Internet-Based Cognitive Behavioral Therapy May Reduce Fatigue and Increase School Attendance in Adolescents with Chronic Fatigue Syndrome

DynaMed Weekly Update - Volume 7, Issue 21

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Chronic fatigue syndrome is characterized by severe, disabling fatigue lasting at least 6 months in combination with other symptoms, including musculoskeletal pain, sleep disturbance, and impaired concentration. In adolescents, it may cause extended school absence and impaired academic and social functioning. Cognitive behavioral therapy (CBT) has shown promise for treating chronic fatigue syndrome in adolescents (BMJ 2005 Jan 1;330(7481):14), but access to treatment can be problematic. A new randomized trial evaluated the efficacy of a 6-month internet-based CBT program (FITNET) in 135 adolescents (mean age 16 years, 82% girls) with chronic fatigue syndrome in the Netherlands.

The FITNET program included 21 interactive modules for the patients to work through on the computer, plus support from a trained CBT therapist through email. Patients could send email at any time and received responses once per week at the beginning of the program and later once every 2 weeks. They also received psychoeducational materials and were assigned a school mentor who acted as a coach, advisor, and tutor. In addition, there was a program for parents including email correspondence with the therapist. The control group received usual care with individual and group rehabilitation programs including face-to-face CBT and physical therapy.

At 6 months, the absence of severe fatigue was reported by 85% with FITNET vs. 27% with usual care (p < 0.0001, NNT 2), and full school attendance (defined as < 10% absenteeism) was significantly increased in the FITNET group (75% vs. 16%, p < 0.0001, NNT 2) (level 2 [mid-level] evidence). FITNET was also associated with an increase in normal physical functioning (78% vs. 20%, p < 0.0001, NNT 2) and greater rates of patients reporting a self-rating of completely recovered or much better (78% vs. 27%, p < 0.001, NNT 2) (Lancet 2012 Apr 14;379(9824):1412). FITNET is currently available only in Dutch.

For more information, see the Chronic fatigue syndrome topic in DynaMed.