Assessment of the scientific rigour of randomized controlled trials on the effectiveness of cognitive behavioural therapy and graded exercise therapy for patients with myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review

2019 ◽  
Vol 25 (2) ◽  
pp. 240-255 ◽  
Author(s):  
SA Ahmed ◽  
JC Mewes ◽  
HJM Vrijhoef
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Exercise Therapy ◽  
Methodological Quality ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Fatigue Syndrome ◽  
Cognitive Behavioural ◽  
Graded Exercise Therapy ◽  
Graded Exercise

Cognitive behavioural therapy and graded exercise therapy have been promoted as effective treatments for patients with myalgic encephalomyelitis/chronic fatigue syndrome. However, criticism on the scientific rigour of these studies has been raised. This review assessed the methodological quality of studies on the effectiveness of cognitive behavioural therapy and graded exercise therapy. The methodological quality of the 18 included studies was found to be relatively low, as bias was prominently found, affecting the main outcome measures of the studies (fatigue, physical functioning and functional impairment/status). Future research should focus on including more objective outcome measures in a well-defined patient population.

Myalgic encephalomyelitis/chronic fatigue syndrome patients’ reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments: Analysis of a primary survey compared with secondary surveys

2017 ◽  
Vol 24 (10) ◽  
pp. 1318-1333 ◽  
Author(s):  
Keith Geraghty ◽  
Mark Hann ◽  
Stoyan Kurtev
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cognitive Behavioural Therapy ◽  
Exercise Therapy ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Myalgic Encephalomyelitis ◽  
Fatigue Syndrome ◽  
Cognitive Behavioural ◽  
Graded Exercise Therapy ◽  
Graded Exercise

Cognitive behavioural therapy and graded exercise therapy are promoted as evidence-based treatments for myalgic encephalomyelitis/chronic fatigue syndrome. This article explores patients’ symptom responses following these treatments versus pacing therapy, an approach favoured by many sufferers. We analyse data from a large cross-sectional patient survey ( n = 1428) and compare our findings with those from comparable patient surveys ( n = 16,665), using a mix of descriptive statistics and regression analysis modelling. Findings from analysis of primary and secondary surveys suggest that cognitive behavioural therapy is of benefit to a small percentage of patients (8%–35%), graded exercise therapy brings about large negative responses in patients (54%–74%), while pacing is the most favoured treatment with the lowest negative response rate and the highest reported benefit (44%–82%).

The concept of ‘illness without disease’ impedes understanding of chronic fatigue syndrome: a response to Sharpe and Greco

2020 ◽  
pp. medhum-2019-011807
Author(s):  
Steven Lubet ◽  
David Tuller
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Medical Humanities ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Behavioural Interventions ◽  
Fatigue Syndrome ◽  
Cognitive Behavioural ◽  
Graded Exercise Therapy ◽  
Objective Evidence ◽  
Graded Exercise

In a recent article in Medical Humanities, Sharpe and Greco characterise myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as an ‘illness without disease’, citing the absence of identified diagnostic markers. They attribute patients’ rejection of psychological and behavioural interventions, such as cognitive–behavioural therapy (CBT) and graded exercise therapy (GET), to a ‘paradox’ resulting from a supposed failure to acknowledge that ‘there is no good objective evidence of bodily disease’. In response, we explain that understandings about the causes of and treatments for medical complaints have shifted across centuries, and that conditions once thought to be ‘psychosomatic’ have later been determined to have physiological causes. We also note that Sharpe and Greco do not disclose that leading scientists and physicians believe that ME/CFS is a biomedical disease, and that numerous experts, not just patients, have rejected the research underlying the CBT/GET treatment approach. In conclusion, we remind investigators that medical classifications are always subject to revision based on subsequent research, and we therefore call for more humility before declaring categorically that patients are experiencing ‘illness without disease’.

scholarly journals The planning, implementation and publication of a complex intervention trial for chronic fatigue syndrome: the PACE trial

2015 ◽  
Vol 39 (1) ◽  
pp. 24-27 ◽  
Author(s):  
Peter D. White ◽  
Trudie Chalder ◽  
Michael Sharpe
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Medical Care ◽  
Physical Disability ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Intervention Trial ◽  
Fatigue Syndrome ◽  
Cognitive Behavioural ◽  
Graded Exercise Therapy ◽  
Graded Exercise

SummaryThe PACE trial was a four-arm trial of specialist medical care, compared with specialist medical care with a supplementary therapy: adaptive pacing therapy, cognitive–behavioural therapy or graded exercise therapy, for patients with chronic fatigue syndrome. The trial found that both cognitive–behavioural and graded exercise therapies were more effective than either of the other two treatments in reducing fatigue and improving physical disability. This paper describes the design, conduct and main results of the trial, along with a description of the challenges that had to be overcome in order to produce clear answers to the clinically important questions the trial posed.

scholarly journals Cognitive behavioural therapy for chronic fatigue and chronic fatigue syndrome: outcomes from a specialist clinic in the UK

2020 ◽  
Vol 113 (10) ◽  
pp. 394-402
Author(s):  
James Adamson ◽  
Sheila Ali ◽  
Alastair Santhouse ◽  
Simon Wessely ◽  
Trudie Chalder
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cognitive Behavioural Therapy ◽  
Social Adjustment ◽  
Physical Functioning ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Fatigue Syndrome ◽  
Cognitive Behavioural ◽  
The Uk

Objectives Cognitive behavioural therapy is commonly used to treat chronic fatigue syndrome and has been shown to be effective for reducing fatigue and improving physical functioning. Most of the evidence on the effectiveness of cognitive behavioural therapy for chronic fatigue syndrome is from randomised control trials, but there are only a few studies in naturalistic treatment settings. Our aim was to examine the effectiveness of cognitive behavioural therapy for chronic fatigue syndrome in a naturalistic setting and examine what factors, if any, predicted outcome. Design Using linear mixed effects analysis, we analysed patients' self-reported symptomology over the course of treatment and at three-month follow-up. Furthermore, we explored what baseline factors were associated with improvement at follow-up. Setting Data were available for 995 patients receiving cognitive behavioural therapy for chronic fatigue syndrome at an outpatient clinic in the UK. Participants Participants were referred consecutively to a specialist unit for chronic fatigue or chronic fatigue syndrome. Main outcome measures Patients were assessed throughout their treatment using self-report measures including the Chalder Fatigue Scale, 36-item Short Form Health Survey, Hospital Anxiety and Depression Scale and Global Improvement and Satisfaction. Results Patients’ fatigue, physical functioning and social adjustment scores significantly improved over the duration of treatment with medium to large effect sizes (|d| = 0.45–0.91). Furthermore, 85% of patients self-reported that they felt an improvement in their fatigue at follow-up and 90% were satisfied with their treatment. None of the regression models convincingly predicted improvement in outcomes with the best model being (R2 = 0.137). Conclusions Patients’ fatigue, physical functioning and social adjustment all significantly improved following cognitive behavioural therapy for chronic fatigue syndrome in a naturalistic outpatient setting. These findings support the growing evidence from previous randomised control trials and suggest that cognitive behavioural therapy could be an effective treatment in routine treatment settings.

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