, K., Struyf, F., Meeus, M., & Lundberg, M. (2013) · Clinical Rheumatology · doi:10.1007/s10067-013-2277-4 · Cited by 177 · see citing works
Strength and physiological response to exercise in patients with chronic fatigue syndrome
Fulcher, K. Y. (2000) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.69.3.302 · Cited by 176 · see citing works
Illness beliefs and treatment outcome in chronic fatigue syndrome
Deale, A., Chalder, T., & Wessely, S. (1998) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(98)00021-x · Cited by 159 · see citing works
Self-citationWiborg, J. F., Knoop, H., Stulemeijer, M., Prins, J. B., & Bleijenberg, G. (2010) · Psychological Medicine · doi:10.1017/s0033291709992212 · Cited by 147 · see citing works
the PACE trial group, White, P. D., Sharpe, M., Chalder, T., DeCesare, J. C., & Walwyn, R. E. A. (2007) · BMC Neurology · doi:10.1186/1471-2377-7-6 · Cited by 145 · see citing works
Self-citationStanton, A. L., Luecken, L. J., MacKinnon, D. P., & Thompson, E. H. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0028833 · Cited by 114 · see citing works
Nijs, J., Aelbrecht, S., Meeus, M., Oosterwijck, J. V., Zinzen, E., & Clarys, P. (2010) · Disability and Rehabilitation · doi:10.3109/09638288.2010.541543 · Cited by 76 · see citing works
Sleep Quality and Psychological Adjustment in Chronic Fatigue Syndrome
Fossey, M. E., Libman, E., Bailes, S., Baltzan, M., Schondorf, R., Amsel, R., & Fichten, C. S. (2004) · Journal of Behavioral Medicine · doi:10.1007/s10865-004-0004-y · Cited by 60 · see citing works
Wiborg, J. F., Knoop, H., Prins, J. B., & Bleijenberg, G. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.12.011 · Cited by 56 · see citing works
Wiborg, J. F., Knoop, H., Frank, L. E., & Bleijenberg, G. (2012) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.01.018 · Cited by 54 · see citing works
Mediators of the effects on fatigue of pragmatic rehabilitation for chronic fatigue syndrome.
Wearden, A. J., & Emsley, R. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0033561 · Cited by 51 · see citing works
Burgess, M., Andiappan, M., & Chalder, T. (2011) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465811000543 · Cited by 48 · see citing works
Self-citationAn Empirical Investigation of the Envelope Theory
Pesek, J., Jason, L. A., & Taylor, R. R. (2000) · Journal of Human Behavior in the Social Environment · doi:10.1300/j137v03n01_04 · Cited by 40 · see citing works
Stahl, D. R., Rimes, K. A., & Chalder, T. (2013) · Psychological Medicine · doi:10.1017/s0033291713002006 · Cited by 39 · see citing works
Self-citationDaily physical activity of patients with the chronic fatigue syndrome: a systematic review
Evering, R., Weering, M. D.-V., Groothuis‐Oudshoorn, C. G. M., & Vollenbroek-Hutten, M. M. R. (2010) · Clinical Rehabilitation · doi:10.1177/0269215510380831 · Cited by 35 · see citing works
Dennison, L., Stanbrook, R., Moss-Morris, R. E., Yardley, L., & Chalder, T. (2009) · British Journal of Health Psychology · doi:10.1348/135910709x440034 · Cited by 29 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 2
- Clark LV, White PD. The role of deconditioning and therapeutic exercises in chronic fatigue syndrome (CFS). JMent Health 2005; 14: 237-52.
- First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV-TR, research version, patient edition with psychotic screen. New York: Biometrics Research, New York State Psychiatric Institute, 2002.
Cited by
Sorted by citations
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): An Overview
Deumer, U.-S., Varesi, A., Floris, V., Savioli, G., Mantovani, E., López-Carrasco, P., Rosati, G. M., Prasad, S., & Ricevuti, G. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10204786 · Cited by 153 · see citing works
Wilshire, C. E., Kindlon, T., Courtney, R. H., Matthees, A., Tuller, D., Geraghty, K., & Levin, B. L. (2018) · BMC Psychology · doi:10.1186/s40359-018-0218-3 · Cited by 129 · see citing works
Rief, W., Burton, C., Frostholm, L., Henningsen, P., Kleinstäuber, M., Kop, W. J., Löwe, B., Martin, A., Malt, U., Rosmalen, J., et al. (2017) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000502 · Cited by 129 · see citing works
Wormgoor, M. E. A., & Rodenburg, S. C. (2021) · Journal of Translational Medicine · doi:10.1186/s12967-020-02683-4 · Cited by 117 · see citing works
Cohort description: The Danish study of Functional Disorders
Dantoft, T. M., Ebstrup, J. F., Linneberg, A. R., Skovbjerg, S., Madsen, A. L., Mehlsen, J., Brinth, L. S., Eplov, L. F., Carstensen, T. B. W., Schröder, A., et al. (2017) · Clinical Epidemiology · doi:10.2147/clep.s129335 · Cited by 108 · see citing works
Goldsmith, K. A., MacKinnon, D. P., Chalder, T., White, P. D., Sharpe, M., & Pickles, A. (2018) · Psychological Methods · doi:10.1037/met0000154 · Cited by 99 · see citing works
Self-citationFunctional neurological disorders: mechanisms and treatment
Lehn, A., Gelauff, J., Hoeritzauer, I., Ludwig, L., McWhirter, L., Williams, S., Gardiner, P., Carson, A. J., & Stone, J. (2015) · Journal of Neurology · doi:10.1007/s00415-015-7893-2 · Cited by 96 · see citing works
Comparison of methods for the analysis of relatively simple mediation models
Rijnhart, J. J. M., Twisk, J. W. R., Chinapaw, M. J. M., de Boer, M. R., & Heymans, M. W. (2017) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2017.06.005 · Cited by 87 · see citing works
Murillo, C., Vo, T., Vansteelandt, S., Harrison, L. E., Cagnie, B. J., Coppieters, I., Chys, M., Timmers, I., & Meeus, M. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102160 · Cited by 85 · see citing works
Hendrix, J., Nijs, J., Ickmans, K., Godderis, L., Ghosh, M., & Polli, A. (2020) · Antioxidants · doi:10.3390/antiox9111166 · Cited by 74 · see citing works
Establishing how psychological therapies work: the importance of mediation analysis
Windgassen, S., Goldsmith, K., Moss-Morris, R. E., & Chalder, T. (2016) · Journal of Mental Health · doi:10.3109/09638237.2015.1124400 · Cited by 60 · see citing works
Self-citationRyan, E., Vitoratou, S., Goldsmith, K., & Chalder, T. (2017) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000536 · Cited by 55 · see citing works
Self-citationWilshire, C. E., Kindlon, T., Matthees, A., & McGrath, S. J. (2016) · Fatigue Biomedicine Health & Behavior · doi:10.1080/21641846.2017.1259724 · Cited by 54 · see citing works
The ‘cognitive behavioural model’ of chronic fatigue syndrome: Critique of a flawed model
Geraghty, K., Jason, L. A., Sunnquist, M., Tuller, D., Blease, C., & Adeniji, C. (2019) · Health Psychology Open · doi:10.1177/2055102919838907 · Cited by 56 · see citing works
Marques, M. M., De Gucht, V., Gouveia, M. J., Leal, I., & Maes, S. (2015) · Clinical Psychology Review · doi:10.1016/j.cpr.2015.05.009 · Cited by 50 · see citing works
Hughes, A. M., Hirsch, C. R., Chalder, T., & Moss-Morris, R. E. (2016) · British Journal of Health Psychology · doi:10.1111/bjhp.12207 · Cited by 49 · see citing works
Self-citationNeuroticism and maladaptive coping in patients with functional somatic syndromes
Pedersen, H. F., Frostholm, L., Jensen, J. S., Ørnbøl, E., & Schröder, A. (2016) · British Journal of Health Psychology · doi:10.1111/bjhp.12206 · Cited by 47 · see citing works
Do graded activity therapies cause harm in chronic fatigue syndrome?
Kindlon, T. (2017) · Journal of Health Psychology · doi:10.1177/1359105317697323 · Cited by 47 · see citing works
Psychosocial interventions for fatigue during cancer treatment with palliative intent
Poort, H., Peters, M. E. W. J., Bleijenberg, G., Gielissen, M. F. M., Goedendorp, M. M., Jacobsen, P. B., Verhagen, S. C. A. H. H. V. M., & Knoop, H. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012030.pub2 · Cited by 46 · see citing works
Landau, S., Emsley, R., & Dunn, G. (2018) · Clinical Trials · doi:10.1177/1740774518760300 · Cited by 43 · see citing works
Vink, M., & Vink-Niese, F. (2019) · Diagnostics · doi:10.3390/diagnostics9040124 · Cited by 45 · see citing works
Gerber, M., Cheval, B., Cody, R., Colledge, F., Hohberg, V., Klimentidis, Y. C., Lang, C., Looser, V. N., Ludyga, S., Stults‐Kolehmainen, M., et al. (2025) · Physiological Reviews · doi:10.1152/physrev.00021.2024 · Cited by 53 · see citing works
Association of Fatigue and Stress With Gray Matter Volume
Kokubun, K., Nemoto, K., Oka, H., Fukuda, H., Yamakawa, Y., & Watanabe, Y. (2018) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2018.00154 · Cited by 41 · see citing works
Vink, M., & Vink-Niese, A. (2018) · Health Psychology Open · doi:10.1177/2055102918805187 · Cited by 38 · see citing works
Abonie, U. S., Edwards, A. M., & Hettinga, F. J. (2020) · Journal of Sports Sciences · doi:10.1080/02640414.2020.1721254 · Cited by 38 · see citing works
Carnahan, N. D., Carter, M. M., & Sbrocco, T. (2021) · International Journal of Cognitive Therapy · doi:10.1007/s41811-021-00123-9 · Cited by 39 · see citing works
Picariello, F., Hudson, J. L., Moss-Morris, R. E., Macdougall, I. C., & Chilcot, J. (2017) · Health Psychology Review · doi:10.1080/17437199.2017.1298045 · Cited by 34 · see citing works
Geraghty, K., & Blease, C. R. (2016) · Journal of Health Psychology · doi:10.1177/1359105316667798 · Cited by 34 · see citing works
Goldsmith, K., Chalder, T., White, P. D., Sharpe, M., & Pickles, A. R. (2016) · Statistical Methods in Medical Research · doi:10.1177/0962280216666111 · Cited by 29 · see citing works
Self-citationBroughton, J., Harris, S., Beasant, L., Crawley, E. M., & Collin, S. M. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2337-6 · Cited by 30 · see citing works
Chalder, T., Patel, M., James, K., Hotopf, M. H., Frank, P., Watts, K., McCrone, P., David, A. S., Ashworth, M. J., Husain, M., et al. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2297-y · Cited by 30 · see citing works
Self-citationFeasibility Trial of Cognitive Behavioral Therapy for Fatigue in Hemodialysis (BReF Intervention)
Picariello, F., Moss-Morris, R. E., Norton, S., Macdougall, I. C., Silva‐Gane, M. D., Farrington, K., Clayton, H., & Chilcot, J. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.10.005 · Cited by 30 · see citing works
Treatment Outcome and Metacognitive Change in CBT and GET for Chronic Fatigue Syndrome
Fernie, B. A., Murphy, G., Adrian Wells, A., Nikčević, A. V., & Spada, M. M. (2015) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246581500017x · Cited by 30 · see citing works
Vink, M., & Vink-Niese, F. (2020) · Work · doi:10.3233/wor-203174 · Cited by 31 · see citing works
Psychologic treatment of functional neurologic disorders
Goldstein, L. H., & Mellers, J. D. C. (2016) · Handbook of clinical neurology · doi:10.1016/b978-0-12-801772-2.00046-1 · Cited by 28 · see citing works
Kallesøe, K. H., Schröder, A., Wicksell, R. K., Preuss, T., Jensen, J. S., & Rask, C. U. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02862-z · Cited by 24 · see citing works
Picariello, F., Chilcot, J., Chalder, T., Herdman, D., & Moss-Morris, R. E. (2023) · British Journal of Health Psychology · doi:10.1111/bjhp.12644 · Cited by 26 · see citing works
Self-citationDensham, S., Williams, D., Johnson, A., & Turner‐Cobb, J. M. (2016) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2016.07.009 · Cited by 26 · see citing works
Evidence-Based Care for People with Chronic Fatigue Syndrome and Myalgic Encephalomyelitis
Sharpe, M., Chalder, T., & White, P. D. (2021) · Journal of General Internal Medicine · doi:10.1007/s11606-021-07188-4 · Cited by 25 · see citing works
Self-citationGuided graded Exercise Self-help for chronic fatigue syndrome: patient experiences and perceptions
Cheshire, A., Ridge, D., Clark, L., & White, P. D. (2018) · Disability and Rehabilitation · doi:10.1080/09638288.2018.1499822 · Cited by 24 · see citing works
Self-citationKallesøe, K. H., Schröder, A., Wicksell, R. K., Fink, P., Ørnbøl, E., & Rask, C. U. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-012743 · Cited by 23 · see citing works
“The analytical strategy previously used in a large-scale trial will be used.(86)”
MethodGouraud, C., Thoreux, P., Vedrines, C. O., Pitron, V., Betouche, S., Bolloch, K., Caumes, É., Guemouni, S., Xiang, K., Lemogne, C., et al. (2023) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2023.111475 · Cited by 23 · see citing works
Worm-Smeitink, M., Nikolaus, S., Goldsmith, K., Wiborg, J. F., Ali, S., Knoop, H., & Chalder, T. (2016) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2016.06.006 · Cited by 22 · see citing works
Self-citationRacine, M., Jensen, M. P., Harth, M., Morley-Forster, P., & Nielson, W. R. (2018) · Journal of Pain · doi:10.1016/j.jpain.2018.09.013 · Cited by 22 · see citing works
Loades, M. E., Rimes, K. A., Lievesley, K., Ali, S., & Chalder, T. (2019) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104519835583 · Cited by 22 · see citing works
Self-citationPsychosocial interventions for fatigue during cancer treatment with palliative intent
Poort, H., Goedendorp, M. M., Peters, M., Bleijenberg, G., Gielissen, M. F., Jacobsen, P., Verhagen, S., & Knoop, H. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012030 · Cited by 21 · see citing works
Vugts, M. A. P., Zedlitz, A. M. E. E., Joosen, M. C. W., & Vrijhoef, H. J. (2019) · Journal of Medical Internet Research · doi:10.2196/14766 · Cited by 18 · see citing works
de Gier, M., Picariello, F., Slot, M., Janse, A., Keijmel, S. P., Menting, J., Worm-Smeitink, M., Beckerman, H., de Groot, V., Moss-Morris, R. E., et al. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104243 · Cited by 19 · see citing works
Band, R. J., Barrowclough, C., Caldwell, K., Emsley, R., & Wearden, A. J. (2016) · Health Psychology · doi:10.1037/hea0000422 · Cited by 19 · see citing works
Corbett, T., Walsh, J. C., Groarke, A., Moss-Morris, R., Morrissey, E., & McGuire, B. E. (2017) · JMIR Cancer · doi:10.2196/cancer.6987 · Cited by 18 · see citing works
Frostholm, L., & Rask, C. U. (2019) · Clinical Psychology in Europe · doi:10.32872/cpe.v1i1.32217 · Cited by 18 · see citing works
Breukers, E. M. C., Raijmakers, R. P. H., Nieuwkerk, P. T., Bleijenberg, G., van der Meer, J. W. M., Bleeker‐Rovers, C. P., Keijmel, S. P., & Knoop, H. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.109841 · Cited by 18 · see citing works
Patterns of daytime physical activity in patients with chronic fatigue syndrome
King, E., Beynon, M., Chalder, T., Sharpe, M., & White, P. D. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110154 · Cited by 18 · see citing works
Self-citationReliability and Validity of the Modified Korean Version of the Chalder Fatigue Scale (mKCFQ11)
Ahn, Y., Lee, J., & Son, C. (2020) · Healthcare · doi:10.3390/healthcare8040427 · Cited by 18 · see citing works
The problem of bias in behavioural intervention studies: Lessons from the PACE trial
Wilshire, C. E. (2017) · Journal of Health Psychology · doi:10.1177/1359105317700885 · Cited by 17 · see citing works
An attention and interpretation bias for illness-specific information in chronic fatigue syndrome
Hughes, A. M., Chalder, T., Hirsch, C. R., & Moss-Morris, R. E. (2016) · Psychological Medicine · doi:10.1017/s0033291716002890 · Cited by 17 · see citing works
Self-citationVethe, D., Kallestad, H., Jacobsen, H. B., Landrø, N. I., Borchgrevink, P. C., & Stiles, T. C. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01764 · Cited by 16 · see citing works
Goldsmith, L. P., Dunn, G., Bentall, R. P., Lewis, S. W., & Wearden, A. J. (2015) · PLoS ONE · doi:10.1371/journal.pone.0144623 · Cited by 16 · see citing works
Oka, T., Wakita, H., & Kimura, K. (2017) · BioPsychoSocial Medicine · doi:10.1186/s13030-017-0090-z · Cited by 15 · see citing works
Smakowski, A., Adamson, J., Turner, T., & Chalder, T. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1949049 · Cited by 15 · see citing works
Self-citationSandler, C. X., Hamilton, B. A., Horsfield, S., Bennett, B. K., Vollmer-Conna, U. S., Tzarimas, C., & Lloyd, A. R. (2016) · Internal Medicine Journal · doi:10.1111/imj.13251 · Cited by 15 · see citing works
Myalgische Enzephalomyelitis/chronisches Fatigue-Syndrom: eine Übersicht zur aktuellen Evidenz
Ludwig, B., Olbert, E., Trimmel, K., Seidel, S., Rommer, P. S., Müller, C., Struhal, W., & Berger, T. (2023) · Der Nervenarzt · doi:10.1007/s00115-022-01431-x · Cited by 14 · see citing works
Ahmed, A., Mewes, J. C., & Vrijhoef, H. J. (2019) · Journal of Health Psychology · doi:10.1177/1359105319847261 · Cited by 14 · see citing works
Abrahams, H. J. G., Gielissen, M. F. M., Braamse, A. M. J., Bleijenberg, G., Buffart, L. M., & Knoop, H. (2019) · Acta Oncologica · doi:10.1080/0284186x.2019.1659513 · Cited by 14 · see citing works
Global sensitivity analysis of clinical trials with missing patient-reported outcomes
Scharfstein, D. O., & McDermott, A. (2018) · Statistical Methods in Medical Research · doi:10.1177/0962280218759565 · Cited by 13 · see citing works
Loades, M. E., Vitoratou, S., Rimes, K. A., Ali, S., & Chalder, T. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465819000390 · Cited by 13 · see citing works
Self-citationThe long wait for a breakthrough in chronic fatigue syndrome
Lloyd, A. R., & Meer, J. W. M. V. D. (2015) · BMJ · doi:10.1136/bmj.h2087 · Cited by 13 · see citing works
Prediction of Discontinuation of Structured Exercise Programme in Chronic Fatigue Syndrome Patients
Kujawski, S., Cossington, J., Słomko, J., Dawes, H., Strong, J. W. L., Estévez‐López, F., Murovska, M., Newton, J. L., Hodges, L. D., & Zalewski, P. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9113436 · Cited by 12 · see citing works
Vink, M. (2016) · Journal of Neurology and Neurobiology · doi:10.16966/2379-7150.124 · Cited by 12 · see citing works
Zhang, B., Chaiton, M., Diemert, L. M., Bondy, S. J., Brown, K. S., & Ferrence, R. G. (2016) · Preventive Medicine · doi:10.1016/j.ypmed.2016.07.027 · Cited by 11 · see citing works
A Novel Approach to Treating CFS and Co‐morbid Health Anxiety: A Case Study
Daniels, J., & Loades, M. E. (2016) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2042 · Cited by 11 · see citing works
Marques, M. M., Gucht, V. D., Leal, I. M. P., & Maes, S. (2016) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2016.12.012 · Cited by 11 · see citing works
Hughes, A. M., Campbell, L. J., Graham, H., Post, F. A., & Chalder, T. (2020) · Behavioral Medicine · doi:10.1080/08964289.2020.1712582 · Cited by 11 · see citing works
Self-citationSalzmann, S., de Vroege, L., Engelmann, P., Fink, P., Fischer, S., Frisch, S., Gormsen, L. K., Hüfner, K., Kop, W. J., Köteles, F. G., et al. (2025) · BMC Medicine · doi:10.1186/s12916-025-03927-0 · Cited by 10 · see citing works
van der Schaaf, M. E., Schmits, I. C., Roerink, M. E., Geurts, D. E. M., Toni, I., Roelofs, K., de Lange, F. P., Nater, U. M., van der Meer, J. W. M., & Knoop, H. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0515-9 · Cited by 10 · see citing works
Russell, C., Kyle, S. D., & Wearden, A. J. (2016) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2016.05.001 · Cited by 12 · see citing works
Vink, M. (2017) · Journal of Neurology and Neurobiology · doi:10.16966/2379-7150.136 · Cited by 9 · see citing works
Cognitive behaviour therapy and objective assessments in chronic fatigue syndrome
McPhee, G. (2017) · Journal of Health Psychology · doi:10.1177/1359105317707215 · Cited by 9 · see citing works
Thompson, D. P., Antcliff, D., & Woby, S. R. (2019) · Physiotherapy · doi:10.1016/j.physio.2019.01.006 · Cited by 9 · see citing works
Gillespie, D. C., Barber, M., Brady, M., Carson, A. J., Chalder, T., Chun, Y., Cvoro, V., Dennis, M. S., Hackett, M. L., Haig, E. L., et al. (2020) · Pilot and Feasibility Studies · doi:10.1186/s40814-020-00622-0 · Cited by 9 · see citing works
Self-citationGoudsmit, E. M., & Howes, S. (2017) · Journal of Health Psychology · doi:10.1177/1359105317707216 · Cited by 9 · see citing works
Waite, F., Chilcot, J., Moss-Morris, R. E., Farrington, K., & Picariello, F. (2022) · Journal of Renal Care · doi:10.1111/jorc.12418 · Cited by 8 · see citing works
Thompson, D. P., Antcliff, D., & Woby, S. R. (2021) · Physiotherapy · doi:10.1016/j.physio.2021.03.009 · Cited by 8 · see citing works
Chalder, T., Landau, S., Stone, J., Carson, A. J., Reuber, M., Medford, N., Robinson, E. J., & Goldstein, L. H. (2024) · Psychological Medicine · doi:10.1017/s0033291723003665 · Cited by 7 · see citing works
Self-citationVariable Selection for Mediators under a Bayesian Mediation Model
Shi, D., Shi, D., & Fairchild, A. J. (2023) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705511.2022.2164285 · Cited by 7 · see citing works
Vink, M., & Vink-Niese, A. (2025) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2025.1495050 · Cited by 7 · see citing works
Tack, M., Tuller, D. M., & Struthers, C. (2020) · Fatigue Biomedicine Health & Behavior · doi:10.1080/21641846.2020.1848262 · Cited by 7 · see citing works
Kalfas, M., Smakowski, A., Hirsch, C. R., Simiao, F., & Chalder, T. (2022) · Behavior Therapy · doi:10.1016/j.beth.2022.01.004 · Cited by 7 · see citing works
Self-citationPost-exertional malaise in chronic fatigue syndrome
Twisk, F. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00044-9 · Cited by 7 · see citing works
Lange, T., & Starkopf, L. (2016) · Epidemiology · doi:10.1097/ede.0000000000000518 · Cited by 6 · see citing works
Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
White, P. D., Clauw, D. J., van der Meer, J. W. M., Moss-Morris, R. E., & Taylor, R. R. (2015) · Annals of Internal Medicine · doi:10.7326/l15-5171 · Cited by 6 · see citing works
Self-citationAbonie, U. S., Seves, B. L., Hoekstra, F., Hoekstra, T., van der Woude, L. H. V., Dekker, R., & Hettinga, F. J. (2021) · International Journal of MS Care · doi:10.7224/1537-2073.2020-047 · Cited by 5 · see citing works
The presence of attentional and interpretation biases in patients with severe MS‐related fatigue
de Gier, M., Oosterman, J. M., Hughes, A. M., Moss-Morris, R. E., Hirsch, C. R., Beckerman, H., de Groot, V., & Knoop, H. (2024) · British Journal of Health Psychology · doi:10.1111/bjhp.12723 · Cited by 4 · see citing works
Thompson, D. P., Antcliff, D., & Woby, S. R. (2017) · Physiotherapy · doi:10.1016/j.physio.2017.07.005 · Cited by 4 · see citing works
Crawley, E. M., Anderson, E. C., Cochrane, M., Shirkey, B. A., Parslow, R. M., Hollingworth, W., Mills, N., Gaunt, D., Treneman‐Evans, G., Rai, M., et al. (2024) · Health Technology Assessment · doi:10.3310/vlrw6701 · Cited by 4 · see citing works
Nutritional advice for community patients: insights from a panel discussion
Thomas, L. V., Jenkins, G., Belton, J., Clements, S., Jacob, C., Johnson, N., Joy, D., Low, J., Munson, E., & Sheppard, J. (2016) · British Journal of Community Nursing · doi:10.12968/bjcn.2016.21.3.130 · Cited by 4 · see citing works
Omission of data weakens the case for causal mediation in the PACE Trial
McGrath, S. J. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00085-1 · Cited by 4 · see citing works
Burton, C. D., Dawes, H., & Dalton, C. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112091 · Cited by 3 · see citing works
Prolonged Abnormal Effects of Exercise in Myalgic Encephalomyelitis and Chronic Fatigue Syndrome
Twisk, F. (2015) · Cited by 3 · see citing works
Loades, M. E., & Chalder, T. (2017) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465817000108 · Cited by 3 · see citing works
Self-citation
- Authors
- Chalder, T., Goldsmith, K. A., White, P. D., Sharpe, M., & Pickles, A. R.
- Affiliations
- King's College London (GB)
- Queen Mary University of London (GB)
- University of Oxford (GB)
- Corresponding author
- Chalder, Trudie
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2015-02
- Volume
- 2
- Issue
- 2
- Pages
- 141-152
- ISSN
- 2215-0366 (ISSN-L)
- OpenAlex
- W2087736673
- Cited by
- 134
- References
- 34
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 4 · 2023: 5 · 2022: 4 · 2021: 8 · 2020: 15 · 2019: 11 · 2018: 8 · 2017: 20 · 2016: 24 · 2015: 17
- FWCI
- 18.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- Funders
- South London and Maudsley NHS Foundation Trust
- National Institute for Health and Care Research (DRF-2011-04-061)
- Medical Research Council
- Menzies Centre for Australian Studies, King's College London, University of London
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- chronic fatigue syndrome, cognitive behavioral therapy, graded exercise therapy, specialist care, fear-avoidance beliefs, exercise tolerance, fatigue, physical function, therapeutic mechanisms, mediation analysis, PACE trial, disability, 6-minute walk test, Chalder Fatigue Scale, SF-36 physical function
- MeSH terms
- Humans, Rehabilitation, Fatigue Syndrome, Chronic, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
