Worm-Smeitink, Margreet, Monden, Rei, Groen, Robin Nikita et al. · Journal of psychosomatic research · 2021 · DOI
Researchers tracked what 50 ME/CFS patients experienced throughout their day—their thoughts, activities, and mood—five times daily using phones and activity monitors. They found that two main patterns seemed connected to fatigue: feeling psychologically uncomfortable and how much patients were moving around. However, these patterns looked different for each person, and knowing about them didn't clearly predict who would improve with cognitive behavioural therapy (CBT).
This study highlights an important reality: ME/CFS fatigue is not perpetuated the same way in every patient. Rather than searching for one-size-fits-all explanations, this research suggests that personalised assessment at the individual level may be necessary to understand what maintains fatigue in each person and potentially improve treatment targeting.
This study does not prove that the identified components (psychological discomfort and activity) actually cause fatigue in ME/CFS, only that they may be associated with it. It also does not demonstrate that CBT outcomes can be predicted from these factors, nor does it establish whether tailoring treatment based on individual perpetuating patterns would improve results. The small sample and observational design limit generalisability.
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, Monden, Rei, Groen, Robin Nikita, van Gils, Anne, Bekhuis, Ella, Rosmalen, Judith, et al. (2021). Towards personalized assessment of fatigue perpetuating factors in patients with chronic fatigue syndrome using ecological momentary assessment: A pilot study.. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2020.110296
BibTeX
@article{mecfsatlas-worm-smeitink-2021-towards-personalized,
author = {Worm-Smeitink, Margreet and Monden, Rei and Groen, Robin Nikita and van Gils, Anne and Bekhuis, Ella and Rosmalen, Judith and Knoop, Hans},
title = {Towards personalized assessment of fatigue perpetuating factors in patients with chronic fatigue syndrome using ecological momentary assessment: A pilot study.},
journal = {Journal of psychosomatic research},
year = {2021},
doi = {10.1016/j.jpsychores.2020.110296},
note = {PubMed: 33264751},
url = {https://www.mecfsatlas.com/evidence/worm-smeitink-2021-towards-personalized},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/worm-smeitink-2021-towards-personalized
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