Heins, Marianne J, Knoop, Hans, Lobbestael, Jill et al. · Journal of psychosomatic research · 2011 · DOI
This study looked at whether people with ME/CFS who experienced abuse or neglect as children respond differently to cognitive behavior therapy (CBT) than those without such histories. Researchers followed 216 patients with ME/CFS who received CBT and found that both groups improved similarly with treatment. However, patients with childhood maltreatment histories still had more disability and emotional distress even after CBT.
This study is clinically relevant because it suggests that ME/CFS patients with trauma histories should not be excluded from or assumed to have poor outcomes with CBT, challenging potential clinical biases. It highlights that while CBT may be equally effective across groups, trauma-exposed patients may require additional psychosocial support to address residual psychological distress and functional limitations post-treatment.
This study does not establish whether childhood maltreatment causes ME/CFS or worsens prognosis—it only examines treatment response, not etiology or disease severity correlations. The observational design cannot prove CBT causes equivalent improvement in both groups; it demonstrates similar measured change scores without controlling for confounding variables. It also does not address whether alternative or adjunctive psychological interventions might be more beneficial for trauma-exposed patients.
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
Heins, Marianne J, Knoop, Hans, Lobbestael, Jill, & Bleijenberg, Gijs (2011). Childhood maltreatment and the response to cognitive behavior therapy for chronic fatigue syndrome.. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2011.05.005
BibTeX
@article{mecfsatlas-heins-2011-childhood-maltreatment,
author = {Heins, Marianne J and Knoop, Hans and Lobbestael, Jill and Bleijenberg, Gijs},
title = {Childhood maltreatment and the response to cognitive behavior therapy for chronic fatigue syndrome.},
journal = {Journal of psychosomatic research},
year = {2011},
doi = {10.1016/j.jpsychores.2011.05.005},
note = {PubMed: 22118383},
url = {https://www.mecfsatlas.com/evidence/heins-2011-childhood-maltreatment},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/heins-2011-childhood-maltreatment
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