A systematic literature review of randomized controlled trials evaluating prognosis following treatment for adults with chronic fatigue syndrome
Open accessAbstract
This systematic review investigated randomized controlled trials evaluating cognitive behavioral therapy (CBT) and graded exercise therapy (GET) for adults with chronic fatigue syndrome (CFS). The objective was to determine prognosis following treatment. Studies were eligible if they were peer-reviewed and investigated treatment at least 12 weeks in duration. Studies were excluded if they used co-morbid diagnoses as entry criteria or if they did not measure fatigue, disability, or functioning. Literature published between 1988 and 2021 was searched using MEDLINE, EMBASE, PsycINFO, and Web of Science. Study quality was assessed using the Effective Public Health Practice Project assessment tool. Outcomes were synthesized when three or more studies reported outcomes obtained from the same validated measurement tool. The review included 15 publications comprising 1990 participants. Following CBT, and at short-term to medium-term follow-up, 44% considered themselves better and 11% considered themselves worse. Following GET, and at post-treatment to short-term follow-up, 43% considered themselves better and 14% considered themselves worse. These outcomes were 8–26% more favorable compared to control conditions. Two-thirds of studies were of moderate quality and the remainder were of weak quality. Limitations of this review relate to the clinical heterogeneity of studies and that most outcomes were self-reported. Results suggest some support for the positive effects of CBT and GET at short-term to medium-term follow-up although this requires further investigation given the inconsistent findings of previous reviews. Findings may not be generalizable to severe CFS. This review was registered with PROSPERO (CRD42018086002).
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Cases of clinically relevant worsening of symptoms due to CBT are rather rare in CFS.
“While cases of clinically relevant worsening of symptoms due to CBT are rather rare in CFS [16], they might still have an increased risk of dropping out of treatment.”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [16]
The Results (Table 4; page unavailable) report global worsening in 11% of CBT participants, versus 19% of controls, supporting the description of worsening as relatively uncommon. But the measure includes ratings of ‘a little worse,’ rather than establishing clinically relevant symptom worsening, and the review describes worsening following CBT, not necessarily caused by it. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAcross all studies, only a small proportion of studies reported uptake and discontinuation; this could indicate attrition bias.
“However, it is noticeable that across all studies, only a small proportion of studies reported uptake and discontinuation; which could indicate attrition bias [16].”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [16]
The Results (Study quality and risk of bias; page unavailable) say five studies (33%) did not adequately describe drop-out by study group. The Discussion (Limitations; page unavailable) says this can indicate vulnerability to attrition bias. The paper does not establish the claim that only a small proportion of studies reported both uptake and discontinuation. (LLM, conf=0.87)
Experimental — accuracy not yet measuredA recent systematic review showed that several studies have been published since previous meta-analyses that could provide valuable information.
“A recent systematic review showed that several studies have been published since then, that could provide valuable information [16].”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [16]
These results are in line with previous research, indicating that CBT can alleviate CFS symptoms and improve patients' overall well-being.
“All in all, these results are in line with previous research [8, 11, 12, 16, 49], indicating that CBT can alleviate CFS symptoms and improve patients’ overall well-being.”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [16]
As most studies included at least some face-to-face contact, it might disadvantage those CFS patients who, due to their pronounced symptom severity, are housebound.
“Moreover, as most studies included at least some face-to-face contact, it might disadvantage those CFS patients who, due to their pronounced symptom severity, are housebound [16].”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [16]
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- Authors
- Ingman, T., Smakowski, A., Goldsmith, K., & Chalder, T.
- Affiliations
- King's College London (GB)
- South London and Maudsley NHS Foundation Trust (GB)
- Corresponding author
- Ingman, Tom
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2022-09-05
- Volume
- 52
- Issue
- 14
- Pages
- 2917-2929
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC9693680
- OpenAlex
- W4294629101
- Cited by
- 27
- References
- 45
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 6 · 2023: 8
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- South London and Maudsley NHS Foundation Trust
- King's College Hospital NHS Foundation Trust
- National Institute for Health and Care Research
- Department of Health and Social Care
- King's College London
- NIHR Maudsley Biomedical Research Centre
- National Institute for Health Research Applied Research Collaboration South 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 › Epidemiology › Traumatic Brain Injury Research
- Keywords
- chronic fatigue syndrome, cognitive behavioral therapy, graded exercise therapy, prognosis, treatment outcomes, fatigue, disability, functioning, self-reported outcomes, follow-up
- MeSH terms
- Adult, Exercise Therapy, Humans, Prognosis, Quality of Life, Fatigue Syndrome, Chronic, Randomized Controlled Trials as Topic
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 ›
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