Roberts, Amanda D L, Papadopoulos, Andrew S, Wessely, Simon et al. · Journal of affective disorders · 2009 · DOI
This study looked at whether cognitive behavioural therapy (CBT)—a type of talk therapy—could help fix a hormone imbalance found in ME/CFS patients. Researchers measured a stress hormone called cortisol in the saliva of 41 patients before and after 15 sessions of CBT. They found that cortisol levels increased after therapy, suggesting that CBT may help restore this hormone to healthier levels.
This study provides evidence that one of the biological abnormalities found in ME/CFS—low cortisol levels—may be partially reversible through targeted psychological therapy. If lowered cortisol contributes to maintaining ME/CFS symptoms, this finding suggests CBT might work partly by correcting this hormonal dysfunction, offering a potential mechanistic explanation for treatment benefit.
This study does not prove that CBT directly causes cortisol increases, as there was no untreated control group to account for the passage of time or natural recovery. It also does not establish whether cortisol normalization is essential for symptom improvement or merely associated with it. Finally, the findings may not generalise to all ME/CFS patients, particularly those with more severe disease.
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
Roberts, Amanda D L, Papadopoulos, Andrew S, Wessely, Simon, Chalder, Trudie, & Cleare, Anthony J (2009). Salivary cortisol output before and after cognitive behavioural therapy for chronic fatigue syndrome.. Journal of affective disorders. https://doi.org/10.1016/j.jad.2008.09.013
BibTeX
@article{mecfsatlas-roberts-2009-salivary-cortisol,
author = {Roberts, Amanda D L and Papadopoulos, Andrew S and Wessely, Simon and Chalder, Trudie and Cleare, Anthony J},
title = {Salivary cortisol output before and after cognitive behavioural therapy for chronic fatigue syndrome.},
journal = {Journal of affective disorders},
year = {2009},
doi = {10.1016/j.jad.2008.09.013},
note = {PubMed: 18937978},
url = {https://www.mecfsatlas.com/evidence/roberts-2009-salivary-cortisol},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/roberts-2009-salivary-cortisol
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