Cognitive behavioral therapy and graded exercise for chronic fatigue syndrome: A meta‐analysis.

Abstract

Several reviews have concluded that graded exercise therapy (GET) and cognitive behavioral therapy (CBT) may be the most efficacious treatments for chronic fatigue syndrome (CFS). The current review extends the evidence for overall and outcome-specific effects of CBT and GET by directly comparing the treatments and addressing the methodological limitations of previous reviews. GET (n = 5) and CBT (n = 16) randomized controlled trials were meta-analyzed. Overall effect sizes suggested that GET (g = 0.28) and CBT (g = 0.33) were equally efficacious. However, CBT effect sizes were lower in primary care settings and for treatments offering fewer hours of contact. The results suggested that both CBT and GET are promising treatments for CFS, although CBT may be a more effective treatment when patients have comorbid anxiety and depressive symptoms.

Cognitive behavior therapy in patients with chronic fatigue syndrome: The role of illness acceptance and neuroticism

“…For acceptance and fatigue, the effect size was moderate, for QoL the effect sizes are small, which is comparable to the effect sizes reported in the meta-analysis of Castell et al [10]. Although our results corroborate the overall consensus that CBT is an evidence-based treatment for CFS, its effects are not the same for all patients.…”

“…No evidence was found that the treatment format (group or individual) and treatment duration (weeks) affected the effect size of CBT [10]. Although group programs are often preferred because of the cost efficacy and they involve peer support, support groups without therapy do not yield similar outcome results as CBT [12].…”

“…Research has shown that CBT improves physical functioning and fatigue reduction immediately and some time after treatment [9,10]. Nevertheless, complete recovery is uncommon.…”

“…A recent meta-analytical study of Castell and colleagues shows an overall effect size for CBT of 0.33, which is small according to Cohen's recommendations [10,11]. This research group suggested that the variability in fatigue outcomes in CBT reflects the existence of moderating variables and examined illness characteristics and treatment characteristics.…”

Pain in chronic fatigue syndrome: response to rehabilitative treatments in the PACE trial

“…The trial demonstrated that CBT and GET can be added to SMC to safely and moderately reduce fatigue and physical disability for CFS, but that APT was not an effective addition. This is consistent with meta-analyses and systematic reviews which also suggest that both CBT and GET are moderately effective treatments (Edmonds et al 2004;Malouff et al 2008;Price et al 2008;Castell et al 2011), something reflected in the guideline of the UK National Institute for Health and Clinical Excellence (NICE, 2007).…”