Does the effect of cognitive behavior therapy for chronic fatigue syndrome (ME/CFS) vary by patient characteristics? A systematic review and individual patient data meta-analysis
Open accessAbstract
Debate is ongoing on the efficacy of cognitive behavior therapy (CBT) for myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). With an individual patient data (IPD) meta-analysis we investigated whether the effect of CBT varied by patient characteristics. These included post-exertional malaise (PEM), a central feature of ME/CFS according to many. We searched for randomized controlled trials similar with respect to comparison condition, outcomes and treatment-protocol. Moderation on fatigue severity (Checklist Individual Strength, subscale fatigue severity), functional impairment (Sickness Impact Profile-8) and physical functioning (Short Form-36, subscale physical functioning) was investigated using linear mixed model analyses and interaction tests. PROSPERO (CRD42022358245). Data from eight trials ( n = 1298 patients) were pooled. CBT showed beneficial effects on fatigue severity ( β = −11.46, 95% CI −15.13 to −7.79); p < 0.001, functional impairment (β = −448.40, 95% CI −625.58 to −271.23); p < 0.001; and physical functioning (β = 9.64, 95% CI 3.30 to 15.98); p < 0.001. The effect of CBT on fatigue severity varied by age ( p interaction = 0.003), functional impairment ( p interaction = 0.045) and physical activity pattern ( p interaction = 0.027). Patients who were younger, reported less functional impairments and had a fluctuating activity pattern benefitted more. The effect on physical functioning varied by self-efficacy ( p interaction = 0.025), with patients with higher self-efficacy benefitting most. No other moderators were found. It can be concluded from this study that CBT for ME/CFS can lead to significant reductions of fatigue, functional impairment, and physical limitations. There is no indication patients meeting different case definitions or reporting additional symptoms benefit less from CBT. Our findings do not support recent guidelines in which evidence from studies not mandating PEM was downgraded.
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The recently published individual patient data meta-analysis in CBT for CFS had a data base limited to a specific treatment-protocol and was therefore less generalizable.
“While there is a recently published individual patient data meta-analysis in CBT for CFS [49], the data base for that project was limited to a specific treatment-protocol (e.g., [50]) and therefore less generalizable.”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [49]
The limitations discussion (Psychological Medicine, p. 451) confirms that eligibility criteria restricted the CBT protocols included and calls for replication with other protocols. But the same discussion says the protocols have more similarities than differences and that the findings are likely generalizable to other CBT protocols, contrary to the claim’s conclusion. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThese 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 [49]
A recently published individual patient data meta-analysis did not find evidence suggesting that patients meeting different case definitions or reporting additional symptoms benefited less from CBT.
“However, a recently published individual patient data meta-analysis did not find evidence suggesting that patients meeting different case definitions or reporting additional symptoms benefited less from CBT [49].”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [49]
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- Authors
- Kuut, T. A., Buffart, L. M., Braamse, A. M. J., Csorba, I., Bleijenberg, G., Nieuwkerk, P., Moss-Morris, R., Müller, F., & Knoop, H.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Radboud University Medical Center (NL)
- King's College London (GB)
- Corresponding author
- Knoop, H.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2023-11-06
- Volume
- 54
- Issue
- 3
- Pages
- 447-456
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W4388414943
- Cited by
- 27
- References
- 42
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 3
- FWCI
- 1.23
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (acceptedVersion, cc-by)
- Radboud Repository (Radboud University) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- 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
- cognitive behavioral therapy, chronic fatigue syndrome, post-exertional malaise, fatigue severity, functional disability, physical function, treatment moderators, age, self-efficacy, treatment guidelines
- MeSH terms
- Humans, Severity of Illness Index, Fatigue Syndrome, Chronic, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome
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