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Description: Review question The aim of the planned meta-analyses is to examine the efficacy and the acceptance of cognitive behavioral therapy including third wave treatments in adults with chronic fatigue syndrome. Condition or domain being studied Exhaustion is a mostly temporary reaction to prolonged physical or mental strain, such as distress. In some cases, exhaustion can be long-lasting, even chronic. This leads to a severe impairment of the affected person's life. If the persistent exhaustion is not based on a psychological or organic cause this condition is referred to as chronic fatigue syndrome (CFS) (Martin et al., 2013; Martin, 2015). According to previous meta-analyses in the field, cognitive behavioral therapy (CBT) is considered effective and has the highest level of evidence in the treatment of chronic fatigue syndrome (Martin et al., 2013). The National Institutes for Health and Care Excellence (NICE) guideline also recommended CBT for the treatment of CFS in 2007. However, with the publication of the 2021 guideline, there was a change in thinking in which CBT was now only classified as a complementary therapy. An update of the current state of research is needed regarding two aspects. First, the last meta-analysis which examined the efficacy of CBT in the treatment of CFS was published eleven years ago (Castell et al., 2011). Second, the release of the 2021 NICE guidelines is debated: While patient associations mostly welcome the changes, many voices of the scientific community criticize the methodological approach of the guideline and its conclusion regarding the individual therapies, especially regarding CBT and therapies with a focus on activity enhancement of the patients (e.g., Turner-Stokes, 2020; Vink et al., 2022). The purpose of this meta-analysis is to examine the efficacy of cognitive behavioral therapy in adult CFS patients. However, looking only at the efficacy of a treatment is not sufficient. Acceptance in terms of dropping out from an intervention should also be considered. An effective treatment is only beneficial on a larger scale if patients accept it and thus started in the first place (Swift et al. 2017). Currently, there is a large gap in research regarding the study of acceptability of cognitive behavioral therapy in adults with chronic fatigue syndrome. Existing meta-analyses are limited to the efficacy of specific interventions in the treatment of chronic fatigue syndrome. Dropout rates, if reported, are solely listed descriptively. To close this research gap, the planned meta-analysis examines the percentage of individuals participating in (efficacy) trials who terminate treatment prematurely. In addition, it will examine at what point these individuals discontinue treatment.