Janse, A, Worm-Smeitink, M, Bleijenberg, G et al. · The British journal of psychiatry : the journal of mental science · 2018 · DOI
This study tested whether online cognitive-behavioural therapy (a type of talk therapy focused on thoughts and behaviours) could reduce fatigue in ME/CFS patients. 240 people with ME/CFS were randomly assigned to receive online therapy with regular therapist check-ins, online therapy with check-ins only when needed, or a waiting list. Both online therapy groups showed significant improvements in fatigue compared to those who waited, and both worked equally well.
This study provides evidence that CBT for ME/CFS can be effectively delivered online, making treatment more accessible to geographically isolated or housebound patients who cannot attend face-to-face appointments. The finding that feedback-on-demand is equally effective but more efficient suggests a potentially scalable model for delivering psychological support within healthcare systems with limited resources.
This study does not prove that online CBT works for all ME/CFS patients or that it is a cure; it only demonstrates that it reduces fatigue symptoms compared to a waiting list. It does not establish whether improvements persist long-term, nor does it clarify whether CBT-induced improvements involve harmful activity increases or post-exertional malaise in patients with documented symptom exacerbation patterns. The study cannot determine causation or rule out placebo effects from the therapeutic attention itself.
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
Janse, A, Worm-Smeitink, M, Bleijenberg, G, Donders, R, & Knoop, H (2018). Efficacy of web-based cognitive-behavioural therapy for chronic fatigue syndrome: randomised controlled trial.. The British journal of psychiatry : the journal of mental science. https://doi.org/10.1192/bjp.2017.22
BibTeX
@article{mecfsatlas-janse-2018-efficacy-web,
author = {Janse, A and Worm-Smeitink, M and Bleijenberg, G and Donders, R and Knoop, H},
title = {Efficacy of web-based cognitive-behavioural therapy for chronic fatigue syndrome: randomised controlled trial.},
journal = {The British journal of psychiatry : the journal of mental science},
year = {2018},
doi = {10.1192/bjp.2017.22},
note = {PubMed: 29436329},
url = {https://www.mecfsatlas.com/evidence/janse-2018-efficacy-web},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/janse-2018-efficacy-web
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