Cognitive behavioral therapy positively affects fatigue in patients with multiple sclerosis: Results of a randomized controlled trial
Open accessAbstract
BACKGROUND: Fatigue is a common symptom in multiple sclerosis (MS) and often restricts societal participation. Cognitive behavioral therapy (CBT) may alleviate MS-related fatigue, but evidence in literature is inconclusive. OBJECTIVE: To evaluate the effectiveness of CBT to improve MS-related fatigue and participation. METHODS: In a multi-center, assessor-masked, randomized controlled trial, participants with severe MS-related fatigue were assigned to CBT or control treatment. CBT consisted of 12 individual sessions with a psychologist trained in CBT, the control treatment consisted of three consultations with a MS nurse, both delivered over 16 weeks. Assessments were at baseline, 8, 16 (i.e. post-intervention), 26, and 52 weeks post-baseline. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed according to the intention-to-treat principle, using mixed-model analysis. RESULTS: Between 2011 and 2014, 91 patients were randomized (CBT: n = 44; control: n = 47). Between-group analysis showed a positive post-intervention effect for CBT on CIS20r fatigue (T16: -6.7 (95% confidence interval (CI) = -10.7; -2.7) points) that diminished during follow-up (T52: 0.5 (95% CI = -3.6; 4.4)). No clinically relevant effects were found on societal participation. CONCLUSION: Severe MS-related fatigue can be reduced effectively with CBT in the short term. More research is needed on how to maintain this effect over the long term.
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Several studies have demonstrated that online CBT-based fatigue management programs are a cost-effective and accessible treatment option for pwMS.
“Several studies have demonstrated that online CBT-based fatigue management programs are a cost-effective and accessible treatment option for pwMS (Pottgen et al., 2018;Moss-Morris et al., 2012;van den Akker et al., 2017).”
From Neuropsychology intervention for managing invisible symptoms of MS (NIMIS-MS) group: A pilot effectiveness and acceptability study (2024) · cites this paper as van den Akker et al., 2017
The Abstract reports that CBT reduced severe MS-related fatigue in the short term. But the Procedures describe 12 face-to-face sessions, not an online program, and the Discussion calls CBT expensive and intensive while suggesting e-health delivery as a possible future solution. This trial therefore does not demonstrate that online CBT is cost-effective or accessible. (LLM, conf=0.88)
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- Van den Akker LE, Beckerman H, Collette EH, et al. Effectiveness of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: A systematic review and meta-analysis. J Psychosom Res 2016; 90: 33-42.
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- Authors
- van den Akker, L. E., Beckerman, H., Collette, E. H., Twisk, J. W., Bleijenberg, G., Dekker, J., Knoop, H., de Groot, V., & TREFAMS-ACE Study Group
- Affiliations
- Department of Rehabilitation Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health (NL)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Radboud University Medical Center (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Venue
- Multiple Sclerosis Journal
- Publisher
- SAGE Publications
- Published
- 2017-05-22
- Volume
- 23
- Issue
- 11
- Pages
- 1542-1553
- ISSN
- 1352-4585 (ISSN-L)
- 1477-0970
- OpenAlex
- W2617720549
- Cited by
- 80
- References
- 29
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 13 · 2023: 8 · 2022: 9 · 2021: 14 · 2020: 5 · 2019: 6 · 2018: 8 · 2017: 2
- FWCI
- 4.51
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Locations
- Multiple Sclerosis Journal (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Keywords
- cognitive behavioral therapy, multiple sclerosis, fatigue, participation, social participation (health and rehabilitation), autonomy, psychological intervention
- MeSH terms
- Adult, Fatigue, Female, Humans, Male, Middle Aged, Multiple Sclerosis, Cognitive Behavioral Therapy, Outcome Assessment, Health Care
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