Testing the efficacy of web-based cognitive behavioural therapy for adult patients with chronic fatigue syndrome (CBIT): study protocol for a randomized controlled trial.

Anthonie Janse,Stephanie Nikolaus,Gijs Bleijenberg,José Bussel-Lagarde,Margreet Worm-Smeitink,Hans Knoop

doi:10.1186/s12883-015-0392-3

Abstract

BackgroundCognitive behavioural therapy (CBT) is an effective treatment for fatigue and disabilities in patients with chronic fatigue syndrome (CFS). However, treatment capacity is limited. Providing web-based CBT and tailoring the amount of contact with the therapist to the individual needs of the patient may increase the efficiency of the intervention. Web-based CBT for adolescents with CFS has proven to be effective in reducing fatigue and increasing school attendance. In the proposed study the efficacy of a web-based CBT intervention for adult patients with CFS will be explored. Two different formats of web-based CBT will be tested. In the first format named protocol driven feedback, patients report on their progress and receive feedback from a therapist according to a preset schedule. In the second format named support on demand, feedback and support of the therapist is only given when patients ask for it. The primary objective of the study is to determine the efficacy of a web-based CBT intervention on fatigue severity.Method/DesignA randomized clinical trial will be conducted. Two-hundred-forty adults who have been diagnosed with CFS according to the US Centers for Disease Control and Prevention (CDC) consensus criteria will be recruited and randomized to one of three conditions: web-based CBT with protocol driven feedback, web-based CBT with support on demand, or wait list. Feedback will be delivered by therapists specialized in CBT for CFS. Each of the web-based CBT interventions will be compared to a wait list condition with respect to its effect on the primary outcome measure; fatigue severity. Secondary outcome measures are level of disability, physical functioning, psychological distress, and the proportion of patients with clinical significant improvement in fatigue severity. Outcomes will be assessed at baseline and six months post randomization. The web-based CBT formats will be compared with respect to the time therapists need to deliver the intervention.DiscussionAs far as we know this is the first randomized controlled trial (RCT) that evaluates the efficacy of a web-based CBT intervention for adult patients with CFS.Trial registrationNTR4013

Highlights

Cognitive behavioural therapy (CBT) is an effective treatment for fatigue and disabilities in patients with chronic fatigue syndrome (CFS)
As far as we know this is the first randomized controlled trial (RCT) that evaluates the efficacy of a web-based CBT intervention for adult patients with CFS
Chronic fatigue syndrome (CFS) i.e. often named Myalgic encephalomyelitis/encephalopathy (ME) by patient groups is characterised by medically unexplained, severe, and persisting fatigue that leads to substantial disability

Summary

Introduction

Cognitive behavioural therapy (CBT) is an effective treatment for fatigue and disabilities in patients with chronic fatigue syndrome (CFS). Providing web-based CBT and tailoring the amount of contact with the therapist to the individual needs of the patient may increase the efficiency of the intervention. Cognitive behavioural therapy (CBT) for CFS is an effective treatment [4], leading to a significant reduction of fatigue and disabilities. For a subgroup of about 25 to 30 % of CFS patients the level of fatigue was within normal limits following the intervention. This is less than in face-to-face CBT. Stepped care started with guided self-instruction and, if insufficient, was followed by regular face-to-face CBT. Stepped care was as effective as face-to-face CBT but more time efficient as therapists had to invest less time per patient [13]

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