Sunnquist, Madison, Jason, Leonard A · Journal of clinical psychology · 2018 · DOI
This study tested whether the idea that ME/CFS is caused or worsened mainly by unhelpful thoughts and not being active enough actually explains what happens to patients with ME/CFS. Researchers looked at 990 people with ME/CFS and found this explanation didn't fit well, especially for people who met stricter diagnostic criteria. The findings suggest that ME/CFS may work differently than this model assumes.
This research directly challenges a widely-promoted treatment approach for ME/CFS. If the cognitive-behavioral model doesn't accurately represent the disease, then treatments based solely on this model may not be appropriate for many patients, particularly those with more severe or clearly-defined ME/CFS. This supports the need to consider ME/CFS as a physiological illness requiring different treatment approaches.
This observational study cannot prove that cognitive-behavioral interventions are ineffective for all ME/CFS patients or that thought patterns play no role in symptom management. It does not establish causation or rule out that other unmeasured biological factors might explain the findings. The study also does not address whether psychological support may help with coping, separate from the disease mechanism itself.
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
Sunnquist, Madison & Jason, Leonard A (2018). A reexamination of the cognitive behavioral model of chronic fatigue syndrome.. Journal of clinical psychology. https://doi.org/10.1002/jclp.22593
BibTeX
@article{mecfsatlas-sunnquist-2018-reexamination-cognitive,
author = {Sunnquist, Madison and Jason, Leonard A},
title = {A reexamination of the cognitive behavioral model of chronic fatigue syndrome.},
journal = {Journal of clinical psychology},
year = {2018},
doi = {10.1002/jclp.22593},
note = {PubMed: 29457646},
url = {https://www.mecfsatlas.com/evidence/sunnquist-2018-reexamination-cognitive},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/sunnquist-2018-reexamination-cognitive
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