Cognitive behavioral therapy found to be beneficial for patients with myalgic encephalomyelitis/chronic fatigue syndrome

Researchers from Amsterdam UMC and King's College London have shown that cognitive behavioral therapy (CBT) is beneficial for those with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). They analyzed data from trials involving almost 1,300 patients and found that CBT led to a reduction in fatigue and physical limitations. These results are published today in Psychological Medicine.

"We found CBT led to a clinically relevant reduction in fatigue and functional impairment as well as an increase in physical functioning. These results give a clear picture that CBT can be beneficial for a substantial number of patients. About half were no longer severely fatigued after treatment," says Professor Hans Knoop, Clinical Psychologist at Amsterdam UMC and leader of the research group.

Who benefits?

It is often assumed that patients who experience an increase of symptoms following exertion, also known as post-exertional malaise (PEM), do not profit from CBT or, even, that CBT makes their symptoms worse. The researchers tried to determine for which patients CBT was beneficial. They found that patients could profit from CBT irrespective of which symptoms they experienced or how ME/CFS was diagnosed.

There were differences between patients in the extent they benefitted from CBT: Younger patients, patients with less functional impairment and patients who were still relatively active profited more from CBT.

"Reporting more functional impairments and being physical inactive may indicate more severe disease and this subgroup of patients probably needs additional or more intensive treatment," says Tanja Kuut, clinical psychologist at Amsterdam UMC and lead author of this study.

Findings contradict guidelines

In 2021, NICE, the British National Institute of Clinical Excellence, published new guidelines for ME/CFS. They not only proposed to use a new case definition for ME/CFS but concluded that CBT may merely support patients in managing symptoms but cannot be seen as a treatment that can reduce symptoms and help recovery. This conclusion was partly based on the lack of evidence of the efficacy of CBT when certain (new) case definitions of ME/CFS were used to diagnose it or when PEM was reported by patients.

The findings of the new study show that CBT can also be effective for patients with PEM and those diagnosed using the new case definitions. In the eyes of Knoop and Kuut, this is encouraging news for patients, and it provides guidance for health care providers who were uncertain which patients they should refer to CBT.