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.

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 Internet-based Cognitive Behaviour Therapy (I-CBT) for chronic fatigue syndrome integrated in routine clinical care: an implementation study. (Preprint)

2019 ◽  
Author(s):  
Margreet Worm-Smeitink ◽  
Arno van Dam ◽  
Saskia van Es ◽  
Roos van der Vaart ◽  
Andrea Evers ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Clinical Care ◽  
Chronic Fatigue ◽  
Stepped Care ◽  
Behaviour Therapy ◽  
Routine Clinical Care ◽  
Median Reduction ◽  
Fatigue Syndrome ◽  
Cognitive Behaviour ◽  
Fatigue Severity

BACKGROUND In a clinical trial, web-based cognitive behaviour therapy (I-CBT) embedded in stepped care was found to be non-inferior to face-to-face (f2f) CBT for chronic fatigue syndrome. However, results of clinical trials are not necessarily retained after implementation. OBJECTIVE Our aim was to investigate whether stepped care starting with I-CBT, followed by f2f CBT is also effective in routine clinical care. Second aim was to explore the role of therapist attitudes towards e-health and manualised treatment on reduction of fatigue severity. METHODS I-CBT was implemented in five mental health care centres (MHCs) with nine treatment sites throughout the Netherlands. All patients with chronic fatigue syndrome were offered I-CBT, followed by f2f CBT if still severely fatigued or disabled after I-CBT. Outcomes were fatigue severity (Checklist Individual Strength), physical and social functioning (SF-36) and limitations in daily functioning (Work and social adjustment scale). The change scores were compared to a benchmark, derived from an RCT testing this treatment format. We calculated correlations of therapists' attitudes towards manualised treatment and e-health with reduction of fatigue severity. RESULTS In total, 100 CFS patients were referred to the centres. Of them, 79 started with I-CBT, 20 commenced directly with f2f CBT and one did not start at all. After I-CBT, 11 stepped up to f2f CBT. Increase in physical functioning (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 was smaller in the MHCs (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). Therapists were divided into two groups, one with the largest median reduction of fatigue and one with the smallest median reduction. Patients treated by first group had a significantly larger reduction of fatigue severity (15.7 versus 9.0, T=2.42 (P=.02)). There were no (statistically significant) correlations between therapists’ attitudes and reduction of fatigue severity. 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 after the treatment form, there are indications that the reduction of fatigue severity is lower than in the clinical trial. Further development of the treatment should aim at avoiding drop-out and at encouraging stepping up after I-CBT with limited results. Median reduction of fatigue severity varied largely between therapists. An investigation with more patients per therapist is needed to draw conclusions on the role of therapists' attitudes in treatment outcome.

scholarly journals Effectiveness of Internet-Based Cognitive Behavior Therapy (Fatigue in Teenagers on the Internet) for Adolescents With Chronic Fatigue Syndrome in Routine Clinical Care: Observational Study (Preprint)

2020 ◽  
Author(s):  
Eline Albers ◽  
Linde N Nijhof ◽  
Emma E Berkelbach van der Sprenkel ◽  
Elise M van de Putte ◽  
Sanne L Nijhof ◽  
...  
Keyword(s):  
Physical Functioning ◽  
School Attendance ◽  
Clinical Care ◽  
Chronic Fatigue ◽  
The Internet ◽  
Cognitive Behavior ◽  
Face To Face ◽  
Routine Clinical Care ◽  
Fatigue Syndrome ◽  
Fatigue Severity

BACKGROUND Internet-based cognitive behavior therapy (I-CBT) for adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has been shown to be effective in a randomized controlled trial (RCT; Fatigue in Teenagers on the Internet [FITNET]). FITNET can cause a significant reduction in fatigue and disability. OBJECTIVE We aimed to investigate whether FITNET treatment implemented in routine clinical care (IMP-FITNET) was as effective, using the outcomes of the FITNET RCT as the benchmark. METHODS Outcomes of CFS/ME adolescents who started IMP-FITNET between October 2012 and March 2018 as part of routine clinical care were compared to the outcomes in the FITNET RCT. The primary outcome was fatigue severity assessed posttreatment. The secondary outcomes were self-reported physical functioning, school attendance, and recovery rates. Clinically relevant deterioration was assessed posttreatment, and for this outcome, a face-to-face CBT trial was used as the benchmark. The attitude of therapists toward the usability of IMP-FITNET was assessed through semistructured interviews. The number of face-to-face consultations during IMP-FITNET was registered. RESULTS Of the 384 referred adolescents with CFS/ME, 244 (63.5%) started IMP-FITNET, 84 (21.9%) started face-to-face CBT, and 56 (14.6%) were not eligible for CBT. Posttreatment scores for fatigue severity (mean 26.0, SD 13.8), physical functioning (mean 88.2, SD 15.0), and full school attendance (mean 84.3, SD 26.5) fell within the 95% CIs of the FITNET RCT. Deterioration of fatigue and physical functioning after IMP-FITNET was observed at rates of 1.2% (n=3) and 4.1% (n=10), respectively, which is comparable to a waiting list condition (fatigue: 1.2% vs 5.7%, χ<sup>2</sup><sub>1</sub>=3.5, <i>P</i>=.06; physical functioning: 4.1% vs 11.4%, χ<sup>2</sup><sub>1</sub>=3.3, <i>P</i>=.07). Moreover, 41 (16.8%) IMP-FITNET patients made use of face-to-face consultations. CONCLUSIONS IMP-FITNET is an effective and safe treatment for adolescents with CFS/ME in routine clinical care.

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 Effectiveness of Internet-Based Cognitive Behavior Therapy (Fatigue in Teenagers on the Internet) for Adolescents With Chronic Fatigue Syndrome in Routine Clinical Care: Observational Study

10.2196/24839 ◽  
2021 ◽  
Vol 23 (8) ◽  
pp. e24839
Author(s):  
Eline Albers ◽  
Linde N Nijhof ◽  
Emma E Berkelbach van der Sprenkel ◽  
Elise M van de Putte ◽  
Sanne L Nijhof ◽  
...  
Keyword(s):  
Physical Functioning ◽  
School Attendance ◽  
Clinical Care ◽  
Chronic Fatigue ◽  
The Internet ◽  
Cognitive Behavior ◽  
Face To Face ◽  
Routine Clinical Care ◽  
Fatigue Syndrome ◽  
Fatigue Severity

Background Internet-based cognitive behavior therapy (I-CBT) for adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has been shown to be effective in a randomized controlled trial (RCT; Fatigue in Teenagers on the Internet [FITNET]). FITNET can cause a significant reduction in fatigue and disability. Objective We aimed to investigate whether FITNET treatment implemented in routine clinical care (IMP-FITNET) was as effective, using the outcomes of the FITNET RCT as the benchmark. Methods Outcomes of CFS/ME adolescents who started IMP-FITNET between October 2012 and March 2018 as part of routine clinical care were compared to the outcomes in the FITNET RCT. The primary outcome was fatigue severity assessed posttreatment. The secondary outcomes were self-reported physical functioning, school attendance, and recovery rates. Clinically relevant deterioration was assessed posttreatment, and for this outcome, a face-to-face CBT trial was used as the benchmark. The attitude of therapists toward the usability of IMP-FITNET was assessed through semistructured interviews. The number of face-to-face consultations during IMP-FITNET was registered. Results Of the 384 referred adolescents with CFS/ME, 244 (63.5%) started IMP-FITNET, 84 (21.9%) started face-to-face CBT, and 56 (14.6%) were not eligible for CBT. Posttreatment scores for fatigue severity (mean 26.0, SD 13.8), physical functioning (mean 88.2, SD 15.0), and full school attendance (mean 84.3, SD 26.5) fell within the 95% CIs of the FITNET RCT. Deterioration of fatigue and physical functioning after IMP-FITNET was observed at rates of 1.2% (n=3) and 4.1% (n=10), respectively, which is comparable to a waiting list condition (fatigue: 1.2% vs 5.7%, χ21=3.5, P=.06; physical functioning: 4.1% vs 11.4%, χ21=3.3, P=.07). Moreover, 41 (16.8%) IMP-FITNET patients made use of face-to-face consultations. Conclusions IMP-FITNET is an effective and safe treatment for adolescents with CFS/ME in routine clinical care.

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.

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