Cognitive behaviour therapy for chronic fatigue syndrome in adults
Open accessAbstract
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 STRATEGY: 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.
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Systematic reviews have shown low strength of evidence for the effectiveness of complementary therapies, CBT, counseling and behavioral therapies, and graded exercise therapy for improvement of fatigue, physical functioning, sleep, and quality of life in patients with ME/CFS.
“Systematic reviews have shown low strength of evidence for the effectiveness of different complementary therapies [19], cognitive-behavioral therapy (CBT), counseling and behavioral therapies [14,22], and graded exercise therapy [23] for improvement of fatigue, physical functioning, sleep, and quality of life in patients with ME/CFS.”
From Systematic review of mind‐body interventions to treat myalgic encephalomyelitis/chronic fatigue syndrome (2021) · cites this paper as [22]
The evidence base for the long-term efficacy of CBT in CFS remains unclear.
“However, the evidence base for the long-term efficacy remains unclear [10].”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [8]
The Cochrane review by Price et al. found a small effect for physical functioning (SMD = 0.11, 95% CI -0.32 to 0.54) compared with inactive control conditions.
“The Cochrane review (k = 15) by Price et al. [8] resulted in small to moderate effects, e.g., for fatigue severity (SMD = -0.39, 95% CI -0.0.60 to -0.19), physical functioning (SMD = 0.11, 95%CI -0.32 to 0.54), depression (SMD = -0.24, 95%CI -0.53 to 0.05), and anxiety symptoms (SMD = -0.30, 95%CI -0.59 to -0.01) compared with inactive control conditions.”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [8]
The Cochrane review by Price et al. (k = 15) found a small to moderate effect for fatigue severity (SMD = -0.39, 95% CI -0.60 to -0.19) compared with inactive control conditions.
“The Cochrane review (k = 15) by Price et al. [8] resulted in small to moderate effects, e.g., for fatigue severity (SMD = -0.39, 95% CI -0.0.60 to -0.19), physical functioning (SMD = 0.11, 95%CI -0.32 to 0.54), depression (SMD = -0.24, 95%CI -0.53 to 0.05), and anxiety symptoms (SMD = -0.30, 95%CI -0.59 to -0.01) compared with inactive control conditions.”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [8]
The Cochrane review by Price et al. found a small effect for anxiety symptoms (SMD = -0.30, 95% CI -0.59 to -0.01) compared with inactive control conditions.
“The Cochrane review (k = 15) by Price et al. [8] resulted in small to moderate effects, e.g., for fatigue severity (SMD = -0.39, 95% CI -0.0.60 to -0.19), physical functioning (SMD = 0.11, 95%CI -0.32 to 0.54), depression (SMD = -0.24, 95%CI -0.53 to 0.05), and anxiety symptoms (SMD = -0.30, 95%CI -0.59 to -0.01) compared with inactive control conditions.”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [8]
The Cochrane review by Price et al. found a small effect for depression (SMD = -0.24, 95% CI -0.53 to 0.05) compared with inactive control conditions.
“The Cochrane review (k = 15) by Price et al. [8] resulted in small to moderate effects, e.g., for fatigue severity (SMD = -0.39, 95% CI -0.0.60 to -0.19), physical functioning (SMD = 0.11, 95%CI -0.32 to 0.54), depression (SMD = -0.24, 95%CI -0.53 to 0.05), and anxiety symptoms (SMD = -0.30, 95%CI -0.59 to -0.01) compared with inactive control conditions.”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [8]
These results are in line with previous research, indicating that CBT can alleviate CFS symptoms and improve patients' overall well-being.
“All in all, these results are in line with previous research [8, 11, 12, 16, 49], indicating that CBT can alleviate CFS symptoms and improve patients’ overall well-being.”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [8]
Price et al. reported an odds ratio of 1.77 (95% CI 1.13 to 2.75) for drop-out of the intervention arms compared to usual care in CFS.
“For CFS, the review by Price et al. [8] reported an odds ratio of 1.77 (95%CI 1.13 to 2.75) for drop-out of the intervention arms compared to usual care.”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [8]
Treatment format (individual or group) might influence the acceptability of treatments for patients.
“Other aspects of the treatment itself, such as format in individual or group intervention, might influence the acceptability of treatments for patients as well [8].”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [8]
This is the first project that provides meaningful aggregated long-term effects; previous works had only short-term follow-up effects or aggregation was not possible.
“Besides, this is the first project that provides meaningful aggregated long-term effects; in previous works, there were only short-term follow-up effects [8] or aggregation was not possible [12].”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [8]
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References 108 · Cited by 401
- Authors
- Price, J. R., Mitchell, E., Tidy, E., & Hunot, V.
- Affiliations
- University of Oxford (GB)
- University of Bristol (GB)
- ORCID
- Mitchell, Edward
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2008-07-16
- Volume
- 2021
- Issue
- 3
- Pages
- CD001027-CD001027
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC7028002
- OpenAlex
- W1517101073
- Cited by
- 401
- References
- 108
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 10 · 2023: 10 · 2022: 10 · 2021: 18 · 2020: 27 · 2019: 30 · 2018: 11 · 2017: 27 · 2016: 33 · 2015: 17 · 2014: 25 · 2013: 23 · 2012: 34
- FWCI
- 4.14
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- chronic fatigue syndrome, cognitive behavioral therapy, fatigue severity, psychotherapy, usual care, clinical response, treatment acceptability, combined intervention, relaxation, counseling, adults, follow-up outcomes
- MeSH terms
- Adult, Humans, Fatigue Syndrome, Chronic, Cognitive Behavioral Therapy
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