Knoop, Hans, Stulemeijer, Maja, de Jong, Lieke W A M et al. · Pediatrics · 2008 · DOI
This study followed teenagers with ME/CFS for about 2 years after they completed cognitive behavioral therapy (CBT). The teenagers who received CBT stayed improved or got better at follow-up, with less fatigue and better school attendance compared to those who didn't receive CBT. Interestingly, if the teenager's mother had high fatigue levels at the start, the teen was less likely to improve with treatment.
This study provides rare long-term outcome data for adolescents with ME/CFS treated with CBT, showing sustained improvements beyond the initial treatment phase. Understanding predictive factors like parental fatigue may help clinicians identify which patients will respond best to CBT and inform family-centered treatment approaches.
This study does not prove that CBT is curative for ME/CFS or that it works equally well in all adolescents. The mechanisms by which maternal fatigue affects treatment outcome remain unclear—this could reflect genetic factors, household stress, or other unmeasured confounders rather than a direct causal relationship. The study cannot determine whether CBT effects are specific to ME/CFS or represent general improvements from expectancy and behavioral activation.
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
Knoop, Hans, Stulemeijer, Maja, de Jong, Lieke W A M, Fiselier, Theo J W, & Bleijenberg, Gijs (2008). Efficacy of cognitive behavioral therapy for adolescents with chronic fatigue syndrome: long-term follow-up of a randomized, controlled trial.. Pediatrics. https://doi.org/10.1542/peds.2007-1488
BibTeX
@article{mecfsatlas-knoop-2008-efficacy-cognitive,
author = {Knoop, Hans and Stulemeijer, Maja and de Jong, Lieke W A M and Fiselier, Theo J W and Bleijenberg, Gijs},
title = {Efficacy of cognitive behavioral therapy for adolescents with chronic fatigue syndrome: long-term follow-up of a randomized, controlled trial.},
journal = {Pediatrics},
year = {2008},
doi = {10.1542/peds.2007-1488},
note = {PubMed: 18310181},
url = {https://www.mecfsatlas.com/evidence/knoop-2008-efficacy-cognitive},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/knoop-2008-efficacy-cognitive
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