Wilshire, Carolyn E, Kindlon, Tom, Courtney, Robert et al. · BMC psychology · 2018 · DOI
This study re-examined a large, well-known trial called PACE that tested whether exercise therapy and talking therapy could help people with ME/CFS. When researchers checked the original study data using the methods that were promised before the trial started, they found much weaker benefits than originally reported. The treatments did not clearly work better than standard care, recovery rates were very low, and improvements seemed to fade after two years.
This reanalysis is crucial because the original PACE trial conclusions influenced clinical guidelines recommending GET and CBT for ME/CFS worldwide. This critical re-examination reveals that the evidence base for these treatments may be substantially weaker than previously believed, which has significant implications for treatment recommendations and patient care decisions.
This reanalysis does not prove that GET and CBT are completely ineffective for all ME/CFS patients. It does not establish what treatments would be more effective, nor does it explain the mechanisms of ME/CFS itself. The study relies on reanalysis of existing data rather than new experimental evidence.
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
Wilshire, Carolyn E, Kindlon, Tom, Courtney, Robert, Matthees, Alem, Tuller, David, Geraghty, Keith, et al. (2018). Rethinking the treatment of chronic fatigue syndrome-a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT.. BMC psychology. https://doi.org/10.1186/s40359-018-0218-3
BibTeX
@article{mecfsatlas-wilshire-2018-rethinking-treatment,
author = {Wilshire, Carolyn E and Kindlon, Tom and Courtney, Robert and Matthees, Alem and Tuller, David and Geraghty, Keith and Levin, Bruce},
title = {Rethinking the treatment of chronic fatigue syndrome-a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT.},
journal = {BMC psychology},
year = {2018},
doi = {10.1186/s40359-018-0218-3},
note = {PubMed: 29562932},
url = {https://www.mecfsatlas.com/evidence/wilshire-2018-rethinking-treatment},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/wilshire-2018-rethinking-treatment
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