scholarly journals Internet-Based Cognitive Behavioral Therapy in Stepped Care for Chronic Fatigue Syndrome: Randomized Noninferiority Trial

10.2196/11276 ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. e11276 ◽  
Author(s):  
Margreet Worm-Smeitink ◽  
Anthonie Janse ◽  
Arno van Dam ◽  
Andrea Evers ◽  
Rosalie van der Vaart ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Chronic Fatigue ◽  
Stepped Care ◽  
Cognitive Behavioral ◽  
Fatigue Syndrome ◽  
Noninferiority Trial

scholarly journals Internet-Based Cognitive Behavioral Therapy in Stepped Care for Chronic Fatigue Syndrome: Randomized Noninferiority Trial (Preprint)

2018 ◽  
Author(s):  
Margreet Worm-Smeitink ◽  
Anthonie Janse ◽  
Arno van Dam ◽  
Andrea Evers ◽  
Rosalie van der Vaart ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Chronic Fatigue ◽  
Stepped Care ◽  
Cognitive Behavioral ◽  
Fatigue Syndrome ◽  
Fatigue Severity ◽  
Secondary Outcomes ◽  
The Difference

BACKGROUND Internet-based cognitive behavioral therapy (I-CBT) leads to a reduction of fatigue severity and disability in adults with chronic fatigue syndrome (CFS). However, not all patients profit and it remains unclear how I-CBT is best embedded in the care of CFS patients. OBJECTIVE This study aimed to compare the efficacy of stepped care, using therapist-assisted I-CBT, followed by face-to-face (f2f) cognitive behavioral therapy (CBT) when needed, with f2f CBT (treatment as usual [TAU]) on fatigue severity. The secondary aim was to investigate treatment efficiency. METHODS A total of 363 CFS patients were randomized to 1 of the 3 treatment arms (n=121). There were 2 stepped care conditions that differed in the therapists’ feedback during I-CBT: prescheduled or on-demand. When still severely fatigued or disabled after I-CBT, the patients were offered f2f CBT. Noninferiority of both stepped care conditions to TAU was tested using analysis of covariance. The primary outcome was fatigue severity (Checklist Individual Strength). Disabilities (Sickness Impact Profile -8), physical functioning (Medical Outcomes Survey Short Form-36), psychological distress (Symptom Checklist-90), and proportion of patients with clinically significant improvement in fatigue were the secondary outcomes. The amount of invested therapist time was compared between stepped care and TAU. Exploratory comparisons were made between the stepped care conditions of invested therapist time and proportion of patients who continued with f2f CBT. RESULTS Noninferiority was indicated, as the upper boundary of the one-sided 98.75% CI of the difference in the change in fatigue severity between both forms of stepped care and TAU were below the noninferiority margin of 5.2 (4.25 and 3.81, respectively). The between-group differences on the secondary outcomes were also not significant (P=.11 to P=.79). Both stepped care formats required less therapist time than TAU (median 8 hours, 9 minutes and 7 hours, 25 minutes in stepped care vs 12 hours in TAU; P<.001). The difference in therapist time between both stepped care formats was not significant. Approximately half of the patients meeting step-up criteria for f2f CBT after I-CBT did not continue. CONCLUSIONS Stepped care, including I-CBT followed by f2f CBT when indicated, is noninferior to TAU of f2f CBT and requires less therapist time. I-CBT for CFS can be used as a first step in stepped care. CLINICALTRIAL Nederlands Trial Register NTR4809; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4809 (Archived by WebCite at http://www.webcitation.org/74SWkw1V5)

scholarly journals Cognitive Behavioral Therapy and Fasting Therapy for a Patient with Chronic Fatigue Syndrome.

2001 ◽  
Vol 40 (11) ◽  
pp. 1158-1161 ◽  
Author(s):  
Akinori MASUDA ◽  
Takashi NAKAYAMA ◽  
Takao YAMANAKA ◽  
Kenji HATSUTANMARU ◽  
Chuwa TEI
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Chronic Fatigue ◽  
Cognitive Behavioral ◽  
Fatigue Syndrome

A Controlled Trial of Immunologic and Cognitive-Behavioral Therapy for Patients with Chronic Fatigue Syndrome

1994 ◽  
Vol 18 (Supplement_1) ◽  
pp. S112-S112
Author(s):  
Andrew R. Lloyd ◽  
Ian Hickle ◽  
Alan Brockman ◽  
Catherine Hickie ◽  
Andrew Wilson ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Chronic Fatigue ◽  
Cognitive Behavioral ◽  
Fatigue Syndrome

scholarly journals Pain in Patients with Chronic Fatigue Syndrome: Time for Specific Pain Treatment?

2012 ◽  
Vol 5;15 (5;9) ◽  
pp. E677-E686
Author(s):  
Jo Nijs
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cognitive Behavioral Therapy ◽  
Central Sensitization ◽  
Pain Treatment ◽  
Pain Catastrophizing ◽  
Behavioral Therapy ◽  
Chronic Fatigue ◽  
Cognitive Behavioral ◽  
Fatigue Syndrome ◽  
Endogenous Analgesia

Background: Besides chronic fatigue, patients with chronic fatigue syndrome (CFS) have debilitating widespread pain. Yet pain from CFS is often ignored by clinicians and researchers. Objectives: To examine whether pain is a unique feature of CFS, or does it share the same underlying mechanisms as other CFS symptoms? Second, it is examined whether effective treatments for pain from CFS are currently available. Study Design: Narrative review covering the scientific literature up through December 2011. Setting: Several universities. Results: From the available literature, it is concluded that musculoskeletal factors are unlikely to account for pain from CFS. Pain seems to be one out of many symptoms related to central sensitization from CFS. This idea is supported by the findings of generalized hyperalgesia (including widespread increased responsiveness to painful stimuli) and dysfunctional endogenous analgesia in response to noxious thermal stimuli. Pain catastrophizing and depression partly account for pain from CFS. Pain increases during exercise is probably due to the lack of endogenous analgesia and activation of several genes in response to exercise in CFS. There is currently no evidence in support for the efficacy of complementary medicine in the treatment of pain from CFS. Intensive education about the biology of pain from CFS (within the framework of central sensitization) has positive short-term effects for patients with CFS, and fatigue-targeting cognitive behavioral therapy appears to be effective for pain from CFS as well. Limitations: The role of the deficient hypothalamus-pituitary-adrenal axis in relation to pain from CFS, as well as the interactions with immune (dys)functioning require further study. Conclusion: Recent research has increased our understanding of pain from CFS, including its treatment. It is advocated to optimize current CFS treatment protocols by targeting the underlying mechanism for those patients having severe pain. Key words: Chronic pain, chronic fatigue syndrome, fibromyalgia, central sensitization, catastrophizing, exercise, cognitive behavioral therapy.

scholarly journals Internet-Based Cognitive Behavioral Therapy for Chronic Fatigue Syndrome Integrated in Routine Clinical Care: Implementation Study

10.2196/14037 ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. e14037 ◽  
Author(s):  
Margreet Worm-Smeitink ◽  
Arno van Dam ◽  
Saskia van Es ◽  
Rosalie van der Vaart ◽  
Andrea Evers ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Clinical Care ◽  
Chronic Fatigue ◽  
Stepped Care ◽  
Cognitive Behavioral ◽  
Face To Face ◽  
Routine Clinical Care ◽  
Fatigue Syndrome ◽  
Fatigue Severity

Background In a clinical trial, internet-based cognitive behavioral therapy (I-CBT) embedded in stepped care was established as noninferior to face-to-face cognitive behavioral therapy (CBT) for chronic fatigue syndrome (CFS). However, treatment effects observed in clinical trials may not necessarily be retained after implementation. Objective This study aimed to investigate whether stepped care for CFS starting with I-CBT, followed by face-to-face CBT, if needed, was also effective in routine clinical care. Another objective was to explore the role of therapists’ attitudes toward electronic health (eHealth) and manualized treatment on treatment outcome. Methods I-CBT was implemented in five mental health care centers (MHCs) with nine treatment sites throughout the Netherlands. All patients with CFS were offered I-CBT, followed by face-to-face CBT if still severely fatigued or disabled after I-CBT. Outcomes were the Checklist Individual Strength, physical and social functioning (Short-Form 36), and limitations in daily functioning according to the Work and Social Adjustment Scale. The change scores (pre to post stepped care) were compared with a benchmark: stepped care from a randomized controlled trial (RCT) testing this treatment format. We calculated correlations of therapists’ attitudes toward manualized treatment and eHealth with reduction of fatigue severity. Results Overall, 100 CFS patients were referred to the centers. Of them, 79 started with I-CBT, 20 commenced directly with face-to-face CBT, and one did not start at all. After I-CBT, 48 patients met step-up criteria; of them, 11 stepped up to face-to-face CBT. Increase in physical functioning (score of 13.4), social functioning (20.4), and reduction of limitations (10.3) after stepped care delivered in routine clinical care fell within the benchmarks of the RCT (95% CIs: 12.8-17.6; 25.2-7.8; and 7.4-9.8, respectively). Reduction of fatigue severity in the MHCs was smaller (12.6) than in the RCT (95% CI 13.2-16.5). After I-CBT only, reduction of fatigue severity (13.2) fell within the benchmark of I-CBT alone (95% CI 11.1-14.2). Twenty therapists treated between one and 18 patients. Therapists were divided into two groups: one with the largest median reduction of fatigue and one with the smallest. Patients treated by the first group had a significantly larger reduction of fatigue severity (15.7 vs 9.0; t=2.42; P=.02). There were no (statistically significant) correlations between therapists’ attitudes and reduction in fatigue. Conclusions This study is one of the first to evaluate stepped care with I-CBT as a first step in routine clinical care. Although fatigue severity and disabilities were reduced, reduction of fatigue severity appeared smaller than in the clinical trial. Further development of the treatment should aim at avoiding dropout and encouraging stepping up after I-CBT with limited results. Median reduction of fatigue severity varied largely between therapists. Further research will help understand the role of therapists’ attitudes in treatment outcome.

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