Loades, Maria · Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc · 2015 · DOI
This study describes treating a 16-year-old girl with ME/CFS who also had depression and low self-esteem using cognitive behavioral therapy (CBT), a talking treatment that helps change unhelpful thinking patterns. While the therapy successfully improved her mood and self-esteem, her ME/CFS symptoms got worse during treatment. This suggests that mood treatments for people with ME/CFS need to be carefully designed to avoid making fatigue symptoms worse.
Many young people with ME/CFS experience depression, but there is limited evidence on how to safely treat both conditions together. This case highlights an important clinical concern—that standard depression treatments might worsen physical symptoms—which underscores the need for specialized, integrated approaches to mental health support in ME/CFS.
This single case study cannot prove that CBT always worsens ME/CFS symptoms, nor can it establish causation between the therapy and symptom exacerbation. The findings may not apply to other young people with ME/CFS, and alternative explanations for the symptom worsening (disease progression, other factors) cannot be ruled out from one case.
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
Loades, Maria (2015). The Cognitive Behavioral Treatment of Depression and Low Self-Esteem in the Context of Pediatric Chronic Fatigue Syndrome (CFS/ME): A Case Study.. Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc. https://doi.org/10.1111/jcap.12125
BibTeX
@article{mecfsatlas-loades-2015-cognitive-behavioral,
author = {Loades, Maria},
title = {The Cognitive Behavioral Treatment of Depression and Low Self-Esteem in the Context of Pediatric Chronic Fatigue Syndrome (CFS/ME): A Case Study.},
journal = {Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc},
year = {2015},
doi = {10.1111/jcap.12125},
note = {PubMed: 26470755},
url = {https://www.mecfsatlas.com/evidence/loades-2015-cognitive-behavioral},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/loades-2015-cognitive-behavioral
Contribute
Private, reviewed by a human. Not a public comment thread.