Ingman, Tom, Smakowski, Abigail, Goldsmith, Kimberley et al. · Psychological medicine · 2022 · DOI
This review examined 15 studies testing whether cognitive behavioral therapy (CBT) and graded exercise therapy (GET) help adults with ME/CFS. About 44% of people felt better after CBT and 43% felt better after GET in the short to medium term, compared to smaller improvements in control groups. However, most studies were only moderate to weak quality, and results may not apply to people with severe ME/CFS.
This review provides a comprehensive overview of evidence for two commonly recommended treatments for ME/CFS, helping patients and clinicians make informed decisions about therapy options. It identifies both the modest support for these treatments and important gaps, including that findings may not represent severe ME/CFS cases and that most outcomes relied on patient self-report rather than objective measures.
This review does not prove CBT and GET are universally effective—outcomes show mixed results and the review notes inconsistent findings across studies. The research does not establish whether improvements are due to the specific treatments themselves or other factors, and importantly, findings may not apply to people with severe ME/CFS, who were largely excluded from the reviewed trials.
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
Ingman, Tom, Smakowski, Abigail, Goldsmith, Kimberley, & Chalder, Trudie (2022). A systematic literature review of randomized controlled trials evaluating prognosis following treatment for adults with chronic fatigue syndrome.. Psychological medicine. https://doi.org/10.1017/S0033291722002471
BibTeX
@article{mecfsatlas-ingman-2022-systematic-literature,
author = {Ingman, Tom and Smakowski, Abigail and Goldsmith, Kimberley and Chalder, Trudie},
title = {A systematic literature review of randomized controlled trials evaluating prognosis following treatment for adults with chronic fatigue syndrome.},
journal = {Psychological medicine},
year = {2022},
doi = {10.1017/S0033291722002471},
note = {PubMed: 36059125},
url = {https://www.mecfsatlas.com/evidence/ingman-2022-systematic-literature},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/ingman-2022-systematic-literature
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