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Evidence summaries

Cognitive Behaviour Therapy for Chronic Fatigue Syndrome (Cfs) in Adults

CBT is effective in reducing the symptoms of fatigue at post-treatment compared with usual care, and may be more effective in reducing fatigue symptoms compared with other psychological therapies. The evidence base at follow-up is limited to a small group of studies with inconsistent findings. Level of evidence: "A"

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.

References

  • Price JR, Mitchell E, Tidy E et al. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev 2008;(3):CD001027. [PubMed]
  • NHS Centre for Reviews, Dissemination. Interventions for the management of CFS/ME. York: Centre for Reviews and Dissemination (CRD), 2002:7(4). [DARE]
  • Defining and managing chronic fatigue syndrome. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ), 2001:42. [DARE]
  • NHS Centre for Reviews, Dissemination. The effectiveness of interventions used in the treatment/management of chronic fatigue syndrome and/or myalgic encephalomyelitis in adults and children. York: Centre for Reviews and Dissemination (CRD), 2002:22. [DARE]
  • Dolors Estrada M. Chronic fatigue syndrome. Barcelona: Catalan Agency for Health Technology Assessment and Research (CAHTA), IN01/2001. [DARE]
  • Ross SD, Levine C, Ganz N, Frame D, Estok R, Stone L, Ludensky V. Systematic review of the current literature related to disability and chronic fatigue syndrome. Evid Rep Technol Assess (Summ) 2002 Dec;(66):1-3. [PubMed] [DARE]

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