Table II.

An overview of included papers referring effects of non-pharmacological programmes.

	Aim/research question	Setting for intervention, Diagnostic criteria	Interventions and control	Length of follow-up	Sample characteristics	Primary outcome measures	Statistically significant group differences in primary outcome variable, and effect size if reported
Cognitive behavioural therapy (CBT) for adults:
Janse et al., 2018 Netherlands	To test the efficacy of internet-based CBT (iCBT)	Outpatient specialized clinic CDC-94 criteria †	Protocol-driven- feedback iCBT vs. feedback-on-demand iCBT vs. waiting list	At end of therapy at 6 months	80 patients in each three groups, 145 women. Mean age in groups from 37 to 40 yrs	Checklist Individual Strength fatigue severity subscale	No difference between the two iCBT formats, but both groups better fatigue than controls. 43% in iCBT groups reached normal fatigue and 15% in waiting list control group No serious adverse events
Tummers et al., 2012 Netherlands	To test whether a minimal intervention was effective when delivered in a community-based mental health centre	Community-based mental health centre CDC-94 criteria †	Self-instruction booklet based on CBT and email-contacts once every 2 weeks vs. waiting list	At time of completing intervention and waiting list after 6 months	Guided CBT, n=62, 46 women, mean age 36 yrs, illness duration 6 to 464 months Waiting list, n=61, 50 women, mean age 36 years, illness duration 6 to 625 months	Checklist Individual Strength fatigue severity subscale	Decreased fatigue was found in guided CBT group compared with waiting list controls. Controlled effect size was 0.70. 33% showed clinical reduced fatigue compared to 9% in waiting list control group
Tummers et al., 2010 Netherlands	To examine effectiveness of a stepped care guided self-instruction and CBT compared to usual care	Expert centre of ME/CFS CDC-94 criteria †	Stepped care: Minimal self-instruction booklet followed by 6 months individual face to face CBT vs. waiting list followed by CBT	At completion self-instruction/waiting period. After completing additional CBT or regular CBT	Self-instruction and CBT, n=84, 69 women, mean age 37 yrs Waiting list and regular CBT, n=85, characteristics not reported	Checklist Individual Strength fatigue severity subscale	No statistically significant difference between two groups in fatigue, effect size 1.37 Number of patients reaching clinical significant improvement higher in the stepped care group than the other group
CBT for adolescents:
Nijhof et al., 2012 Netherlands	To compare short-term effectiveness of the FITNET programme with usual care in reduction of fatigue, school absence, and physical dysfunction	Outpatient specialist care CDC-94 criteria †	CBT delivered as 21 modules over internet, with interactions between trained CBT therapists and children and their parents separately first once a week and then each other week vs. usual care controls	At 6 months	CBT group, n=68, usual care n= 67, CBT group, 54 girls, mean age 16 yrs and duration of symptoms 16 yrs Usual care group, 57 girls, mean age 16 yrs and duration of disease 19 yrs.	School attendance in % of normal	School attendance in CBT group increased to 84% vs 51% in usual care group, and 75% reached full school attendance at 6 months vs 16% in usual care group.
Rehabilita-tion:
Nunez et al., 2011 Spain	To compare quality of life of those receiving conventional drugs, group CBT and GET with drug and exercise counselling	Outpatient specialist clinic CDC-94 criteria †	Multidisciplinary rehabilitation with CBT, supervised GET and conventional drugs vs. GET counselling and conventional drugs	3 months therapy assessed 1 year after end of the programme	Rehabilitation, n=60, 53 women, mean age 43 yrs and illness duration 32 months Controls, n=60, 48 women mean age 44 years, illness duration 33 months	Medical Outcomes Study-Short Form-36	No group differences in quality of health, worse bodily pain scores in rehabilitation group than control group
Vos-Vromans et al., 2016 Netherlands	To evaluate the difference in treatment effect between CBT and multidisciplinary rehabilitation (MR)	Rehabilitation centres CDC-94 criteria †	CBT alone (tailored to active or passive patients) vs. Rehabilitation (including CBT and a mix of strategies)	26 and 52 weeks after treatment initiation	CBT, n=60, 47 women, mean age 41 yrs and illness duration mostly ≥ 5 yrs MR, n=62, 50 women, mean age 40, illness duration mostly ≥5 yrs	Checklist Individual Strength fatigue severity subscale	Fatigue improved more in MR than in CBT group After one year the improvement in fatigue score was sustained in MR group, but not in the CBT group.
Activity pacing:
Kos et al., 2015 Belgium	To evaluate effectiveness of activity pacing self-management	Outpatient rehabilitation clinic CDC-94 criteria †	Three individual sessions with either activity-pacing self-management (APS) or relaxation therapy (RT)	At end of therapy at 3 weeks	APS, n= 16 women, mean age 39 yrs RT, n= 17 women, mean age 41 yrs	Canadian Occupational Performance Measure (COPM)	COPM performance and COPM satisfaction scores changed significantly in both group with moderate to high effect size in favour of APS group with 33% and 42% in APS group vs. 14% and none in the RT group.
Pinxsterhuis et al., 2017 Norway	To evaluate the effectiveness of a group-based self-management programme	Primary health care setting CDC-94 criteria † CCD criteria ‡	Self-management educational program vs. treatment as usual (controls)	At 6 months and after 1 year	Self-management, n=71, 67 women, mean age 44 yrs, diagnose for 1-21 yrs Controls n=66, 54 women and diagnosis for 0-17 yrs	SF-36 physical functioning subscale	No group difference in physical functioning after 6 or 12 months

† the Centres for Disease Control and Prevention diagnosis criteria

‡ the Canadian Consensus Criteria for diagnosis