Rauwerda, Nynke L, Kuut, Tanja A, Braamse, Annemarie M J et al. · Behavioural and cognitive psychotherapy · 2025 · DOI
This study looked at whether having both severe fatigue and sleep problems at the same time affects how well cognitive behavioural therapy (CBT) works. Researchers found that CBT was equally effective whether patients had just fatigue, just insomnia, or both together. Interestingly, when one symptom improved during treatment, the other often improved too—but sometimes one symptom stayed even after the other got better.
Many ME/CFS patients experience both severe fatigue and sleep disturbances simultaneously, yet evidence on how to treat these co-occurring symptoms has been limited. This study shows that standard CBT approaches remain effective despite symptom co-occurrence, providing reassurance to patients considering these therapies. The finding that symptoms can improve together suggests shared underlying mechanisms that warrant further investigation.
This observational study cannot establish causation between fatigue and insomnia improvements—the association may reflect shared biological pathways, placebo effects, or unmeasured confounders. The study does not prove that CBT is the optimal treatment for all patients with both conditions, nor does it explain why some patients experience residual symptoms despite successful primary treatment. The findings may not generalize beyond the studied populations or treatment protocols.
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
Rauwerda, Nynke L, Kuut, Tanja A, Braamse, Annemarie M J, Nieuwkerk, Pythia, Boss, H Myrthe, Knoop, Hans, et al. (2025). Co-occurrence of severe fatigue and insomnia: implications for the outcome of cognitive behavioural therapies.. Behavioural and cognitive psychotherapy. https://doi.org/10.1017/S1352465825100945
BibTeX
@article{mecfsatlas-rauwerda-2025-occurrence-severe,
author = {Rauwerda, Nynke L and Kuut, Tanja A and Braamse, Annemarie M J and Nieuwkerk, Pythia and Boss, H Myrthe and Knoop, Hans and van Straten, Annemieke},
title = {Co-occurrence of severe fatigue and insomnia: implications for the outcome of cognitive behavioural therapies.},
journal = {Behavioural and cognitive psychotherapy},
year = {2025},
doi = {10.1017/S1352465825100945},
note = {PubMed: 40820959},
url = {https://www.mecfsatlas.com/evidence/rauwerda-2025-occurrence-severe},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/rauwerda-2025-occurrence-severe
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