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CBT And Graded Exercise Therapy Help with Chronic Fatigue

08 Apr

Researchers from the Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University in the UK investigated the effectiveness and safety of four treatments for Chronic Fatigue Syndrome: (1) Specialist Medical Care (SMC) alone, or with (2) Adaptive Pacing Therapy (APT), (3) Cognitive Behavioral Therapy (CBT), or (4) Graded Exercize Therapy (GET).

In a parallel-group randomized trial, patients meeting Oxford criteria for chronic fatigue syndrome were recruited from six secondary-care clinics in the UK and randomly allocated by computer-generated sequence to receive one of the four conditions.  

Primary outcomes were fatigue (measured by Chalder fatigue questionnaire score) and physical function (measured by short form-36 subscale score) up to 52 weeks after randomization, and safety was assessed primarily by recording all serious adverse events, including reactions to the trial treatments.

Primary outcomes were also rated by participants. The statistician was blinded to treatment assignment for the analysis of primary outcomes. Longitudinal regression models were used to compare SMC alone with other treatments, APT with CBT, and APT with GET.

Investigators recruited 641 eligible patients, of whom 160 were assigned to the APT group, 161 to the CBT group, 160 to the GET group, and 160 to the SMC-alone group.

Compared with SMC alone, mean fatigue scores at 52 weeks were 3·4 points lower for CBT (p = 0·0001) and 3·2 points lower for GET (p = 0·0003), but did not differ for APT, at 0·7 points lower  (p = 0·38).

Compared with SMC alone, mean physical function scores were 7·1 points higher for CBT (p = 0·0068) and 9·4 points higher for GET (p = 0·0005), but did not differ for APT, which yielded 3·4 points lower (p=0·18).

Compared with APT, CBT and GET were associated with less fatigue (CBT p = 0·0027; GET p = 0·0059) and better physical function (CBT p=0·0002; GET p<0·0001).

Subgroup analysis of 427 participants meeting international criteria for chronic fatigue syndrome and 329 participants meeting London criteria for myalgic encephalomyelitis, yielded equivalent results.

Serious adverse reactions were recorded in two (1%) of 159 participants in the APT group, three (2%) of 161 in the CBT group, two (1%) of 160 in the GET group, and two (1%) of 160 in the SMC-alone group.

The researchers conclude that CBT and GET can safely be added to SMC to moderately improve outcomes for chronic fatigue syndrome, but APT is not an effective addition.

Citation: White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, DeCesare JC, Baber HL, Burgess M, Clark LV, Cox DL, Bavinton J, Angus BJ, Murphy G, Murphy M, O'Dowd H, Wilks D, McCrone P, Chalder T, Sharpe M; PACE trial management group. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011 Mar 5;377 (9768): pages 823-36. Epub 2011 Feb 18. This email address is being protected from spambots. You need JavaScript enabled to view it.

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award