As clinical trialists, we are interested in both whether an intervention works and for whom does it work. However, it can be hard to so this in an any one clinical trial as you need a lot of statistical power (i.e. lots of participants). In this study, we used individual patient data analysis where we combined data across a number of similar trials. This has allowed us to look with confidence as to whether CBT is ineffective for patients with certain demographic or symptom profiles.Co-author of the study Professor Rona Moss-Morris, from the School of Mental Health & Psychological Sciences
06 November 2023
Cognitive Behavioural Therapy beneficial for patients with chronic fatigue syndrome
Cognitive Behavioural Therapy (CBT) is beneficial for people with myalgic encephalomyelitis, also known as chronic fatigue syndrome or ME/CFS, new research shows.
The study, published today in Psychological Medicine by researchers from Amsterdam UMC, Radboudumc and the Institute of Psychiatry, Psychology & Neuroscience at King’s College London analysed data from trials involving almost 1300 patients and found that CBT led to a reduction in fatigue and physical limitations.
Professor Hans Knoop, Clinical Psychologist at Amsterdam UMC and leader of the research group said: “We found CBT led to a clinically relevant reduction in fatigue and functional impairment as well as an increase in physical functioning. These results indicate that CBT can be beneficial for a substantial number of patients. About half were no longer severely fatigued after treatment."
It is often assumed that patients who experience an increase of symptoms following exertion, also known as post-exertional malaise (PEM), do not benefit from CBT or, even, that CBT makes their symptoms worse. The researchers aimed to determine for which patients CBT was beneficial. They found that patients could profit from CBT irrespective of which symptoms they experienced or how ME/CFS was diagnosed.
Not all patients benefitted from CBT equally. Younger patients, patients with less functional impairment and patients who were still relatively active benefitted more from CBT.
Tanja Kuut, clinical psychologist at Amsterdam UMC and lead author of the study said: “Reporting more functional impairments and being physically inactive may indicate more severe disease and this subgroup of patients probably needs additional or more intensive treatment."
The findings contradict guidelines published by the NICE in 2021. They proposed to use a new case definition for ME/CFS and concluded that CBT may merely support patients in managing symptoms but cannot be seen as a treatment that can reduce symptoms and help recovery. This conclusion was partly based on the lack of evidence of the efficacy of CBT when certain (new) case definitions of ME/CFS were used to diagnose it or when PEM was reported by patients.
The findings of the new study show that CBT can also be effective for patients with PEM and those diagnosed using the new case definitions. The authors say this is encouraging news for patients, and it provides guidance for healthcare providers who were uncertain which patients they should refer to CBT.