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 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.

THE TREATMENT OF WHEELCHAIR-BOUND CHRONIC FATIGUE SYNDROME PATIENTS: TWO CASE STUDIES OF A PRAGMATIC REHABILITATION APPROACH

1999 ◽  
Vol 27 (3) ◽  
pp. 249-260 ◽  
Author(s):  
Pauline Powell ◽  
Richard H. T. Edwards ◽  
Richard P. Bentall
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Case Studies ◽  
Chronic Fatigue ◽  
Behaviour Therapy ◽  
Face To Face ◽  
Fatigue Syndrome ◽  
End Of Treatment ◽  
Cognitive Behaviour ◽  
Ambulatory Patients ◽  
Clinically Significant

Chronic fatigue syndrome is a disabling condition characterized by persistent mental and physical fatigue. Its aetiology is controversial, and it has been attributed to both physical and psychological causes. Previous controlled trials with ambulatory patients have shown that a proportion of CFS patients respond to cognitive-behaviour therapy. In this paper, we report two case studies of patients who are wheelchair-bound, who have been treated by a pragmatic intervention designed to increase activity and challenge dysfunctional illness beliefs. The patients received 60 and 55 contacts with the therapist, some of which were face-to-face and some of which were by telephone. At the end of treatment, the patients experienced clinically significant reductions in fatigue, were not using wheelchairs, showed an increase in occupational and social functioning and were leading relatively independent existences.

Long-term follow-up after cognitive behaviour therapy for chronic fatigue syndrome

2017 ◽  
Vol 97 ◽  
pp. 45-51 ◽  
Author(s):  
Anthonie Janse ◽  
Stephanie Nikolaus ◽  
Jan F. Wiborg ◽  
Marianne Heins ◽  
Jos W.M. van der Meer ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cognitive Behaviour Therapy ◽  
Chronic Fatigue ◽  
Behaviour Therapy ◽  
Fatigue Syndrome ◽  
Cognitive Behaviour ◽  
Long Term Follow Up

Chronic Fatigue Syndrome: An Evaluation of an Occupational Therapy Inpatient Intervention

2002 ◽  
Vol 65 (10) ◽  
pp. 461-468 ◽  
Author(s):  
Diane L Cox
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Occupational Therapy ◽  
Cognitive Behaviour Therapy ◽  
Comparison Group ◽  
Chronic Fatigue ◽  
Behaviour Therapy ◽  
Fatigue Syndrome ◽  
Cognitive Behaviour ◽  
Significant Difference ◽  
Inpatient Group

It has been stated that, although most chronic fatigue syndrome (CFS) patients can be treated in primary care and that cognitive behaviour therapy and prescribed, graded aerobic exercise appear to be promising in outpatient management, a minority of patients will require inpatient care (Royal Colleges of Physicians, General Practitioners and Psychiatrists 1996). To date, little has been written on the need for and impact of an inpatient approach for patients with CFS. This study builds on previous work to show how patients with complex CFS responded to a specifically designed occupational therapy inpatient programme, using the principles of cognitive behaviour therapy and graded activity. A quasi-experimental study was carried out using current inpatients with those on the waiting list as a comparison. At 6 months following discharge, a significant difference between the groups in terms of symptoms and level of ability was not demonstrated. However, a significant effect was shown in patients' perceived health, length of time tired and management of the illness. Thirty-one (72%) of the inpatient group, compared with 10 (53%) of the comparison group, stated that they felt better than the previous year. Thirty-one (72%) of the inpatient group, compared with 7 (37%) of the comparison group, indicated better management of their illness. These findings give some evidence of the need for an inpatient CFS management programme for specific patients with complex CFS.

scholarly journals Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial

BMJ ◽  
2004 ◽  
Vol 330 (7481) ◽  
pp. 14 ◽  
Author(s):  
Maja Stulemeijer ◽  
Lieke W A M de Jong ◽  
Theo J W Fiselier ◽  
Sigrid W B Hoogveld ◽  
Gijs Bleijenberg
Keyword(s):  
Randomised Controlled Trial ◽  
Chronic Fatigue Syndrome ◽  
Cognitive Behaviour Therapy ◽  
Controlled Trial ◽  
Chronic Fatigue ◽  
Behaviour Therapy ◽  
Fatigue Syndrome ◽  
Cognitive Behaviour ◽  
Randomised Controlled
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