Leone, Stephanie S, Huibers, Marcus J H, Kant, Ijmert et al. · Journal of psychosomatic research · 2006 · DOI
Researchers tested whether cognitive-behavioral therapy (CBT), a talk-based treatment, delivered by general doctors could help people with fatigue who were on sick leave. They followed up with patients 4 years after the original study ended. The results showed that CBT did not help—both the treatment group and the control group still had high fatigue and work absences after 4 years, suggesting that persistent fatigue has a poor long-term outlook.
This study challenges the assumption that CBT delivered in primary care can improve long-term outcomes in patients with persistent fatigue. For ME/CFS patients, it raises important questions about the effectiveness of psychological interventions as standalone treatments and suggests that fatigue-related conditions may require different therapeutic approaches or multimodal interventions.
This study does not prove that CBT is ineffective for all fatigue conditions or all delivery formats—it specifically evaluated GP-delivered CBT in employed individuals on sick leave, and results may not generalize to specialized CBT programs or different patient populations. The study also does not establish that fatigue is purely biological; it only demonstrates that this particular intervention approach was unsuccessful. Additionally, the study cannot explain why the intervention group showed worse trends than controls.
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
Leone, Stephanie S, Huibers, Marcus J H, Kant, Ijmert, van Amelsvoort, Ludovic G P M, van Schayck, Constant P, Bleijenberg, Gijs, et al. (2006). Long-term efficacy of cognitive-behavioral therapy by general practitioners for fatigue: a 4-year follow-up study.. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2006.04.010
BibTeX
@article{mecfsatlas-leone-2006-long-term-2,
author = {Leone, Stephanie S and Huibers, Marcus J H and Kant, Ijmert and van Amelsvoort, Ludovic G P M and van Schayck, Constant P and Bleijenberg, Gijs and Knottnerus, J André},
title = {Long-term efficacy of cognitive-behavioral therapy by general practitioners for fatigue: a 4-year follow-up study.},
journal = {Journal of psychosomatic research},
year = {2006},
doi = {10.1016/j.jpsychores.2006.04.010},
note = {PubMed: 17084137},
url = {https://www.mecfsatlas.com/evidence/leone-2006-long-term-2},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/leone-2006-long-term-2
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