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 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 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 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.

Cognitive Behaviour Therapy for Chronic Fatigue Syndrome in Adults: Face to Face versus Telephone Treatment - A Randomized Controlled Trial

2011 ◽  
Vol 40 (2) ◽  
pp. 175-191 ◽  
Author(s):  
Mary Burgess ◽  
Manoharan Andiappan ◽  
Trudie Chalder
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Effective Treatment ◽  
Physical Functioning ◽  
Cognitive Behaviour Therapy ◽  
Controlled Trial ◽  
Chronic Fatigue ◽  
Behaviour Therapy ◽  
Face To Face ◽  
Fatigue Syndrome ◽  
Cognitive Behaviour

Background: Previous research has shown that face to face cognitive behaviour therapy (CBT) is an effective treatment for chronic fatigue syndrome (CFS)/Myalgic Encephalomyelitis (ME). However, some patients are unable to travel to the hospital for a number of reasons. Aims: The aim of this study was to assess whether face to face CBT was more effective than telephone CBT (with face to face assessment and discharge appointment) for patients with CFS. Method: Patients aged 18–65 were recruited from consecutive referrals to the Chronic Fatigue Syndrome (CFS) Research and Treatment Unit at The South London and Maudsley NHS Trust in London. Participants were randomly allocated to either face to face CBT or telephone CBT by a departmental administrator. Blinding of participants and care givers was inappropriate for this trial. A parallel-groups randomised controlled trial was used to compare the two treatments. The primary outcomes were physical functioning and fatigue. Results: Significant improvements in the primary outcomes of physical functioning and fatigue occurred and were maintained to one year follow-up after discharge from treatment. Improvements in social adjustment and global outcome were noted and patient satisfaction was similar in both groups. Conclusions: Results from this study indicate that telephone CBT with two face to face appointments is a mild to moderately effective treatment for CFS and may be offered to patients where face to face treatment is not a viable option. Despite these encouraging conclusions, dropout was relatively high and therapists should be aware of this potential problem.

Interpersonal Psychotherapy for the Treatment of Eating Disorders

2010 ◽  
pp. 347-372 ◽  
Author(s):  
Marian Tanofsky-Kraff ◽  
Denise E. Wilfley
Keyword(s):  
Anorexia Nervosa ◽  
Clinical Care ◽  
Interpersonal Psychotherapy ◽  
Future Research ◽  
Cognitive Behavior ◽  
Research Directions ◽  
Routine Clinical Care ◽  
Interpersonal Factors ◽  
Future Research Directions

Interpersonal psychotherapy (IPT) is a focused, time-limited treatment that targets interpersonal problem(s) associated with the onset and/or maintenance of EDs. IPT is supported by substantial empirical evidence documenting the role of interpersonal factors in the onset and maintenance of EDs. IPT is a viable alternative to cognitive behavior therapy for the treatment of bulimia nervosa and binge eating disorder. The effectiveness of IPT for the treatment of anorexia nervosa requires further investigation. The utility of IPT for the prevention of obesity is currently being explored. Future research directions include enhancing the delivery of IPT for EDs, increasing the availability of IPT in routine clinical care settings, exploring IPT adolescent and parent–child adaptations, and developing IPT for the prevention of eating and weight-related problems that may promote full-syndrome EDs or obesity.

scholarly journals Investigating the effectiveness and cost-effectiveness of FITNET-NHS (Fatigue In Teenagers on the interNET in the NHS) compared to activity management to treat paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME): amendment to the published protocol

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Emma Anderson ◽  
Daisy Gaunt ◽  
Chris Metcalfe ◽  
Manmita Rai ◽  
William Hollingworth ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cost Effective ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
The Internet ◽  
Trial Protocol ◽  
Fatigue Syndrome ◽  
Therapy Program ◽  
Cognitive Behavioural ◽  
Activity Management

Abstract The FITNET-NHS Trial is a UK, national, trial investigating whether an online cognitive behavioural therapy program (FITNET-NHS) for treating chronic fatigue syndrome/ME in adolescents is clinically effective and cost-effective in the NHS. At the time of writing (September 2019), the trial was recruiting participants. This article presents an update to the planned sample size and data collection duration previously published within the trial protocol. Trial registration ISRCTN, ID: 18020851. Registered 8 April 2016.

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