Heins, Marianne J, Knoop, Hans, Burk, William J et al. · Journal of psychosomatic research · 2013 · DOI
This study looked at how cognitive behaviour therapy (CBT) helps reduce fatigue in ME/CFS patients by tracking what changes during treatment. Researchers followed 183 patients over 18 weeks, measuring fatigue and factors like sense of control, symptom focus, activity levels, and physical functioning. They found that gaining a better sense of control over fatigue, doing more activity, improving physical functioning, and thinking less about symptoms were linked to fatigue improvement—explaining about 20-46% of the fatigue reduction.
Understanding what actually drives fatigue improvement during CBT helps explain why this treatment works for some ME/CFS patients and informs personalized treatment approaches. The finding that cognitive changes (sense of control, reduced symptom focus) are more important than objective activity levels validates a psychological component while highlighting that different patients may improve through different mechanisms.
This study does not prove that cognitive changes cause fatigue reduction—only that they correlate with it. The large variation in individual patterns means these findings may not apply equally to all patients. Additionally, the fact that objective activity didn't predict improvement doesn't mean physical activity is unimportant—only that subjective perception may matter more during CBT.
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, Burk, William J, & Bleijenberg, Gijs (2013). The process of cognitive behaviour therapy for chronic fatigue syndrome: which changes in perpetuating cognitions and behaviour are related to a reduction in fatigue?. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2013.06.034
BibTeX
@article{mecfsatlas-heins-2013-process-cognitive,
author = {Heins, Marianne J and Knoop, Hans and Burk, William J and Bleijenberg, Gijs},
title = {The process of cognitive behaviour therapy for chronic fatigue syndrome: which changes in perpetuating cognitions and behaviour are related to a reduction in fatigue?},
journal = {Journal of psychosomatic research},
year = {2013},
doi = {10.1016/j.jpsychores.2013.06.034},
note = {PubMed: 23972412},
url = {https://www.mecfsatlas.com/evidence/heins-2013-process-cognitive},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/heins-2013-process-cognitive
Contribute
Private, reviewed by a human. Not a public comment thread.