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Meta-Analysis
. 2008 Jul 16;2008(3):CD001027.
doi: 10.1002/14651858.CD001027.pub2.

Cognitive behaviour therapy for chronic fatigue syndrome in adults

Jonathan R Price  1 , Edward Mitchell, Elizabeth Tidy, Vivien Hunot
Affiliations
Meta-Analysis

Cognitive behaviour therapy for chronic fatigue syndrome in adults

Jonathan R Price et al. Cochrane Database Syst Rev. .

Abstract

Background: Chronic fatigue syndrome (CFS) is a common, debilitating and serious health problem. Cognitive behaviour therapy (CBT) may help to alleviate the symptoms of CFS.

Objectives: To examine the effectiveness and acceptability of CBT for CFS, alone and in combination with other interventions, compared with usual care and other interventions.

Search strategy: CCDANCTR-Studies and CCDANCTR-References were searched on 28/3/2008. We conducted supplementary searches of other bibliographic databases. We searched reference lists of retrieved articles and contacted trial authors and experts in the field for information on ongoing/completed trials.

Selection criteria: Randomised controlled trials involving adults with a primary diagnosis of CFS, assigned to a CBT condition compared with usual care or another intervention, alone or in combination.

Data collection and analysis: Data on patients, interventions and outcomes were extracted by two review authors independently, and risk of bias was assessed for each study. The primary outcome was reduction in fatigue severity, based on a continuous measure of symptom reduction, using the standardised mean difference (SMD), or a dichotomous measure of clinical response, using odds ratios (OR), with 95% confidence intervals (CI).

Main results: Fifteen studies (1043 CFS participants) were included in the review. 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.

Authors' conclusions: 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. There is a lack of evidence on the comparative effectiveness of CBT alone or in combination with other treatments, and further studies are required to inform the development of effective treatment programmes for people with CFS.

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Conflict of interest statement

None known

Figures

1
1
Risk of bias graph: review authors' judgement about each risk of bias item presented as percentages across all included studies
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
1.1
1.1. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 1: Reduction in fatigue severity at post‐treatment
1.2
1.2. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 2: Clinical response at post‐treatment
1.3
1.3. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 3: Improvement in overall physical functioning at post‐treatment
1.4
1.4. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 4: Reduction in depression symptoms at post ‐treatment
1.5
1.5. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 5: Reduction in anxiety symptoms at post ‐treatment
1.6
1.6. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 6: Reduction in psychological distress at post ‐treatment
1.7
1.7. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 7: Improvement in overall quality of life at post‐treatment
1.8
1.8. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 8: Dropout at post treatment
1.9
1.9. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 9: Reduction in fatigue severity at follow‐up (short/medium‐term)
1.10
1.10. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 10: Clinical response at follow‐up (short/medium‐term)
1.11
1.11. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 11: Improvement in overall physical functioning at follow‐up (short/medium‐term)
1.12
1.12. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 12: Reduction in depression symptoms at follow‐up (short/medium‐term)
1.13
1.13. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 13: Reduction in anxiety symptoms at follow‐up (short/medium‐term)
1.14
1.14. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 14: Reduction in psychological distress at follow‐up (short/medium‐term)
1.15
1.15. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 15: Improvement in overall quality of life at follow‐up (short/medium term)
1.16
1.16. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 16: Dropout at follow‐up (short/medium‐term)
1.17
1.17. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 17: Employment status: days of registered absenteeism over 12 months
1.18
1.18. Analysis
Comparison 1: Cognitive behaviour therapy versus usual care, Outcome 18: Employment status: Improvement over 12 months
2.1
2.1. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 1: Reduction in fatigue severity at post‐treatment
2.2
2.2. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 2: Clinical response at post‐treatment
2.3
2.3. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 3: Improvement in overall physical functioning at post‐treatment
2.4
2.4. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 4: Reduction in depression symptoms at post‐treatment
2.5
2.5. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 5: Reduction in anxiety symptoms at post‐treatment
2.6
2.6. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 6: Reduction in psychological distress at post‐treatment
2.7
2.7. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 7: Improvement in overall quality of life at post‐treatment
2.8
2.8. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 8: Dropout at post treatment
2.9
2.9. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 9: Reduction in fatigue severity at follow‐up (short‐term)
2.10
2.10. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 10: Clinical response at follow‐up (short/medium‐term)
2.11
2.11. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 11: Improvement in overall physical functioning at follow‐up (short‐term)
2.12
2.12. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 12: Reduction in depression symptoms at follow‐up (short‐term)
2.13
2.13. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 13: Reduction in anxiety symptoms at follow‐up (short‐term)
2.14
2.14. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 14: Reduction in psychological distress at follow‐up (short‐term)
2.15
2.15. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 15: Improvement in overall quality of life at follow‐up (short‐term)
2.16
2.16. Analysis
Comparison 2: Cognitive behaviour therapy versus other psychological therapies, Outcome 16: Dropout during follow‐up (short‐term)
3.1
3.1. Analysis
Comparison 3: Cognitive behaviour therapy versus exercise, Outcome 1: Reduction in fatigue severity at post treatment
3.2
3.2. Analysis
Comparison 3: Cognitive behaviour therapy versus exercise, Outcome 2: Clinical response at post treatment
3.3
3.3. Analysis
Comparison 3: Cognitive behaviour therapy versus exercise, Outcome 3: Clinical response at follow‐up (medium‐term)
4.1
4.1. Analysis
Comparison 4: Cognitive behaviour therapy combined with other interventions versus usual care, Outcome 1: Reduction in fatigue severity at post treatment
4.2
4.2. Analysis
Comparison 4: Cognitive behaviour therapy combined with other interventions versus usual care, Outcome 2: Improvement in overall physical functioning at post treatment
4.3
4.3. Analysis
Comparison 4: Cognitive behaviour therapy combined with other interventions versus usual care, Outcome 3: Dropout at post treatment
5.1
5.1. Analysis
Comparison 5: Subgroup analyses (Comparison 1), Outcome 1: Individual versus group therapy: reduction in fatigue at post treatment
5.2
5.2. Analysis
Comparison 5: Subgroup analyses (Comparison 1), Outcome 2: Usual care versus waiting list: reduction in fatigue at post treatment
5.3
5.3. Analysis
Comparison 5: Subgroup analyses (Comparison 1), Outcome 3: Increased activity versus activity and rest/not specified: reduction in fatigue at post treatment
5.4
5.4. Analysis
Comparison 5: Subgroup analyses (Comparison 1), Outcome 4: 8 or fewer sessions versus more than 8 sessions: reduction in fatigue at post treatment
See this image and copyright information in PMC

Update of

Comment in

References

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