Tag: CBT

Effect of psychiatric disorders on outcome of cognitive-behavioural therapy for chronic fatigue syndrome

Abstract:

Psychiatric disorders have been associated with poor outcome in individuals with chronic fatigue syndrome (CFS). This study examines the impact of psychiatric disorders on outcome of cognitive-behavioural therapy (CBT). Psychiatric diagnoses were assessed with a structured psychiatric interview in a CBT trial of 270 people with CFS. Lifetime and current psychiatric disorders were found in 50 and 32% respectively. No significant differences in fatigue severity and functional impairment following treatment were found between participants with and without psychiatric diagnoses.

 

Source: Prins J, Bleijenberg G, Rouweler EK, van der Meer J. Effect of psychiatric disorders on outcome of cognitive-behavioural therapy for chronic fatigue syndrome. Br J Psychiatry. 2005 Aug;187:184-5. http://bjp.rcpsych.org/content/187/2/184.long (Full article)

 

Cognitive behaviour group therapy for chronic fatigue syndrome: a non-randomised waiting list controlled study

Abstract:

BACKGROUND: It has been demonstrated that individual cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome(CFS). The aim of the present study was to investigate the effectiveness of cognitive behaviour group therapy (CBGT) in an unselected group of CFS patients. Additionally, pretreatment characteristics of CFS patients who improve after CBGT were explored.

METHODS: In a non-randomised waiting list controlled design, 31 patients were allocated to CBGT and 36 to the waiting list condition. CBGT consisted of 12 two-hour sessions during 6 months. Main outcome measures were fatigue (Checklist Individual Strength) and functional impairment (Sickness Impact Profile).

RESULTS: A moderate effect on fatigue in favour of CBGT was found. For functional impairment, the effect was opposite to what was expected. Patients who improved after CBGT had less complaints at baseline compared to patients who did not improve.

CONCLUSIONS: An explanation for the moderate effect might be that during CBGT, rest and relaxation were too much emphasised. Furthermore, an unselected group of CFS patients and therapists inexperienced in CB(G)T for CFS participated. Suggestions to improve CBGT for future research are given.

Copyright (c) 2005 S. Karger AG, Basel.

Comment in: What is the aim of cognitive behaviour therapy in patients with chronic fatigue syndrome? [Psychother Psychosom. 2006]

 

Source: Bazelmans E, Prins JB, Lulofs R, van der Meer JW, Bleijenberg G; Netherlands Fatigue Research Group Nijmegen. Cognitive behaviour group therapy for chronic fatigue syndrome: a non-randomised waiting list controlled study. Psychother Psychosom. 2005;74(4):218-24. http://www.ncbi.nlm.nih.gov/pubmed/15947511

 

Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: data are insufficient and conclusion inappropriate

Comment on: Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial. [BMJ. 2005]

 

Editor—I have concerns about the design and interpretation of the study reported by Stulemeijer et al on cognitive behaviour therapy for adolescents with chronic fatigue syndrome.1 The trial arms were not matched for the number of contacts with healthcare professionals. Experience from larger and more carefully controlled randomised interventional trials of patients with chronic fatigue syndrome has clearly shown that short term improvement in symptoms is related directly to the maintenance of regular contacts with healthcare professionals rather than the therapeutic effect of the intervention itself and consequently, the improvement is not sustained once the contact is lost.2

The authors did not offer patients in their waiting list the opportunity to meet therapists regularly for five months but without having cognitive behaviour therapy. Few follow up data on patients in the intervention arm show that the specific treatment benefit was carried forward without regular contacts with the therapists. A cautious approach is essential in inferring direct benefit from cognitive behaviour therapy in the intervention arm (as opposed to short term benefit from close contact with therapists). The level of activity in some of their participants whom the authors considered to be passive remained unclear.

You can read the rest of this comment here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC555921/

 

Source: Chaudhuri A. Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: data are insufficient and conclusion inappropriate. BMJ. 2005 Apr 2;330(7494):789-90; author reply 790. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC555921/ (Full article)

 

Predictors of outcome following treatment for chronic fatigue

Abstract:

We explored the role of baseline characteristics of 105 patients who presented with fatigue in primary care in determining outcome following either graded exercise or cognitive-behavioural therapy. Meeting the criteria for chronic fatigue syndrome was the most powerful predictor of poor outcome and this negative effect was enhanced by greater functional impairment or greater perceived negative consequences, but was not further enhanced by both.

 

Source: Darbishire L, Seed P, Ridsdale L. Predictors of outcome following treatment for chronic fatigue. Br J Psychiatry. 2005 Apr;186:350-1. http://bjp.rcpsych.org/content/186/4/350.long (Full article)

 

Treatments for chronic fatigue syndrome

Abstract:

AIMS: To review studies evaluating the treatment of chronic fatigue and chronic fatigue syndrome, to describe predictors of response to treatment and to discuss the role of the occupational health physician.

METHODS: A literature search was carried out using Medline and PsychInfo.

RESULTS: Studies evaluating cognitive behaviour therapy, graded exercise therapy, pharmacological interventions (e.g. antidepressants and corticosteroids), immunological interventions and nutritional supplements were reviewed. The most promising results have been found with cognitive behaviour therapy and graded exercise therapy, and some predictors of outcome have been identified. Most of the other interventions were evaluated in just one or two studies and therefore evidence is insufficient to draw firm conclusions.

CONCLUSIONS: By applying the models of fatigue that form the bases for cognitive behaviour therapy and graded exercise therapy, occupational health physicians may play an important role in helping the patients with chronic fatigue syndrome to reduce their symptoms, improve their functioning and return to work.

 

Source: Rimes KA, Chalder T. Treatments for chronic fatigue syndrome. Occup Med (Lond). 2005 Jan;55(1):32-9. http://occmed.oxfordjournals.org/content/55/1/32.long (Full article)

 

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

Erratum in: BMJ. 2005 Apr 9;330(7495):820.

 

Abstract:

OBJECTIVE: To evaluate the efficacy of cognitive behaviour therapy for adolescents aged 10-17 years with chronic fatigue syndrome.

DESIGN: Randomised controlled trial.

SETTING: Department of child psychology.

PARTICIPANTS: 71 consecutively referred patients with chronic fatigue syndrome; 36 were randomly assigned to immediate cognitive behaviour therapy and 35 to the waiting list for therapy.

INTERVENTION: 10 sessions of therapy over five months. Treatment protocols depended on the type of activity pattern (relatively active or passive). All participants were assessed again after five months.

MAIN OUTCOME MEASURES: Fatigue severity (checklist individual strength), functional impairment (SF-36 physical functioning), and school attendance.

RESULTS: 62 patients had complete data at five months (29 in the immediate therapy group and 33 on the waiting list). Patients in the therapy group reported significantly greater decrease in fatigue severity (difference in decrease on checklist individual strength was 14.5, 95% confidence interval 7.4 to 21.6) and functional impairment (difference in increase on SF-36 physical functioning was 17.3, 6.2 to 28.4) and their attendance at school increased significantly (difference in increase in percentage school attendance was 18.2, 0.8 to 35.5). They also reported a significant reduction in several accompanying symptoms. Self reported improvement was largest in the therapy group.

CONCLUSION: Cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome in adolescents.

Comment in: Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: data are insufficient and conclusion inappropriate. [BMJ. 2005]

 

Source: Stulemeijer M, de Jong LW, Fiselier TJ, Hoogveld SW, Bleijenberg G. Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial. BMJ. 2005 Jan 1;330(7481):14. Epub 2004 Dec 7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539840/ (Full article)

 

Manual-based cognitive behaviour therapy for chronic fatigue syndrome: therapists’ adherence and perceptions

Abstract:

Several randomized controlled trials have indicated that cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome. In 1 of these studies 13 therapists applied cognitive behaviour therapy for chronic fatigue syndrome in 83 chronic fatigue syndrome patients.

In the present study therapists’ adherence and perceptions of the manual are studied. Following completion of the study the therapists were asked to complete a questionnaire. Audiotaped sessions were conducted to verify the therapists’ adherence. Analyses of the audiotapes showed that in 87% of the sessions this appeared to be the case.

The questionnaire revealed that the therapists found it more difficult to treat patients with chronic fatigue syndrome than to treat patients with psychological or other physical problems. Treatment aspects posing the most problems were integrating individual problems into the standardized treatment, dealing with the patients’ lack of confidence in the treatment and handling insufficient motivation.

 

Source: Bazelmans E, Prins JB, Hoogveld S, Bleijenberg G. Manual-based cognitive behaviour therapy for chronic fatigue syndrome: therapists’ adherence and perceptions. Cogn Behav Ther. 2004;33(3):143-50. http://www.ncbi.nlm.nih.gov/pubmed/15471384

 

Cost-effectiveness of cognitive behaviour therapy for patients with chronic fatigue syndrome

Comment on: Cost-effectiveness of cognitive behaviour therapy for patients with chronic fatigue syndrome. [QJM. 2004]

 

Sir,

I read Severens et al.’s article on the cost-effectiveness of cognitive behaviour therapy for patients with unexplained chronic fatigue1 with interest, although as several subjects met the CDC criteria for ‘idiopathic chronic fatigue’ rather than ‘chronic fatigue syndrome’,2,,3 I prefer to use the term ‘unexplained chronic fatigue’ as defined by Fukuda et al.3 to describe the patient sample under consideration.

To be able to regard the presented cost estimates as a valid reflection of the medical costs of patients with unexplained chronic fatigue, it is imperative to demonstrate that there are no differences between participants who are included in the analysis and participants who are excluded from the analysis.

According to the authors: ‘An extensive comparison between participants in the cost-effectiveness analyse (n = 171) and the remaining clinical study participants (n = 99) did not reveal any statistically significant differences regarding age, duration of CFS complaints, and scores for Sickness Impact Profile, Karnofsky score, physical activity, a self-efficacy scale, a causal attribution list, and functional impairment.’ (pp. 158–9).

Although details are lacking in the article, baseline data of the included and excluded participants are available from a publication of the Health Care Insurance Board of the Netherlands (College voor zorgverzekeringen).4 Comparing baseline variables of the two groups using two-tailed independent sample t-tests yields the results that are presented in Table 1. The table shows that physical activity (measured by a motion-sensing device called the actometer), self-efficacy, and psychological well-being (measured by the symptom checklist 90) are significantly different at the 0.05 level. The p values for physical activity (p = 0.0081) and self-efficacy (p = 0.0046) are particularly small.

You can read the rest of this comment here: http://qjmed.oxfordjournals.org/content/97/6/379.long

 

Source: Stouten B. Cost-effectiveness of cognitive behaviour therapy for patients with chronic fatigue syndrome. QJM. 2004 Jun;97(6):379-80. http://qjmed.oxfordjournals.org/content/97/6/379.long (Full article)

 

Cost-effectiveness of cognitive behaviour therapy for patients with chronic fatigue syndrome

Sir,

In their economic evaluations of treatments for chronic fatigue syndrome (CFS), Severens et al. compared the cost-effectiveness of cognitive behaviour therapy (CBT) with those of other interventions, and found that the percentage of CFS patients who improved with CBT performed for 8 months was 31% vs. 9% and 12% for other treatments. Considering that, in one study, 28% of CFS patients treated with low-dose hydrocortisone over just one month virtually recovered,  Severens et al. also should have compared the cost-effectiveness of CBT with that of low-dose hydrocortisone.

Treatment with low-dose hydrocortisone for CFS, besides being intuitively far less costly than CBT, is also better-founded clinically than any psychological therapy, because hydrocortisone corrects the hypocortisolism that characterizes at least some CFS patients. Given that ‘frank hypocortisolism’, rather surprisingly, was one of the exclusion criteria for enrolment in the trial of Cleare et al., the percentage of CFS patients who can be effectively treated with low-dose hydrocortisone in day-to-day health care is likely to be higher than the 28% found in that trial.

You can read the rest of this comment here: http://qjmed.oxfordjournals.org/content/97/6/378.long

Comment on: Cost-effectiveness of cognitive behaviour therapy for patients with chronic fatigue syndrome. [QJM. 2004]

 

Source: Baschetti R. Cost-effectiveness of cognitive behaviour therapy for patients with chronic fatigue syndrome. QJM. 2004 Jun;97(6):378-9. http://qjmed.oxfordjournals.org/content/97/6/378.long (Full article)

 

Efficacy of cognitive-behavioural therapy by general practitioners for unexplained fatigue among employees: Randomised controlled trial

Abstract:

BACKGROUND: Fatigue is a common complaint that may lead to long-term sick leave and work disability.

AIMS: To assess the efficacy of cognitive-behavioural therapy by general practitioners for unexplained, persistent fatigue among employees.

METHOD: A randomised controlled trial, using a pre-randomisation design in primary care, investigated 151 employees on sick leave with fatigue. Participants in the experimental group were offered five to seven 30 min sessions of cognitive-behavioural therapy by a general practitioner; those in the control group were offered no treatment. Main outcome measures (fatigue severity, self-reported absenteeism, registered absenteeism and clinical recovery) were assessed at 4 months, 8 months and 12 months.

RESULTS: At baseline, 44% of the patients already met research criteria for chronic fatigue syndrome. There was no significant difference between the experimental group and the control group on primary or secondary outcomes at any point.

CONCLUSIONS: Cognitive-behavioural therapy by general practitioners for unexplained, persistent fatigue did not prove to be an effective intervention. Since these doctors were unable to deliver this therapy effectively under ideal circumstances, it is unlikely that doctors in routine practice would be more successful in doing so.

 

Source: Huibers MJ, Beurskens AJ, Van Schayck CP, Bazelmans E, Metsemakers JF, Knottnerus JA, Bleijenberg G. Efficacy of cognitive-behavioural therapy by general practitioners for unexplained fatigue among employees: Randomised controlled trial. Br J Psychiatry. 2004 Mar;184:240-6. http://bjp.rcpsych.org/content/184/3/240.long (Full article)