Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study.
Deale, A, Husain, K, Chalder, T et al. · The American journal of psychiatry · 2001 · DOI
Quick Summary
Researchers compared two types of therapy for ME/CFS: cognitive behavior therapy (CBT, which focuses on changing thought patterns and gradually increasing activity) and relaxation therapy. After 5 years, 68% of people who received CBT reported feeling much or very much improved, compared to 36% who received relaxation therapy. However, neither therapy fully eliminated fatigue symptoms, and some patients found it hard to keep improving after their regular treatment ended.
Why It Matters
This study provides long-term evidence that CBT may produce sustained functional benefits in ME/CFS beyond the treatment period, offering both patients and clinicians insight into realistic expectations and durability of gains. It highlights that while behavioral interventions can help, they do not typically normalize fatigue or eliminate the need for ongoing symptom management.
Observed Findings
68% of CBT recipients versus 36% of relaxation recipients rated themselves as 'much improved' or 'very much improved' at 5-year follow-up.
CBT recipients showed significantly higher rates of complete recovery and freedom from relapse compared to relaxation controls.
CBT recipients worked significantly more mean hours per week at follow-up than relaxation controls.
Over 80% of CBT recipients continued to use strategies learned during therapy at 5-year follow-up.
Few patients in either group achieved 'normal' fatigue levels despite favorable outcomes on other symptom measures.
Inferred Conclusions
CBT can produce some lasting functional and symptomatic benefits that persist for at least 5 years after treatment ends.
CBT is superior to relaxation therapy for long-term outcome in ME/CFS based on self-rated improvement and relapse rates.
CBT alone is not a cure and does not eliminate fatigue symptoms for most patients.
Maintenance strategies and structured support after formal treatment may be needed to sustain and extend therapeutic gains.
Remaining Questions
Why do some CBT recipients experience relapse or difficulty progressing further after treatment ends?
What This Study Does Not Prove
This study does not prove CBT cures ME/CFS or restores normal fatigue levels. It also does not establish whether CBT's mechanisms of benefit are biological or primarily psychological, nor does it address whether the improvements reflect true physiological recovery or changes in coping and perception. The lack of a true untreated control group limits causal inference about natural history versus treatment effects.
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 →