Rehabilitative efficacy of cognitive behavioral therapy-based intervention for chronic fatigue syndrome

Background: Cognitive behavioral therapy (CBT) has been used for chronic fatigue syndrome (CFS), but previous studies have shown inconsistencies and divergent long-term outcomes. This study aims to assess the effectiveness of CBT in improving fatigue, physical functioning, and psychological health in patients with CFS. Methods: We searched PubMed, Web of Science, Embase, and the Cochrane Library from their inception to March 2025. Studies designed as randomized controlled trials, enrolling patients diagnosed with CFS who received CBT as a treatment intervention delivered face-to-face, in groups, or online were included. The primary outcome was the fatigue score, and the secondary outcomes were the physical function score, psychological outcomes, and adverse events. The quality of the included studies was evaluated using the Cochrane Assessment Tool for Risk of Bias Version 2 (RoB 2; The Cochrane Collaboration). Heterogeneity was detected by subgroup analysis and sensitivity analysis. Results: Fifteen randomized controlled trials with 2270 participants were involved. Meta-analysis demonstrated that CBT yielded significant posttreatment improvements across key outcomes. Fatigue severity was notably reduced, as measured by the Chalder Fatigue Questionnaire (standardized mean difference [SMD] = −0.44, 95% confidence interval [CI]: −0.57–−0.32) and the Checklist Individual Strength (SMD = −0.88, 95% CI: −1.16–−0.60). Physical functioning (physical function subscale of the Short Form Health Survey-36) subscale also improved significantly (SMD = 0.32, 95% CI: 0.23–0.41). Psychological health benefits were evident through reduced Symptom Checklist 90 (SMD = −0.44, 95% CI: −0.62–−0.26) and specific decreases in anxiety (Hospital Anxiety and Depression Scale–anxiety scale: SMD = −0.28, 95% CI: −0.46–−0.10) and depression (Hospital Anxiety and Depression Scale–depression scale: SMD = −0.27, 95% CI: −0.45–−0.09). Follow-up analyses confirmed sustained benefits: short-term (≤ 6 months) showed continued fatigue reduction (Chalder Fatigue Questionnaire: SMD = −0.29, 95% CI: −0.55–−0.03) and improved physical function (physical function subscale of the Short Form Health Survey-36: SMD = 0.31, 95% CI: 0.03–0.58); long-term (6–24 months) maintained fatigue relief (SMD = −0.35, 95% CI: −0.50–−0.19) and functional gains (SMD = 0.21, 95% CI: 0.06–0.37). Safety analysis showed no statistically significant difference in adverse event rates (odds ratio = 0.61, 95% CI: 0.36–1.01, P = .060). Conclusion: Based on our results, CBT may be an effective option for CFS, but further research is warranted.