Online treatment reaps rewards for teenagers with chronic fatigue

Researchers who studied the impact of the Fatigue In Teenagers on the interNET (FITNET) program on a group of adolescents found that the web-based treatment dramatically reduced fatigue, school absence, and physical dysfunction in just six months.

Under the FITNET program, patients can log in and send e-mails to trained cognitive behavioural psychotherapists at any time. Therapists respond to the e-consultations on set days, but also reply immediately to emergency emails.

The patients are expected to keep diaries, answer questionnaires, and take part in reviews of each step in their treatment.

For the study, researchers from The Netherlands recruited 135 adolescents who had suffered from chronic fatigue syndrome for almost 2 years; 68 were randomly assigned to FITNET and 67 to usual care, which consisted mainly of individual and group cognitive behavioral therapy or graded exercise therapy.

After six months, 85% of adolescents in FITNET group reported that they no longer suffered from severe fatigue, compared with 27% in the second group; 78% reported normal physical functioning, compared with 20%; while full school attendance was attained by 75% of students, compared with just 16%.

The results of the study are published online today in the journal The Lancet.

It is estimated that between 40,000 and 140,000 Australians suffer from chronic fatigue syndrome, a mysterious illness of unknown cause that may be linked to a virus. Patients complain they are routinely humiliated and ostracized by people who do not take their physical suffering seriously, because they regard the condition as a psychological, rather than a biological, one.

Sanne Nijhof from the University Medical Centre Utrecht in The Netherlands, and lead author of the research, said that with e-consultations, “effective treatment is within reach for any adolescent with [chronic fatigue syndrome]. These findings stress the need for proper and rapid diagnosis and making medical professionals aware of adolescent chronic fatigue and the treatment options.”

“Web-based treatment has general advantages: it is available at any time, avoids face-to-face treatment barriers – [such as] treatment delay due to poor accessibility, inconvenience of scheduling appointments, missing school or work, travelling to or from a clinician’s office – and reduces treatment time and costs.”

The report concluded that it was unclear which aspect of the FITNET program – “such as being readily accessible soon after diagnosis, 24-hour availability, anonymity, or professional feedback by a trained psychotherapist, is the reason for this increased effectiveness.”

Rosanne Coutts, an Accredited Exercise Physiologist and Lecturer in Sport and Exercise Psychology at Southern Cross University, said the results demonstrated the importance of the psychological aspects within treatment processes.

“By using the internet, which adolescents are very familiar with, they have met them "where they live”,“ Dr. Coutts said. "The patients also seemed fairly involved in what they did, it was quite self-driven, putting patients back in charge of their own recovery. Further detail about the actual physical activity conducted in both groups would be of interest and would assist with understanding any physiological changes that had also occurred.

“The study also relied on self-report, however even with consideration for some self-reporting bias the school attendance is a clear indicator of levels of recovery. Previous studies report a good prognosis for adolescents and this study again supports this.”

Professor Anthony Cleare, a consultant psychiatrist at the Institute of Psychiatry, Kings College London, said that although the effectiveness of cognitive behavioral therapy for chronic fatigue syndrome was beyond doubt, the lack of suitably trained therapists could limit benefits for patients.

“That an internet based therapy is so effective is very good news for patients who either cannot access a therapist, or who prefer therapy delivered over the internet,“ Professor Cleare said. "Indeed, the internet may be a particularly attractive medium for adolescents who have grown up accustomed to using it regularly.

“No one would suggest that the internet can replace face-to-face therapy, but this study suggests that it can certainly be a highly effective alternative in some patients."

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