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Evaluating effectiveness of treatment for adults with chronic fatigue syndrome

A new systematic review of 15 studies, led by researchers from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) and South London and Maudsley NHS Foundation Trust, has investigated the prognosis of adults with chronic fatigue syndrome (CFS) treated with two well-known approaches: cognitive behavioural therapy (CBT) and graded exercise therapy (GET).

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The systematic review, published in Psychological Medicine, is one of the only reviews to have focused on prognosis following these treatments, and captures the proportion of subjects who improved or worsened according to various outcomes including fatigue, functioning or post-treatment change. The study found that prognosis was 8–26% better following CBT and GET compared to control conditions such as relaxation, medical care or wait-list.

CFS is a serious illness, affecting 0.2-0.4% of the population and characterized by unexplained tiredness which is severe enough to result in substantial disability. Other common symptoms include musculoskeletal pain, sleep disturbance and problems with thinking and attention. There is no ‘evidence based’ medical treatment for CFS although CBT and GET have most support within the current literature.

The team conducted a systematic review of studies published between 1988 and 2021. This included 11 studies of CBT and six of GET across 1990 participants. When participants were asked about symptoms within 12 months of completing CBT, 44% considered themselves better (20% more than in control conditions), 43% demonstrated significant improvements in fatigue (23% more than in control conditions), 59% demonstrated significant improvements in physical functioning (14% more than in control groups) and 11% considered themselves worse (8% fewer than in control conditions).

When participants were asked about symptoms within 12 months of completing GET, 43% considered themselves better (26% more than in control conditions), 61% demonstrated significant improvements in physical functioning (23% more than in control groups) and 14% considered themselves worse (10% fewer than in control conditions). This analysis indicates that both CBT and GET result in better prognoses compared to control conditions.

Information about prognosis is vital for translating findings from research to practice. In simple terms, our study showed that a greater proportion of patients improved, and a lower proportion worsened, following GET and CBT compared to control conditions, and that CBT and GET yielded similar outcomes. This should inform patients, clinicians and commissioners about treatments that may help with the debilitating symptoms of CFS.– Dr Tom Ingman, first author of the study and Clinical Psychologist at the Department of Psychology, King's IoPPN

The researchers noted that one third of studies included in the review were of weak quality, most outcomes were self-reported and findings may not generalize to severe CFS given the exclusion of housebound participants. Authors state that further trials are therefore required, not only of CBT and GET, but also of other treatments, particularly for individuals with severe CFS.

This paper represents independent research part-funded by the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London.

A systematic literature review of randomized controlled trials evaluating prognosis following treatment for adults with chronic fatigue syndrome (Tom Ingman, Abigail Smakowski, Kimberley Goldsmith, Trudie Chalder) was published online in Psychological Medicine by Cambridge University Press (DOI: https://doi.org/10.1017/S0033291722002471)

For more information, please contact Patrick O’Brien (Senior Media Officer).

In this story

Trudie Chalder

Trudie Chalder

Professor of Cognitive Behavioural Psychotherapy

Kimberley  Goldsmith

Kimberley Goldsmith

Reader in Medical Statistics