A Cochrane review [Abstract] 1 included 15 trials with a total of 1 043 subjects. When comparing CBT with usual care (six studies, 373 participants), the difference in fatigue mean scores at post-treatment was highly significant in favour of CBT (SMD -0.39, 95% CI -0.60 to -0.19), with 40% of CBT participants (four studies, 371 participants) showing clinical response in contrast with 26% in usual care (OR 0.47, 95% CI 0.29 to 0.76). Findings at follow-up were inconsistent. For CBT versus other psychological therapies, comprising relaxation, counselling and education/support (four studies, 313 participants), the difference in fatigue mean scores at post-treatment favoured CBT (SMD -0.43, 95% CI -0.65 to -0.20). Findings at follow-up were heterogeneous and inconsistent. Only two studies compared CBT against other interventions and one study compared CBT in combination with other interventions against usual care.
Four technology assessment reports 2 3 4 5 on treatments for CFS abstracted in the Health Technology Assessment Database confirm that behavioural interventions that emphasize increasing activity levels may improve physical functioning and quality of life in some people with CFS. Both cognitive behavioural therapy (CBT), in ambulatory regimen and on an individualised basis, and graded exercise therapy (GET) have shown positive results. No specific interventions have been proven to be effective in restoring the ability to work 6.
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