Müller, Fabiola, Verdam, Mathilde G E, Oort, Frans J et al. · International journal of behavioral medicine · 2023 · DOI
This study examined whether cognitive behavioral therapy (CBT) for severe fatigue works partly because patients change how they think about tiredness, rather than simply feeling less tired. Researchers tracked three groups of patients—those with chronic fatigue syndrome, cancer patients, and people with diabetes—who received CBT. They found that CBT did reduce fatigue, and that patients' understanding of what fatigue means to them shifted during treatment, but this shift did not change how well the treatment worked.
Understanding whether fatigue score improvements in ME/CFS reflect true symptom relief versus changed perception is critical for accurately evaluating treatment efficacy. This study provides evidence that CBT's benefit on fatigue measures is genuine even when response shift occurs, strengthening confidence in CBT outcomes. It also highlights that asking patients how their relationship with fatigue has changed—not just symptom scores—may provide a fuller picture of treatment impact.
This study does not prove that response shift is beneficial or that it explains the mechanism of CBT's effect. It also does not establish whether response shift occurs in ME/CFS patients specifically at rates different from cancer or diabetes populations, nor does it demonstrate whether patients' subjective understanding of fatigue genuinely shifted or whether only measurement patterns changed. Correlation between cognition changes and response shift does not establish causation.
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 →
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