May, Marcella, Milrad, Sara F, Perdomo, Dolores M et al. · Fatigue : biomedicine, health & behavior · 2024 · DOI
This study tested whether a stress management program delivered by video could help ME/CFS patients who experience severe post-exertional malaise (PEM)—the worsening of symptoms after activity. Patients either received 10 weeks of cognitive behavioral stress management training or health information. For patients with severe PEM, the stress management program led to meaningful improvements in symptom frequency, symptom intensity, and fatigue-related problems, suggesting that managing stress may help reduce PEM severity.
Post-exertional malaise is one of the most debilitating features of ME/CFS, and most current treatments show limited efficacy for PEM specifically. This study provides evidence that a psychologically-based intervention can meaningfully reduce PEM severity and associated distress, offering a potentially accessible option via videoconference. These findings suggest that stress management may be an important complementary approach for patients with severe PEM.
This study does not prove that psychological stress causes PEM or that CBSM addresses a primary biological mechanism of PEM. The mechanism by which stress management reduces PEM remains unclear—improvement could reflect placebo effects, general coping skills, or unmeasured behavioral changes. The lack of objective biomarkers and reliance on self-reported outcomes also limits causal inference. Additionally, findings apply primarily to middle-aged women and may not generalize to other demographic groups.
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
May, Marcella, Milrad, Sara F, Perdomo, Dolores M, Czaja, Sara J, Jutagir, Devika R, Hall, Daniel L, et al. (2024). Videoconference-delivered group Cognitive Behavioral Stress Management for ME/CFS patients who present with severe PEM: A randomized controlled trial.. Fatigue : biomedicine, health & behavior. https://doi.org/10.1080/21641846.2024.2306801
BibTeX
@article{mecfsatlas-may-2024-videoconference-delivered,
author = {May, Marcella and Milrad, Sara F and Perdomo, Dolores M and Czaja, Sara J and Jutagir, Devika R and Hall, Daniel L and Klimas, Nancy and Antoni, Michael H},
title = {Videoconference-delivered group Cognitive Behavioral Stress Management for ME/CFS patients who present with severe PEM: A randomized controlled trial.},
journal = {Fatigue : biomedicine, health & behavior},
year = {2024},
doi = {10.1080/21641846.2024.2306801},
note = {PubMed: 38736736},
url = {https://www.mecfsatlas.com/evidence/may-2024-videoconference-delivered},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/may-2024-videoconference-delivered
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