Intervention Review

Cognitive behaviour therapy for chronic fatigue syndrome in adults

  1. Jonathan R Price1,*,
  2. Edward Mitchell2,
  3. Elizabeth Tidy3,
  4. Vivien Hunot4

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 16 JUL 2008

Assessed as up-to-date: 2 APR 2008

DOI: 10.1002/14651858.CD001027.pub2


How to Cite

Price JR, Mitchell E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001027. DOI: 10.1002/14651858.CD001027.pub2.

Author Information

  1. 1

    University of Oxford, Department of Psychiatry, Oxford, UK

  2. 2

    Pembroke College, University of Oxford Clinical School, Oxford, UK

  3. 3

    New College, University of Oxford, Oxford, UK

  4. 4

    University of Bristol, Academic Unit of Psychiatry, Community Based Medicine, Bristol, Avon, UK

*Jonathan R Price, Department of Psychiatry, University of Oxford, The Warneford Hospital, Headington, Oxford, OX3 7JX, UK. jonathan.price@psych.ox.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 16 JUL 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Chronic fatigue syndrome (CFS) is a common, debilitating and serious health problem. Cognitive behaviour therapy (CBT) may help to alleviate the symptoms of CFS.

Objectives

To examine the effectiveness and acceptability of CBT for CFS, alone and in combination with other interventions, compared with usual care and other interventions.

Search methods

CCDANCTR-Studies and CCDANCTR-References were searched on 28/3/2008. We conducted supplementary searches of other bibliographic databases. We searched reference lists of retrieved articles and contacted trial authors and experts in the field for information on ongoing/completed trials.

Selection criteria

Randomised controlled trials involving adults with a primary diagnosis of CFS, assigned to a CBT condition compared with usual care or another intervention, alone or in combination.

Data collection and analysis

Data on patients, interventions and outcomes were extracted by two review authors independently, and risk of bias was assessed for each study. The primary outcome was reduction in fatigue severity, based on a continuous measure of symptom reduction, using the standardised mean difference (SMD), or a dichotomous measure of clinical response, using odds ratios (OR), with 95% confidence intervals (CI).

Main results

Fifteen studies (1043 CFS participants) were included in the review. When comparing CBT with usual care (six studies, 373 participants), the difference in fatigue mean scores at post-treatment was highly significant in favour of CBT (SMD -0.39, 95% CI -0.60 to -0.19), with 40% of CBT participants (four studies, 371 participants) showing clinical response in contrast with 26% in usual care (OR 0.47, 95% CI 0.29 to 0.76). Findings at follow-up were inconsistent. For CBT versus other psychological therapies, comprising relaxation, counselling and education/support (four studies, 313 participants), the difference in fatigue mean scores at post-treatment favoured CBT (SMD -0.43, 95% CI -0.65 to -0.20). Findings at follow-up were heterogeneous and inconsistent. Only two studies compared CBT against other interventions and one study compared CBT in combination with other interventions against usual care.

Authors' conclusions

CBT is effective in reducing the symptoms of fatigue at post-treatment compared with usual care, and may be more effective in reducing fatigue symptoms compared with other psychological therapies. The evidence base at follow-up is limited to a small group of studies with inconsistent findings. There is a lack of evidence on the comparative effectiveness of CBT alone or in combination with other treatments, and further studies are required to inform the development of effective treatment programmes for people with CFS.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Cognitive behaviour therapy for chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is a very common and disabling condition, in which people suffer from persistent symptoms of fatigue that are unexplained. Cognitive behaviour therapy is a psychological therapy model that is commonly used to treat a range of psychological and chronic pain conditions. This review aimed to find out whether CBT is effective for CBT, both as a standalone treatment and in combination with other treatments, and whether it is more effective than other treatments used for CFS. The review included 15 studies, with a total of 1043 CFS participants. The review showed that people attending for CBT were more likely to have reduced fatigue symptoms at the end of treatment than people who received usual care or were on a waiting list for therapy, with 40% of people in the CBT group showing clinical improvement, in contrast with 26% in usual care. At follow-up, 1-7 months after treatment ended, people who had completed their course of CBT continued to have lower fatigue levels, but when including people who had dropped out of treatment, there was no difference between CBT and usual care. The review also compared CBT against other types of psychological therapy, including relaxation techniques, counselling and support/education, and found that people attending for CBT was more likely to have reduced fatigue symptoms at the end of treatment than those attending for other psychological therapies. Physical functioning, depression, anxiety and psychological distress symptoms were also more reduced when compared with other psychological therapies. However at follow-up, the results were inconsistent and the studies did not fit well together, making it difficult to draw any conclusions. Very few studies reported on the acceptability of CBT and no studies examined side effects. Only two studies compared the effectiveness of CBT against other treatments, both exercise therapy, and just one study compared a combination of CBT and other treatments with usual care. More studies should be carried out to establish whether CBT is more helpful than other treatments for CFS, and whether CBT in combination with other treatments is more helpful than single treatment approaches.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

成人慢性疲勞症候群的認知行為治療

慢性疲勞症候群(簡稱CFS)是一種常見,虛弱和嚴重的健康問題。認知行為治療(CBT)可能有助於減輕CFS的症狀

目標

檢視CBT對CFS治療的有效性與接受度,採單獨使用或結合其他處遇措施,並與一般照護以及其他處遇措施做比較。

搜尋策略

28/3/2008搜尋CCDANCTRStudies and CCDANCTRReferences。我們額外搜尋其他書目資料庫。我們搜尋了文章檢索理得參考文獻清單,與這些試驗的作者及該領域的專家聯繫,取得正在進行或已完成試驗的資訊。

選擇標準

選擇主要診斷為CFS,並且分派使用CBT或一般照護或其他處遇(不論單獨或合併)治療的隨機對照試驗。

資料收集與分析

由兩名審查者獨立抽出病人的資料,處遇措施與結果,每個研究都進行偏誤(bias)風險評估。主要的預後評估是疲勞減少程度,對於症狀減輕的連續變項會計算standardised mean difference (SMD), 而對於二分變項,則會去計算 odds ratios (OR)並附上95% confidence intervals (CI).

主要結論

納入15個研究(共1043名CFS患者參與)。在比較CBT與一般照護(6項研究,373名參與者)上,治療後疲勞分數的平均數在CBT組呈現明顯改善(SMD −0.39, 95% CI在 −0.60 到 −0.19之間),CBT組有40%的人有臨床反應而在常規照護則只有26%(4項研究,371名參與者)(OR 0.47, 95% CI 在0.29到0.76之間),但在後續追蹤時結果卻呈現不一致。 相較於CBT與其他心理治療,包括放鬆,諮商和教育/支持(4項研究,313名參與者),在治療後疲勞的平均分數,CBT組同樣優於其他組別(SMD −0.43, 95% CI −0.65 到 −0.20之間),不過同樣地,後續追蹤的結果分歧而不一致。 有兩個研究比較CBT處置與其他另外的處遇方式,有一個研究比較CBT合併其他處遇方式與一般照護的差異。

作者結論

與一般照護相較之下,CBT能有效地減少治療後的疲勞症狀,而與其他心理療法比較下,也可能可以減少疲勞症狀。但在後續追蹤研究上卻因為研究不多以及結果不一致而使得證據力薄弱。此外,對於比較單獨使用CBT或結合CBT與其他治療方式的研究則付之闕如,未來還需要更進一步的研究以便發展出有效治療疲勞症狀的方法。

翻譯人

本摘要由彰化基督教醫院陳美貴翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

慢性疲勞綜合徵(簡稱CFS)是一種非常普遍及失能的狀態,人們會持續出現不明原因的疲勞。認知行為療法是一種心理治療模式,通常用於治療各種心理和慢性疼痛。本次文獻回顧的目的是查明在CFS的治療上,是否CBT是有效的,不論是單獨使用或合併其他治療,是否比其他治療更有效。 文獻回顧內容包括15項研究,總共1043的參與者。回顧結果,發現與一般照護及等候治療者相較之下,以CBT治療較能減少疲勞症狀。CBT組有40%的人有臨床反應而在常規照護則只有26%。在後續追蹤方面,在治療後1 – 7個月,已完成CBT療程者在疲倦的程度上較低。但如果將治療中斷者納入審查,則CBT與一般照護之間沒有顯著的差別。審查者還比較了CBT與其他類型的心理治療,包涵了放鬆訓練、諮商與支持/衛教,發現在治療後接受CBT者比其他治療者減輕了疲勞的症狀,身體機能、憂鬱、焦慮與內心痛苦的症狀也減輕許多。然而在追蹤時發現結果不一致,研究無法適切地合併評估,因此無法得出結論。很少有報告指出CBT的接受度,沒有研究探討副作用。只有兩個研究比較CBT與其他治療方法,包含活動治療的效益,只有一個研究比較一般照護與CBT合併其他治療。需要進行更多的研究,才能確立CBT是否比其他療法對CFS更有幫助,是否CBT合併其他治療比單一治療更有幫助。