Friedberg, Fred, Sohl, Stephanie · Journal of clinical psychology · 2009 · DOI
This study looked at whether cognitive-behavioral therapy (CBT)—a type of talk therapy combined with gradually increasing physical activity—helped 11 people with ME/CFS feel better. While most patients reported feeling improved, the researchers found something surprising: some patients who felt better had actually increased their activity levels (shown by motion sensors), while others had decreased their activity levels. This suggests that improvement in ME/CFS may not work the same way the standard CBT model predicts.
This study questions a widely-used treatment approach for ME/CFS by revealing that patients can report feeling better through CBT without necessarily increasing their physical activity as the theory predicts. Understanding how CBT actually works (or doesn't work) for different ME/CFS patients is crucial for developing more effective, personalized treatments and avoiding potential harm from approaches that may not suit everyone.
This small case study cannot prove whether CBT is effective or ineffective for ME/CFS more broadly, nor can it determine whether increased activity causes improvement or vice versa. The study does not establish what mechanism actually produces the reported improvements, and findings from 11 high-functioning patients may not generalize to patients with more severe disease.
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
Friedberg, Fred & Sohl, Stephanie (2009). Cognitive-behavior therapy in chronic fatigue syndrome: is improvement related to increased physical activity?. Journal of clinical psychology. https://doi.org/10.1002/jclp.20551
BibTeX
@article{mecfsatlas-friedberg-2009-cognitive-behavior,
author = {Friedberg, Fred and Sohl, Stephanie},
title = {Cognitive-behavior therapy in chronic fatigue syndrome: is improvement related to increased physical activity?},
journal = {Journal of clinical psychology},
year = {2009},
doi = {10.1002/jclp.20551},
note = {PubMed: 19213007},
url = {https://www.mecfsatlas.com/evidence/friedberg-2009-cognitive-behavior},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/friedberg-2009-cognitive-behavior
Contribute
Private, reviewed by a human. Not a public comment thread.