Cognitive behavioural therapy for ME/CFS sufferers: How strong is the evidence?
Institution: ME Research UK, The Gateway, Perth; and the Department of Medicine, University of Dundee
Aims: Several articles in the medical literature, including recent opinion pieces on the MEDLINE database, present the impression that there is now a powerful, perhaps overwhelming, case for the provision of cognitive behavioural therapy (CBT) as a specific therapy for ME/CFS patients. This investigation examined the scientific literature to determine whether this impression is based on sound scientific evidence.
Conclusions: The evidence for the routine use of CBT for ME/CFS patients is sparse, and does not justify many of the claims made for this intervention. Conclusions about efficacy must be tentative given the paucity of trials; the relatively small number of patients involved; the problems inherent in comparing CBT, which included a graded exercise component in both trials, with control interventions, such as relaxation or group support; and, importantly, the potential effect of publication bias.
Cognitive behaviour therapy for chronic fatigue syndrome
Spence VA, Abbot NC
Lancet 2001 Jul 21;358(9277):239-40; discussion 240-1
Comment on: Lancet. 2001 Mar 17;357(9259):841-7
Thus, with Prins and colleagues' study, there are two randomised controlled trials in which CBT has been compared (in a pooled total of 113 patients) with an active, although not indistinguishable, intervention (110 patients). The two trials show significant benefits on the primary outcome measures, but conclusions about efficacy must be tentative in view of the paucity of trials; the small number of patients involved; the difficulties inherent in comparing CBT-which included a graded exercise component in both trials-with control interventions, such as relaxation or group support; and, importantly, the potential effect of publication bias. No conclusions can be made about the effectiveness of group CBT (the only cost-effective option in the long term) or the generalisability of CBT to the various subgroups of patients, such as those with severe or long-term disability.
We suggest that the state of current evidence could be more rigorously described as follows: in the absence of any available medical treatment for CFS at present, these two trials together provide a small amount of evidence that CBT (or an equivalent beneficial patient-therapist encounter given on a one-to-one basis) can improve, but not cure, some physical symptoms in some members of the subgroup of CFS patients well enough to attend an outpatient clinic. This description is neither crisp nor appealing, but it more closely represents the true evidential picture.
*Vance A Spence, Neil C Abbot
*University Department of Medicine, Ninewells Hospital, Dundee DD1 9SY, UK; and Department of Epidemiology and Public Health, University of Leicester, Leicester
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