Worm-Smeitink, Margreet, Janse, Anthonie, van Dam, Arno et al. · Journal of medical Internet research · 2019 · DOI
This study tested whether ME/CFS patients could be treated effectively with online cognitive behavioral therapy (a talk therapy done through a computer), with face-to-face therapy available if needed, compared to standard face-to-face therapy alone. The online therapy worked about as well as in-person therapy for reducing fatigue and disability, but used significantly less therapist time, making it potentially more efficient.
This study demonstrates that internet-based therapy is a viable, evidence-based first-line treatment for ME/CFS that can be as effective as traditional in-person therapy while reducing resource burden on healthcare systems. The finding that many patients improve with online-only treatment has important implications for increasing access to evidence-based care, particularly for patients with mobility limitations or geographic barriers.
This study does not prove that I-CBT works through reconceptualization of fatigue or changes in activity patterns; it measures symptom outcomes without clarifying mechanisms of change. It also does not establish which patients will respond to I-CBT versus requiring face-to-face care, nor does it address whether CBT approaches are effective for all ME/CFS subtypes or disease stages. The study does not evaluate the impact of post-exertional malaise or validate symptom-specific outcome measures for ME/CFS.
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, Margreet, Janse, Anthonie, van Dam, Arno, Evers, Andrea, van der Vaart, Rosalie, Wensing, Michel, et al. (2019). Internet-Based Cognitive Behavioral Therapy in Stepped Care for Chronic Fatigue Syndrome: Randomized Noninferiority Trial.. Journal of medical Internet research. https://doi.org/10.2196/11276
BibTeX
@article{mecfsatlas-worm-smeitink-2019-internet-based,
author = {Worm-Smeitink, Margreet and Janse, Anthonie and van Dam, Arno and Evers, Andrea and van der Vaart, Rosalie and Wensing, Michel and Knoop, Hans},
title = {Internet-Based Cognitive Behavioral Therapy in Stepped Care for Chronic Fatigue Syndrome: Randomized Noninferiority Trial.},
journal = {Journal of medical Internet research},
year = {2019},
doi = {10.2196/11276},
note = {PubMed: 30869642},
url = {https://www.mecfsatlas.com/evidence/worm-smeitink-2019-internet-based},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/worm-smeitink-2019-internet-based
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