Worm-Smeitink, Margreet, van Dam, Arno, van Es, Saskia et al. · Journal of medical Internet research · 2019 · DOI
This study tested whether an online cognitive behavioral therapy program (I-CBT) for ME/CFS could work as well in regular hospitals and clinics as it did in research trials. Researchers tracked 79 patients who used the online program first, and those who didn't improve enough could then have in-person therapy sessions. The online program reduced fatigue and improved daily functioning, though not quite as much as in the original research trial.
This is one of the first studies testing whether CBT-based stepped care works in routine clinical practice rather than controlled research settings. Understanding how these treatments perform 'in the real world' helps patients and clinicians know what to expect when accessing ME/CFS care through standard healthcare systems. The findings suggest online-first approaches can be effective but may need refinement to achieve trial-level results.
This observational study cannot prove that I-CBT causes fatigue improvement, only that it is associated with fatigue reduction; confounding factors may explain some outcomes. The study does not establish why fatigue reduction was smaller in routine care than trials, nor does it definitively explain the role of therapist factors in treatment success. It also does not prove that therapist attitudes are unimportant—the lack of correlation may reflect measurement limitations rather than true absence of effect.
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, van Dam, Arno, van Es, Saskia, van der Vaart, Rosalie, Evers, Andrea, Wensing, Michel, et al. (2019). Internet-Based Cognitive Behavioral Therapy for Chronic Fatigue Syndrome Integrated in Routine Clinical Care: Implementation Study.. Journal of medical Internet research. https://doi.org/10.2196/14037
BibTeX
@article{mecfsatlas-worm-smeitink-2019-internet-based-2,
author = {Worm-Smeitink, Margreet and van Dam, Arno and van Es, Saskia and van der Vaart, Rosalie and Evers, Andrea and Wensing, Michel and Knoop, Hans},
title = {Internet-Based Cognitive Behavioral Therapy for Chronic Fatigue Syndrome Integrated in Routine Clinical Care: Implementation Study.},
journal = {Journal of medical Internet research},
year = {2019},
doi = {10.2196/14037},
note = {PubMed: 31603428},
url = {https://www.mecfsatlas.com/evidence/worm-smeitink-2019-internet-based-2},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/worm-smeitink-2019-internet-based-2
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