Worm-Smeitink, M, Nikolaus, S, Goldsmith, K et al. · Journal of psychosomatic research · 2016 · DOI
This study compared how well cognitive behaviour therapy (CBT) worked for ME/CFS patients at two different treatment centers—one in the Netherlands and one in the UK. Both centers used CBT but with slightly different approaches. The Dutch center saw larger improvements in fatigue, physical functioning, and ability to work or socialize compared to the UK center. The researchers found that differences in how patients were treated, rather than differences in the patients themselves, likely explained why one center had better results.
Understanding why the same treatment produces different results across settings is crucial for improving ME/CFS care globally. This study suggests that how CBT is delivered—not just whether it's delivered—significantly impacts patient outcomes, highlighting the importance of standardizing and optimizing treatment protocols. These findings can help clinicians refine their approaches to maximize benefits for patients with ME/CFS.
This study does not prove that CBT is universally effective for all ME/CFS patients, as both centers showed considerable variation in individual responses. It also does not definitively identify which specific protocol differences caused better outcomes—only that protocol differences likely matter. The observational design means causation cannot be established, and unmeasured variables affecting treatment delivery were not captured.
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
Worm-Smeitink, M, Nikolaus, S, Goldsmith, K, Wiborg, J, Ali, S, Knoop, H, et al. (2016). Cognitive behaviour therapy for chronic fatigue syndrome: Differences in treatment outcome between a tertiary treatment centre in the United Kingdom and the Netherlands.. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2016.06.006
BibTeX
@article{mecfsatlas-worm-smeitink-2016-cognitive-behaviour,
author = {Worm-Smeitink, M and Nikolaus, S and Goldsmith, K and Wiborg, J and Ali, S and Knoop, H and Chalder, T},
title = {Cognitive behaviour therapy for chronic fatigue syndrome: Differences in treatment outcome between a tertiary treatment centre in the United Kingdom and the Netherlands.},
journal = {Journal of psychosomatic research},
year = {2016},
doi = {10.1016/j.jpsychores.2016.06.006},
note = {PubMed: 27411751},
url = {https://www.mecfsatlas.com/evidence/worm-smeitink-2016-cognitive-behaviour},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/worm-smeitink-2016-cognitive-behaviour
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