Review COGNITIVE BEHAVIOURAL THERAPY FOR THE TREATMENT OF CHRONIC FATIGUE SYNDROME IN ADULTS – A META-ANALYSIS, 2025, Kolala

https://journals.sagepub.com/doi/pdf/10.1177/ANPA_59_1S

RANZCP Abstract Book, 2025

COGNITIVE BEHAVIOURAL THERAPY FOR THE TREATMENT OF CHRONIC FATIGUE SYNDROME IN ADULTS – A META-ANALYSIS

V Kolala1, B La Rosa2, V Vangaveti3, K Chen4

1Canberra Health Services, Canberra, Australia 2Serco, Townsville, Australia
3Research Division, James Cook University, Townsville, Australia 4Queensland Health, Townsville, Australia

Background: The efficacy of cognitive behavioural therapy (CBT) for the treatment of chronic fatigue syndrome (CFS) remains controversial.

Objectives: The purpose of this meta-analysis was to understand the short-term and long-term efficacy of CBT on different outcome measures on patients with CFS, as well as explore its potential adverse effects. The primary outcome was change in level of fatigue, with secondary outcomes being physical functioning, pain, quality of life, anxiety and depression.

Methods: The authors conducted a meta-analysis in accordance with PRISMA guidelines to include randomised controlled trials (RCT) on the efficacy of CBT for adults with CFS. Findings: 12 studies were included in this review. Individual face to face CBT was found to have a large effect size in reducing fatigue (Cohen’s d = 2.91, 95% CI 0.51 to 5.31, p=0.02). Self-directed CBT was found to have a large effect size in improving physical functioning (Cohen’s d = –2.76, 95% CI –5.06 to –0.47, p = 0.04). No serious adverse effects were reported.

Conclusions: CBT as a treatment modality inherently leads to difficulties with blinding and bias. The results suggest that patients with milder disease may benefit more from self-directed CBT. It is unclear why individual face to face CBT and self-directed CBT were only efficacious for fatigue and physical functioning respectively, but not both outcomes. Current guidelines have mixed recommendations with CBT as treatment, however we suggest CBT be offered to all patients with CFS.

Conflicts of interest Nil conflict of interests to report.

 

Nil understanding of methodology to report.

 

I suggest that you read up the issues with subjective outcomes in combination with blinding.

 

I disagree with their conclusion. They clearly haven't spent time properly researching CBT, just done a meta-analysis on the available studies and despite all the bias and problems they acknowledge and consider that the evidence doesn't amount to anything i.e. is "mixed" - suggests it should be offered to all pwME.

Why? I think CBT/mental health therapist's time is a precious resource (in NZ, not sure about Australia, a richer country that pays for private therapy, which is not the case in NZ) and is to be used for specific mental health conditions which is not the case for ME.

First time I have seen any mention of CFS publicly by my college for years, basically since Hickie et al did the Dubbo study and they had two psychiatrists with ME give a talk at the Gold Coast Congress in 2007 (which I didn't attend as I didn't get there early enough, there was no chairs left, the room was packed and people straining to hear at the door).