Existing trials have shown that cognitive behavioural therapy is a promising treatment for chronic fatigue syndrome. The availability of CBT is patchy, so there is an increasing body of research investigating whether internet-based treatment is a viable alternative.
A new small randomised controlled trial conducted by researchers from the Netherlands has been published in the Lancet. The authors have developed a web treatment programme that specifically targets adolescents with chronic fatigue syndrome. It’s called Fatigue In Teenagers on the interNET or FITNET for short.
The trial randomised 135 adolescents to either FITNET or usual care (normally individual or group psychotherapy and exercise therapy) and measured a number of outcomes (school attendance, fatigue severity, and physical functioning) for a 6-month follow-up period. They conducted an intention to treat analysis.
The trial reports that FITNET was significantly more effective than usual care:
- 75% of patients receiving FITNET achieved full school attendance, compared with 16% of the control group (relative risk 4·8, 95% CI 2·7—8·9; p<0·0001)
- 85% of FITNET patients reported absence of severe fatigue, compared to 27% of controls (3·2, 2·1—4·9; p<0·0001)
- 78% of FITNET patients reported normal physical functioning, compared with 20% of controls (3·8, 2·3—6·3; p<0·0001)
- No serious adverse events were reported
It’s worth mentioning that the response to usual care (standard psychotherapy) is lower than has been reported in previous trials. It’s also important to note that this is a small single trial, so the results should be interpreted with caution.
The researchers are excited by the findings and very positive about their intervention. They concluded:
FITNET offers a readily accessible and highly effective treatment for adolescents with chronic fatigue syndrome. The results of this study justify implementation on a broader scale.
Dr Sanne L Nijhof MD,Prof Gijs Bleijenberg PhD,Cuno SPM Uiterwaal PhD,Prof Jan LL Kimpen PhD,Elise M van de Putte PhD. Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial. The Lancet – 1 March 2012. DOI: 10.1016/S0140-6736(12)60025-7. [Abstract]
Chronic fatigue syndrome, NHS Choices.
People might be interested to know that the follow up for this study found that there was no statistical difference between FITNET group and the treatment as usual group.
Bleijenberg has something of a history of being over-excited by findings about CBT’s value as a treatment for CFS. His group reported a strong positive result in 2001 (Prins JB, Bleijenberg G, Bazelmans E, Elving LD, de Boo TM, Severens JL, van der Wilt GJ, Spinhoven P, van der Meer JW. Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial. Lancet. 2001 Mar 17;357(9259):841-7), but waited nearly a decade to release objective measures of activity levels from this trial which found that CBT only served to affect patient’s subjective self-reports, and did not allow patients to increase the amount that they were able to do (Prins JB, Bleijenberg G, Bazelmans E, Elving LD, de Boo TM, Severens JL, van der Wilt GJ, Spinhoven P, van der Meer JW. Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial. Lancet. 2001 Mar 17;357(9259):841-7). They chose to interpret this finding as showing that CBT is so effective it successfully treats patients without even needing them to do any more.
More recently they used a Lancet editorial to claim that the PACE trial had showed about 30% of CFS patients have recovered following CBT/GET, using a “strict criterion for recovery”. In fact, this criteria were so loose that patients could have been classed as ‘recovered’ even if their questionnaires reported no improvement in fatigue, and a decline in physical functioning. The PACE trial’s researchers are currently refusing to release the data for their published protocol’s primary recovery criteria (or their primary outcomes): https://www.whatdotheyknow.com/request/pace_trial_recovery_rates_and_po
It seems that CBT is just grand at altering patient’s questionnaire filling behaviour, but is rather less good at improving outcome measures less prone to response bias (employment levels, activity levels, disability benefit claims, etc). A bit like homeopathy, only more likely to have side-effects.