de Gier, M, Picariello, F, Slot, M et al. · Behaviour research and therapy · 2023 · DOI
This study looked at how people with different long-term illnesses—including ME/CFS—think and behave in response to fatigue, and whether these patterns affect how well cognitive behavioural therapy (CBT) works. Researchers found that certain thought patterns and behaviours, like avoiding activity or believing that fatigue causes damage, were linked to less improvement with CBT. The good news is that when CBT helped patients change these patterns—by reducing fear, worry, and excessive rest—their fatigue improved significantly.
This research identifies specific, modifiable cognitive and behavioural patterns that predict who will benefit most from CBT in ME/CFS. Understanding that certain thought patterns (damage beliefs, catastrophising) and behaviours (avoidance and excessive resting) are key targets for treatment could help clinicians tailor interventions more effectively and help patients understand what changes matter most for fatigue improvement.
This study does not prove that these cognitive-behavioural patterns cause fatigue or that changing them will cure ME/CFS. It is a secondary analysis of existing trial data and cannot determine whether the observed associations reflect true causal mechanisms or bidirectional relationships. The findings apply to people who engaged with CBT and may not represent all ME/CFS patients, particularly those with severe disease or different symptom profiles.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
de Gier, M, Picariello, F, Slot, M, Janse, A, Keijmel, S, Menting, J, et al. (2023). The relation between cognitive-behavioural responses to symptoms in patients with long term medical conditions and the outcome of cognitive behavioural therapy for fatigue - A secondary analysis of four RCTs.. Behaviour research and therapy. https://doi.org/10.1016/j.brat.2022.104243
BibTeX
@article{mecfsatlas-de-gier-2023-relation-between,
author = {de Gier, M and Picariello, F and Slot, M and Janse, A and Keijmel, S and Menting, J and Worm-Smeitink, M and Beckerman, H and de Groot, V and Moss-Morris, R and Knoop, H},
title = {The relation between cognitive-behavioural responses to symptoms in patients with long term medical conditions and the outcome of cognitive behavioural therapy for fatigue - A secondary analysis of four RCTs.},
journal = {Behaviour research and therapy},
year = {2023},
doi = {10.1016/j.brat.2022.104243},
note = {PubMed: 36549190},
url = {https://www.mecfsatlas.com/evidence/de-gier-2023-relation-between},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/de-gier-2023-relation-between
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