A Cochrane review 1 included 15 studies on the effectiveness of cognitive behaviour therapy for chronic fatigue syndrome (CFS), with a total of 1043 subjects. The studies involved adults with a primary diagnosis of CFS, assigned to a CBT condition compared with usual care or another intervention, alone or in combination.
CBT compared 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.
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.
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).
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