Loades, Maria Elizabeth, Rimes, Katharine, Lievesley, Kate et al. · Clinical child psychology and psychiatry · 2019 · DOI
This study looked at how adolescents with ME/CFS think about and respond to their symptoms, compared to teenagers with asthma. Researchers found that young people with ME/CFS tend to have unhelpful thought patterns—like believing symptoms cause permanent damage—and unhelpful behaviors like pushing through activity or avoiding it completely. These unhelpful patterns were linked to more fatigue and disability over a 3-month follow-up period.
Understanding that unhelpful thinking patterns and behaviours may contribute to fatigue maintenance in adolescents with ME/CFS has implications for developing targeted psychological interventions. This research helps explain why some adolescents experience worsening symptoms and disability, potentially offering new avenues for treatment beyond symptom management alone.
This study does not prove that unhelpful cognitions and behaviours *cause* fatigue or disability in ME/CFS; it only shows an association over 3 months. It also does not determine whether these thought patterns develop as a *result* of having ME/CFS rather than contributing to its maintenance. The small asthma comparison group limits generalizability of between-group comparisons.
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 Elizabeth, Rimes, Katharine, Lievesley, Kate, Ali, Sheila, & Chalder, Trudie (2019). Cognitive and behavioural responses to symptoms in adolescents with chronic fatigue syndrome: A case-control study nested within a cohort.. Clinical child psychology and psychiatry. https://doi.org/10.1177/1359104519835583
BibTeX
@article{mecfsatlas-loades-2019-cognitive-behavioural,
author = {Loades, Maria Elizabeth and Rimes, Katharine and Lievesley, Kate and Ali, Sheila and Chalder, Trudie},
title = {Cognitive and behavioural responses to symptoms in adolescents with chronic fatigue syndrome: A case-control study nested within a cohort.},
journal = {Clinical child psychology and psychiatry},
year = {2019},
doi = {10.1177/1359104519835583},
note = {PubMed: 30873864},
url = {https://www.mecfsatlas.com/evidence/loades-2019-cognitive-behavioural},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/loades-2019-cognitive-behavioural
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