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CBT, graded exercise therapy have long-term positive effects for chronic fatigue syndrome

Cognitive behavioral therapy and graded exercise therapy for chronic fatigue syndrome maintained positive outcomes over 2.5 years of follow-up, according to finding in Lancet Psychiatry.

“In March 2005, we started the PACE trial, a multicenter randomized trial to compare outcomes after the most commonly used nonpharmacological treatments in patients with chronic fatigue syndrome. When we planned the trial, some evidence had shown that cognitive behavioral therapy (CBT) and graded exercise therapy could improve patient outcomes. However, these rehabilitative treatments were controversial among patient organizations who regarded adaptive pacing therapy and specialist medical care as better alternatives,” Michael Sharpe, MD, of the University of Oxford, United Kingdom, and colleagues wrote. “The trial found that at 1 year (52 weeks) follow-up from randomization, patients allocated to CBT or [graded exercise therapy] had significantly greater improvements in their fatigue and physical functioning than had those allocated to either [adaptive pacing therapy] or to [specialist medical care] alone.”

To assess additional treatments received after the PACE trial and evaluate long-term outcomes at least 2 years after randomization, researchers sent postal questionnaires to study participants. Between May 2008 and April 2011, 481 participants returned questionnaires with a median time from randomization to return of follow-up of 31 months.

Of the 481 respondents, 210 (44%) received additional treatment, mostly CBT or graded exercise therapy, after the trial.

Study participants originally assigned to specialist medical care (63%) or adaptive pacing therapy (50%) alone were more likely to seek treatment than participants originally assigned to graded exercise therapy (32%) or CBT (31%) (P < .0001).

Improvements in fatigue and physical functioning reported by participants originally assigned to CBT or graded exercise therapy were maintained, according to researchers.

Study participants assigned to specialist medical care or adaptive pacing therapy alone exhibited greater improvements in fatigue and physical functioning during the long-term follow-up period compared with 1 year.

Researchers found little evidence of differing outcomes among randomized treatment groups at long-term follow-up.

“We conclude that the benefits of CBT and [graded exercise therapy] on fatigue and physical functioning are maintained at a median of 2.5 years from randomization and 2 years after the main treatment period ended,” Sharpe and colleagues wrote. “Outcomes with [specialist medical care] alone or [adaptive pacing therapy] improved from the 1 year outcome and were similar to CBT and [graded exercise therapy] at long-term follow-up, but these data should be interpreted in the context of additional therapies having being given according to physician choice and patient preference after the 1 year trial final assessment. Future research should identify predictors of response to CBT and [graded exercise therapy] and also develop better treatments for those who respond to neither.” – by Amanda Oldt

Disclosure: Sharpe reports receiving royalties from Oxford University Press. Please see the full study for a list of all authors’ relevant financial disclosures.