Heins, Marianne J, Knoop, Hans, Bleijenberg, Gijs · Behaviour research and therapy · 2013 · DOI
This study looked at whether the quality of the relationship between patients and their CBT therapist affects how much CBT helps reduce fatigue in ME/CFS. Researchers followed 217 patients through CBT treatment and measured both the therapeutic relationship (like whether patients felt heard and had confidence in treatment) and changes in fatigue-related thoughts and behaviors. They found that when patients started therapy with positive expectations and felt they understood what the therapy aimed to do, they experienced better improvements in fatigue by the end of treatment.
Understanding what makes CBT more effective for some ME/CFS patients than others is crucial for improving treatment outcomes. This study highlights that the therapeutic relationship is an important treatment component, suggesting that therapist-patient compatibility and clear communication about treatment goals may be modifiable factors that enhance CBT efficacy.
This study does not prove that the therapeutic relationship directly causes fatigue reduction—only that it is associated with better outcomes. The correlational design cannot establish causation, and it does not prove that improving the therapeutic relationship alone (without concurrent changes in fatigue-perpetuating factors) would reduce fatigue. The study also does not demonstrate that CBT itself is definitively effective for all ME/CFS 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, & Bleijenberg, Gijs (2013). The role of the therapeutic relationship in cognitive behaviour therapy for chronic fatigue syndrome.. Behaviour research and therapy. https://doi.org/10.1016/j.brat.2013.02.001
BibTeX
@article{mecfsatlas-heins-2013-role-therapeutic,
author = {Heins, Marianne J and Knoop, Hans and Bleijenberg, Gijs},
title = {The role of the therapeutic relationship in cognitive behaviour therapy for chronic fatigue syndrome.},
journal = {Behaviour research and therapy},
year = {2013},
doi = {10.1016/j.brat.2013.02.001},
note = {PubMed: 23639303},
url = {https://www.mecfsatlas.com/evidence/heins-2013-role-therapeutic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/heins-2013-role-therapeutic
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