Adolescents with chronic fatigue syndrome show significant improvement with cognitive-behavioral therapy, according to the first randomized controlled trial involving this age group.
“These results endorse the findings of previous studies on the efficacy of CBT for adults with chronic fatigue syndrome,” reported Maja Stulemeijer and colleagues at University Medical Centre Nijmegen (the Netherlands).
Only one uncontrolled study in adolescents suggests that cognitive-behavioral therapy can reduce chronic fatigue, according to the researchers (BMJ 2005; 330:14).
“We believe that our results can be generalized to other adolescents who fulfill the diagnostic criteria for chronic fatigue syndrome,” they noted.
The study followed 69 patients, aged 10–17 years, who met U.S. Centers for Disease Control and Prevention criteria for chronic fatigue syndrome.
Patients were randomized to either immediate therapy, or to remain on a waiting list for therapy. The intervention involved 10 individual sessions over 5 months, and therapy patients underwent one of two treatment protocols depending on whether they were considered active or passive patients.
Active patients were described as alternating between periods of activity and periods of rest; passive patients were described as spending most of their time lying down and as going out infrequently.
For active patients, treatment started with teaching them to recognize and accept their fatigue and reduce their activity level accordingly. This was followed by a gradual increase in activity.
Passive patients started immediately with a systematic program of activity building. “In such patients it is thought to be counterproductive to reduce activity levels any further or to reinforce the patient's need to respect limitations,” according to the investigators.
Measures of fatigue and functional impairment decreased more significantly in the therapy group, compared with the untreated group. School attendance improved significantly more in the therapy group, with 58% of these patients returning to school full time, compared with 29% of patients on the waiting list for therapy.
Participants in the therapy group also reported significantly less muscle pain, headache, unrefreshing sleep, and impaired concentration. They were also less likely to feel ill after exercise, compared with patients on the waiting list.
There were no significant differences in outcomes between patients in the active or passive treatment protocols. However, the authors noted that patients in all arms of the study continued to report symptoms.