BMJ  2005;330:790 (2 April), doi:10.1136/bmj.330.7494.790

Letter

Cognitive behaviour therapy for adolescents with chronic fatigue syndrome

Authors' reply

EDITOR—Chaudhuri's concerns relate to a possible placebo effect and the way we treat our patients. We consider it unlikely that the positive effects of our treatment are attributable mainly to non-specific treatment factors, since the results were maintained at eight month follow up even in the absence of contacts with the therapist (unpublished data). Moreover, others have shown that cognitive behaviour therapy was more effective than attention control conditions shortly after treatment and at long term follow-up.^1-3

At the start of therapy all patients experienced severe limitations in performing activities appropriate to age. A characteristic belief of patients with chronic fatigue syndrome, especially in case of passive patients, is that fatigue is made worse by exercise. This cognition, although functional in the first phase of the condition, is dysfunctional in the longer term and maintains activity avoidance and symptoms. By challenging these and other activity related cognitions, activity regulation is possible. Thus, patients are taught to regulate and increase their physical and other activities in a systematic and safe way. Our results show that this is possible. The distinction between physically passive and relatively active patients, based on actometry, is helpful to select the correct approach to help the patient.

As in other chronic conditions, we do not have one treatment that leads to recovery in all patients. We believe that our study clearly shows that many of the participants benefited from cognitive behaviour therapy and were able to function as normal adolescents again.

Radboud University Nijmegen Medical Centre, Expert Centre Chronic Fatigue, PO Box 9101, 6500 HB Nijmegen, Netherlands

G.Bleijenberg{at}nkcv.umcn.nl Radboud University Nijmegen Medical Centre, Expert Centre Chronic Fatigue, PO Box 9101, 6500 HB Nijmegen, Netherlands

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Competing interests: None declared.

References

1. Prins JB, Bleijenberg G, Bazelmans E, Elving LD, de Boo Th, Severens JL, et al. Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial. Lancet 2001;357: 841-7.[CrossRef][ISI][Medline]
2. Deale A, Chalder T, Marks I, Wessely S. Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial. Am J Psychiatry 1997;154: 408-14.[Abstract]
3. Deale A, Husain K, Chalder T, Wessely S. Long term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study. Am J Psychiatry 2001;158: 2038-42.[Abstract/Free Full Text]

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Cognitive behaviour therapy for adolescents with chronic fatigue syndrome -- reply to Gijs Bleijenberg, professor

Steven B. DuPre
bmj.com, 8 Apr 2005 [Full text]