Cognitive behavioural therapy for severe fatigue following COVID-19 in adolescents: a serial single-case observational study... 2025 Knoop et al

Full title: Cognitive behavioural therapy for severe fatigue following COVID-19 in adolescents: a serial single-case observational study of five consecutively referred patients

Abstract

Background:
Severe fatigue following COVID-19 is a debilitating symptom in adolescents for which no treatment exists currently.

Aims:
The aim of this study was to determine the effectiveness and feasibility of cognitive behavioural therapy (CBT) for severe fatigue following COVID-19 in adolescents.

Method:
A serial single-case observational design was used. Eligible patients were ≥12 and <18 years old, severely fatigued and ≥6 months post-COVID-19. Five patients, consecutively referred by a paediatrician, were included. The primary outcome was a change in fatigue severity, assessed with the fatigue severity subscale of the Checklist Individual Strength, 12 weeks after the start of CBT, tested with a permutation distancing two-phase A-B test. Secondary outcomes were the presence of severe fatigue, difficulty concentrating and impaired physical functioning directly post-CBT as determined with questionnaires using validated cut-off scores. Also, the frequency of post-exertional malaise (PEM) and absence from school directly post-CBT determined with self-report items were evaluated.

Results:
All five included patients completed CBT. Twelve weeks after starting CBT for severe post-COVID-19 fatigue, three out of five patients showed a significant reduction in fatigue severity. After CBT, all five patients were no longer severely fatigued. Also, four out of five patients were no longer physically impaired and improved regarding PEM following CBT. All five patients reported no school absence post-CBT and no difficulties concentrating.

Conclusion:
This study provides a first indication for the effectiveness and feasibility of CBT among adolescents with post-COVID-19 fatigue.

Open access

 

They don't explain exactly how they characterised PEM, and the link to the Supplementary Material is just the link to the main article.

 

"They all reported PEM, the frequency ranged from ‘every day’ to ‘few times a week’. They all reported school absence ranging from ‘several times a week’ to ‘few times a month’."

Whoot? What kind of PEM is that? Several times a week. For me PEM takes a couple of days. They probably measured fatigue after exertion?

 

Yes, that would be my suspicion as well.

 

How does cherry picking like this get past peer review?

 

The design can’t assess effectiveness at all.

ME-pedia on the CIS-scale:

It does not seem like it’s a good scale.

 

It sounds like the intended to put most of the blame on the children.

I really fear for the safety of the children if their parents are gaslighted as well.

 

What a complete mess. 3/5 not completing the assessments.

 

Case 1 and 2 were already on a downwards trend.
Case 3 and 4 has too much missing data.
Case 5 did not change much and was still severely fatigued.

 

I eventually found the supplementary file. There’s a collapsable menu at the top:

The file does not explain how they characterised PEM. But it has this as an inclusion criteria:

 

I guess Knoop hasn't read Knoop's research? In which he has been claiming this. He is even claiming this here, on the basis of a very cheap anecdote where you have to "just trust him, bro".

It's a good sign of a serious professionals with years of academic and clinical experience promoting a treatment paradigm that has established itself as a fully curative treatment model that they resort to anecdotes / case studies of that treatment. That's how you know these people are serious. They totally could swing a hole-in-one, they just prefer to putt on the practice turfs with no one watching then send you a video titled "trust me bro, I nailed it, hole-in-one wooot!". Got it.