Efficacy of web-based cognitive–behavioural therapy for chronic fatigue syndrome: randomised controlled trial

Janse, A.; Worm-Smeitink, M.; Bleijenberg, G.; Donders, R.; Knoop, H.

doi:10.1192/bjp.2017.22

Cited by 72Fibromyalgia and Chronic Fatigue Syndrome ResearchDigital Mental Health InterventionsTelemedicine and Telehealth Implementation

Efficacy of web-based cognitive–behavioural therapy for chronic fatigue syndrome: randomised controlled trial

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Janse, A., Worm-Smeitink, M., Bleijenberg, G., Donders, R., Knoop, H.·2018·The British Journal of Psychiatry

DOI 10.1192/bjp.2017.22

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Abstract

Background: Face-to-face cognitive–behavioural therapy (CBT) leads to a reduction of fatigue in chronic fatigue syndrome (CFS). Aims: To test the efficacy of internet-based CBT (iCBT) for adults with CFS. Method: A total of 240 patients with CFS were randomised to either iCBT with protocol-driven therapist feedback or with therapist feedback on demand, or a waiting list. Primary outcome was fatigue severity assessed with the Checklist Individual Strength (Netherlands Trial Register: NTR4013). Results: Compared with a waiting list, intention-to-treat (ITT) analysis showed a significant reduction of fatigue for both iCBT conditions (protocol-driven feedback: B = −8.3, 97.5% CI −12.7 to −3.9, P < 0.0001; feedback on demand: B = −7.2, 97.5% CI −11.3 to –3.1, P < 0.0001). No significant differences were found between both iCBT conditions on all outcome measures ( P = 0.3–0.9). An exploratory analysis revealed that feedback-on-demand iCBT required less therapist time (mean 4 h 37 min) than iCBT with protocol-driven feedback (mean 6 h 9 min, P < 0.001) and also less than face-to-face CBT as reported in the literature. Conclusions: Both iCBT conditions are efficacious and time efficient. Declaration of interest: None.

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Post-exertional malaise could not be systematically aggregated as it was seldom assessed and not uniformly reported.
“However, post-exertional malaise – which has been proposed as a cardinal symptom for myalgic encephalomyelitis/CFS in the latest NICE-guidelines [14]– could not be systematically aggregated as it was seldom assessed and not uniformly reported [29, 35, 42].”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [29]
The Primary and Secondary outcome measures sections list fatigue, functioning, psychological distress and adverse events, but no post-exertional malaise measure. This trial therefore supports the narrower point that post-exertional malaise was not specifically assessed here; it does not establish that it was seldom assessed across studies, reported inconsistently, or impossible to aggregate systematically. (LLM, conf=0.78)
Experimental — accuracy not yet measured
For fatigue, there was one outlier [33], as well as for perceived health status [46], non-completion [29], and treatment refusal [43].
“For fatigue, there was one outlier [33] as well as for perceived health status [46], non-completion [29], and treatment refusal [43].”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [29]
The Results report that some patients did not start the intervention, and Fig. 1 describes patient flow, but neither passage identifies treatment refusal as an outlier. Searches for treatment refusal and declined participation found no passage in our copy supporting the outlier designation. (LLM, conf=0.74)
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Identifying disrupted biological factors and patient-tailored interventions for chronic fatigue in adolescents and young adults with Q-Fever Fatigue Syndrome, Chronic Fatigue Syndrome and Juvenile Idiopathic Arthritis (QFS-study): study protocol for a randomized controlled trial with single-subject experimental case series design
Vroegindeweij, A., Swart, J. F., Houtveen, J. H., Eijkelkamp, N., van de Putte, E. M., Wulffraat, N. M., & Nijhof, S. L. (2022) · Trials · doi:10.1186/s13063-022-06620-2 · Cited by 10 · see citing works
“The outcomes are: “fatigue severity at baseline” measured with the CIS-8 questionnaire [26], “quality of life at baseline” measured with the PedsQL GCS [36], “self-efficacy at baseline” measured with the SES-28 [35], “sleep problems” measured with the PedsQL Multidimensional Fatigue Scale (PedsQL MFS) [36], “daily par…”
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Efficacy of Cognitive Behavioral Therapy and Acceptance- and Mindfulness-Based Treatments in Adults with Bodily Distress: A Network Meta-Analysis
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The Draft Report by the Institute for Quality and Efficiency in Healthcare Does Not Provide Any Evidence That Graded Exercise Therapy and Cognitive Behavioral Therapy Are Safe and Effective Treatments for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Vink, M., & Vink-Niese, A. (2023) · Diseases · doi:10.3390/diseases11010011 · Cited by 9 · see citing works
“[24] is substantially more than 20 or 30%.”
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Response Shift After Cognitive Behavioral Therapy Targeting Severe Fatigue: Explorative Analysis of Three Randomized Controlled Trials
Müller, F., Verdam, M. G. E., Oort, F. J., Riper, H. M., van Straten, A., Leeuw, I. M. V., Sprangers, M. A. G., & Knoop, H. (2022) · International Journal of Behavioral Medicine · doi:10.1007/s12529-022-10111-8 · Cited by 7 · see citing works
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Electroacupuncture at BL15 attenuates chronic fatigue syndrome by downregulating iNOS/NO signaling in C57BL/6 mice
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Web-Based Cognitive-Behavioral Therapy to Reduce Severe Cancer-Related Fatigue Among Survivors of Hodgkin Lymphoma: A Feasibility Study
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Serrat, M., Navarrete, J., Ferrés, S., Auer, W., Sentañes, R. S., Nieto, R., Neblett, R., Borràs, X., Luciano, J. V., & Feliu‐Soler, A. (2023) · Health Psychology · doi:10.1037/hea0001346 · Cited by 6 · see citing works
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Bauer, T., Grabowska, W. A., Ortiz, M., Bellmann–Strobl, J., Engelhardt, U., Nögel, R., Hummelsberger, J., Michalsen, A., Roll, S., Stöckigt, B., et al. (2025) · Integrative Medicine Research · doi:10.1016/j.imr.2025.101197 · Cited by 2 · see citing works
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Online-CBT for endometriosis: Exploring the acceptability and impact of the Ed.iTh program
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“…on therapist involvement, future research should examine whether therapist feedback offers sufficient added value to justify its resource intensity, or whether more scalable alternatives, such as on-demand support (Janse et al., 2018; K ¨ all et al., 2023), could meet users' needs more efficiently.”
The Role of Neurorehabilitation in Post-COVID-19 Syndrome
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A culturally adapted mobile cognitive behavioral therapy for individuals with Hepatitis B on depression, anxiety and stress: A pilot randomized controlled trial
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“In terms of fatigue that may be experienced by people with HBV, we drew references from previous psychological interventions for chronic fatigue syndrome (Janse et al., 2018; Menting et al., 2017).”
Co-occurrence of severe fatigue and insomnia: implications for the outcome of cognitive behavioural therapies
Rauwerda, N. L., Kuut, T. A., Braamse, A. M. J., Nieuwkerk, P. T., Boss, H., Knoop, H., & van Straten, A. (2025) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465825100945 · Cited by 1 · see citing works
“Previous studies have shown that video consultation and online therapy interventions are effective therapy formats for CBT-F and CBT-I (Boinon et al ., 2021; Janse et al ., 2018).”
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The effect of an early ambulation program based on cognitive behavioral therapy for elderly patients with kinesiophobia after total hip arthroplasty
Yu, X., Liu, S., Li, C., Luo, Y., Chen, R., Wu, W., Zhang, L., Guo, Q., Zhao, Y., Zhou, S., et al. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1741605 · Cited by 1 · see citing works
“By modifying catastrophic thinking and maladaptive behaviors related to pain and movement, CBT has demonstrated efficacy in alleviating kinesiophobia in contexts such as chronic pain and rehabilitation after total knee arthroplasty (20, 21).”
A Systematic Review Identifying Adverse Health Outcomes and Mortality Rates Associated with Telehealth
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Nater, U. M., & Ali, N. (2020) · Springer eBooks · doi:10.1007/978-3-030-39903-0_7 · Cited by 1 · see citing works
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User Experiences Among Patients and Health Care Professionals Who Participated in a Randomized Controlled Trial of E-nergEYEze, a Vision-Specific eHealth Intervention to Reduce Fatigue in Adults With Visual Impairment: Mixed Methods Study
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Additional file 2 of Identifying disrupted biological factors and patient-tailored interventions for chronic fatigue in adolescents and young adults with Q-Fever Fatigue Syndrome, Chronic Fatigue Syndrome and Juvenile Idiopathic Arthritis (QFS-study): study protocol for a randomized controlled trial with single-subject experimental case series design
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Additional file 1 of Identifying disrupted biological factors and patient-tailored interventions for chronic fatigue in adolescents and young adults with Q-Fever Fatigue Syndrome, Chronic Fatigue Syndrome and Juvenile Idiopathic Arthritis (QFS-study): study protocol for a randomized controlled trial with single-subject experimental case series design
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Influential

Testing the efficacy of web-based cognitive behavioural therapy for adult patients with chronic fatigue syndrome (CBIT): study protocol for a randomized controlled trial
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Internet-based Cognitive Behaviour Therapy (I-CBT) for chronic fatigue syndrome integrated in routine clinical care: an implementation study. (Preprint)Preprint
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Internet-Based Cognitive Behavioral Therapy for Chronic Fatigue Syndrome Integrated in Routine Clinical Care: Implementation Study
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Self-citation

Authors: Janse, A., Worm-Smeitink, M., Bleijenberg, G., Donders, R., & Knoop, H.
Affiliations: Amsterdam UMC Location University of Amsterdam (NL)
Radboud University Medical Center (NL)
Corresponding author: Knoop, H.
ORCID: Janse, A.
Worm-Smeitink, M.
Bleijenberg, G.
Donders, R.
Knoop, H.
Venue: The British Journal of Psychiatry
Publisher: Royal College of Psychiatrists
Published: 2018-02
Volume: 212
Issue: 2
Pages: 112-118
ISSN: 0007-1250 (ISSN-L)
1472-1465
DOI: 10.1192/bjp.2017.22
OpenAlex: W2792151126
Cited by: 72
References: 34
Citations by year: 2026: 8 · 2025: 13 · 2024: 4 · 2023: 12 · 2022: 9 · 2021: 3 · 2020: 12 · 2019: 7 · 2018: 3 · 2017: 1
FWCI: 4.88
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.cambridge.org/core/terms (unspecified)
Locations: The British Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Pure Amsterdam UMC (publishedVersion, other-oa)
Radboud Repository (Radboud University) (submittedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords: chronic fatigue syndrome, internet-based cognitive behavioral therapy, fatigue severity, therapist feedback, Checklist Individual Strength
MeSH terms: Adult, Female, Humans, Male, Middle Aged, Fatigue Syndrome, Chronic, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Telemedicine, Internet, Young Adult

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Efficacy of web-based cognitive–behavioural therapy for chronic fatigue syndrome: randomised controlled trial

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