**Appendix A**





#### **Table A1.** *Cont*.

2. Respiratory: e.g., air hunger, labored breathing, fatigue of chest wall muscles 3. Loss of thermostatic stability: e.g., subnormal body temperature, marked diurnal fluctuations; sweating episodes, recurrent feelings of feverishness with or without low-gradefever,coldextremities

light-headedness/dizziness

 4. Intolerance of extremes of temperature

palpitations with or without cardiac arrhythmias, **Table A2.** Excluded studies.



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**Table A3.** Statistically insignificant outcomes in the included studies using CDC, Canadian and international consensus criteria for diagnosing CFS.



206



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Quality of life: physical

functioning (SF-36) MBCT/MBSR (pre-post) Post treatment (8 weeks) 0.69


ChFS: Chalder's Fatigue Scale, HADS: Hospital Anxiety and Depression Scale, MBSR: Mindfulness-based stress reduction, MBCT: Mindfulness-based cognitive therapy, SF-36: 36- Item

Short-Form Health Survey.

*Medicina* **2021**, *57*, 652


**Table A5.** Risk of Bias (ROBINS-I).

Low risk of bias (the study is comparable to a well-performed randomized trial with regard to this domain), Moderate risk of bias (the study is sound for a nonrandomized study with regard to this domain but cannot be considered comparable to a well-performed randomized trial), Serious risk of bias (the study has some important problems).

> **Table A6.** Brief descriptions of mind-body interventions used in the included studies.


 **MBIs Definition** Mindfulness and cognitive-based Mindfulness-based stress reduction (MBSR): "The program is conducted as an 8- to 10-week course for groups of up to 30 participants who meet weekly for 2—2.5 hr for instruction and practice in mindfulness meditation skills, together with a discussion of stress, coping, and homework assignments". 1 Mindfulness-based cognitive therapy (MBCT): "MBCT incorporates elements of cognitive therapy that facilitate a detached or de-centered view of one's thoughts, including statements such as "thoughts are not facts" and "I am not my thoughts." This decentered approach also is applied to emotions and bodily sensations". 1 Cognitive-behavioral stress managemen<sup>t</sup> (CBSM) is based on cognitive restructuring: "CBSM interventions reduce distress by teaching relaxation techniques; modifying patients' outlook, cognitive appraisals, and coping strategies; and when performed in a group format may also improve their perceptions of social support". 2 Acceptance commitment therapy (ACT) is based on psychological flexibility. "This is defined as the ability to act in line with important long-term goals or values in life, even in the presence of negative experiences (e.g., non-acute somatic symptoms or psychological distress). Psychological flexibility is a complex overarching behavioral construct that includes several behavioral processes such as acceptance/non-acceptance and cognitive fusion/diffusion". 3

**TableA6.***Cont*.

1 Baer RA. Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical psychology: Science and practice. June 2003, 10,125–143. 2 Lopez C, Antoni M, Penedo F, Weiss D, Cruess S, Segotas M-C, et al. A pilot study of cognitive-behavioral stress managemen<sup>t</sup> effects on stress, quality of life, and symptoms in persons with chronic fatigue syndrome. Journal of psychosomatic research. 2011, 70, 328–334. 3 Jonsjö MA, Wicksell RK, Holmström L, Andreasson A, Olsson GL. Acceptance and commitment therapy for ME/CFS (Chronic Fatigue Syndrome)–a feasibility study. Journal of Contextual Behavioral Science. 2019, 12, 89–97.
