Cognitive Behavioral Therapy and Graded Exercise for Chronic Fatigue Syndrome: A Meta-Analysis


  • Bronwyn D. Castell,

  • Nikolaos Kazantzis,

  • Rona E. Moss-Morris

Address correspondence to Bronwyn D. Castell, School of Psychology, Massey University, Private Bag 102-904, North Shore Mail Centre, Auckland 0745, New Zealand. E-mail:


[Clin Psychol Sci Prac 18: 311–324, 2011]

Several reviews have concluded that graded exercise therapy (GET) and cognitive behavioral therapy (CBT) may be the most efficacious treatments for chronic fatigue syndrome (CFS). The current review extends the evidence for overall and outcome-specific effects of CBT and GET by directly comparing the treatments and addressing the methodological limitations of previous reviews. GET (n = 5) and CBT (n = 16) randomized controlled trials were meta-analyzed. Overall effect sizes suggested that GET (g = 0.28) and CBT (g = 0.33) were equally efficacious. However, CBT effect sizes were lower in primary care settings and for treatments offering fewer hours of contact. The results suggested that both CBT and GET are promising treatments for CFS, although CBT may be a more effective treatment when patients have comorbid anxiety and depressive symptoms.