Evidence mapPaperPMID 42219745Full record

SynthesisBrain and behavior2026

Components and Delivery Formats of Cognitive Behavioral Therapy for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Systematic Review and Component Network Meta-Analysis.

Shoujian Wang, Jun Ren, Sitong Fang, Qiukui Hao, Yu-Qing Zhang, Lingjun Kong, Min Fang

Abstract readSystematic ReviewNetwork Meta-Analysis
In one paragraph

Synthesis in Brain and behavior, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Shoujian WangDepartment of Tuina, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Jun RenDepartment of Tuina, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Sitong FangDepartment of Tuina, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Qiukui HaoSchool of Rehabilitation Science, McMaster University, Hamilton, Canada.
Yu-Qing ZhangSchool of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Lingjun KongDepartment of Tuina, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Min FangDepartment of Tuina, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

Funding

Shanghai Central-Local Joint Science and Technology Development Fund YDZX20243100002004Shanghai Key Laboratory of Traditional Chinese Medicine Manipulation Therapy for Musculoskeletal Diseases 24dz2260200Shanghai Pudong New Area Health Commission Special Project PW2023E-01Shanghai Three-Year Action Plan for Advancing TCM Inheritance and Innovation ZY(2025-2027)-3-1-1Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine-Research Leadership Initiative SGYYJBGS-001
6 · The paper itself

Abstract

objectiveChronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a debilitating condition characterized by persistent fatigue, impaired functioning, and substantial societal burden. Although cognitive behavioral therapy (CBT) is commonly used for CFS/ME, the effective components and delivery formats remain unclear.

methodsWe systematically searched MEDLINE, Embase, PsyclNFO, Web of Science, the Cochrane Library, and major English and Chinese databases from inception to January 15, 2025, without language restrictions. Ultimately, a frequentist network meta-analysis (NMA) and component network meta-analysis (cNMA) of 16 randomized controlled trials were conducted to assess the associations between CBT components, delivery formats, and patient-important outcomes.

resultsAt the treatment level, guided self-help CBT (mean difference [MD], -6.89; 95% CI, -9.56 to -4.22; moderate certainty) and individual CBT (MD, -4.81; 95% CI, -6.98 to -2.65; moderate certainty) probably reduced fatigue when measured immediately after treatment. At the component level, goal setting (incremental mean difference [iMD], -8.83; 95% CI, -16.92 to -0.74), third-wave components (iMD, -6.02; 95% CI, -11.33 to -0.72), and cognitive restructuring (iMD, -4.41; 95% CI, -8.83 to 0.01) were associated with reduced fatigue when measured immediately after treatment. Psychoeducation was potentially counterproductive (iMD, 5.23; 95% CI, 0.64 to 9.82). At the end of follow-up, cognitive restructuring was associated with reduced fatigue and depression, and improved physical function; goal setting was also associated with improved physical function. The combination of goal setting, third-wave components, and cognitive restructuring delivered via guided self-help may be an efficacious component-based intervention relative to the nonspecific treatment component (iMD, -16.33; 95% CI, -26.68 to -5.99).

conclusionsThe effective CBT combination probably involves goal setting, third-wave components, and cognitive restructuring delivered via guided self-help, while psychoeducation may be detrimental. Future studies should prospectively examine core CBT components and their interactions, as well as incorporate measures of dose and intensity to guide more personalized and scalable interventions.

trial registrationCRD420251018083.

Indexed as

Cognitive Behavioral TherapyFatigue Syndrome, ChronicHumanschronic fatigue syndromecognitive behavioral therapycomponent network meta‐analysis

Identifiers

PMID42219745
PMCPMC13239200

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.