Abstract
BackgroundChronic fatigue syndrome (CFS) is characterized by profound and disabling fatigue with no known somatic explanation. Cognitive behavioral therapy (CBT) has proven to be a successful intervention leading to a reduction in fatigue and disability. Based on previous neuroimaging findings, it has been suggested that central neural mechanisms may underlie CFS symptoms and play a role in the change brought on by CBT. In this randomized controlled trial we aim to further investigate the neural mechanisms that underlie fatigue in CFS and their change by CBT.Methods/DesignWe will conduct a randomized controlled trial in which we collect anatomical and functional magnetic resonance imaging (MRI) measures from female CFS patients before and after CBT (N = 60) or waiting list (N = 30) and compare these with measures from age and education matched healthy controls (N = 30). By including a large treatment group we will also be able to compare patients that benefit from CBT with those that do not. In addition, to further investigate the role of endocrine and immune biomarkers in CFS, we will determine cortisol and cytokine concentrations in blood, hair and/or saliva.DiscussionThis project creates an unique opportunity to enhance our understanding of CFS symptoms and its change by CBT in terms of neuroanatomical, neurofunctional, endocrinological and immunological mechanisms and can help to further improve future treatments strategies.Trial registrationDutch Trial Register #15852. Registered 9 December 2013 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4311)
Highlights
Chronic fatigue syndrome (CFS) is characterized by profound and disabling fatigue with no known somatic explanation
These changes were located in the dorsolateral prefrontal cortex (DLPFC) [14], a region associated with cognitive-regulatory functions
Previous work shows that CFS patients are characterized by hypocortisolism (Nater et al, [61]a; Nater et al, [62]b), which can normalize to levels comparable to healthy population after Cognitive behavioral therapy (CBT) in adolescents (Nijhof et al, [63]; Rimes et al, [64]) and adults (Roberts et al, [65]). In this project we will replicate and extend these findings, by assessing both diurnal cortisol fluctuations in saliva as well as baseline cortisol levels of the past month in hair. Summary This project aims at investigating neural mechanisms underlying CFS symptoms and its changes after CBT by collection anatomical magnetic resonance imaging (MRI) measures, functional MRI measures, behavioral measures and blood, saliva and hair sampling
Summary
Chronic fatigue syndrome (CFS) is characterized by profound and disabling fatigue with no known somatic explanation. Mediation analysis of randomized controlled trials testing the efficacy of CBT suggested that the reduction of fatigue and disability is mediated by a change in cognitions, such as decreased focusing on symptoms and changes in illness beliefs ([7]; Knoop et al, [8]; Wiborg et al, [9]; Wiborg et al, [10]), rather than van Der Schaaf et al BMC Psychiatry (2015) 15:144 changes in physical fitness ([7]; Wiborg et al, [11]) These findings implicate that neural mechanisms underlying these cognitions may play an important role in CFS. One neuroimaging study demonstrated that treatment of CFS with CBT increased grey matter volume in CFS patients These changes were located in the dorsolateral prefrontal cortex (DLPFC) [14], a region associated with cognitive-regulatory functions. We suggest that a reduction in fatigue and disability brought on by CBT for CFS is accompanied and possibly mediated by anatomical and functional changes in the brain
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