Service based comparison of group cognitive behavior therapy to waiting list control for chronic fatigue syndrome with regard to symptom reduction and positive psychological dimensions
Authors: Helen Lyon Jones
Louise Barber
Sanam Farman
Adrian Heald
Andreas Walther
Journal: Medicine (2019)
Discipline: CLINICAL MEDICINE
Keywords: Chronic fatigue syndrome; cognitive behavioral therapy; group therapy; effectiveness; psychological effects
Affiliations: Department of Endocrinology., Department of Clinical Psychology, Salford Royal NHS Foundation Trust, University of Manchester, Salford., Mersey Deanery Psychiatry Rotation, Liverpool, UK., Biological Psychology, TU Dresden, Dresden, Germany.

Abstract:  Background: Although chronic fatigue syndrome (CFS) sometimes referred to as myalgic encephalomyelitis (ME) is a very challenging condition to treat, there is evidence that individual cognitive behavioral therapy (ICBT) can be effective for treatment and management of its symptoms. Furthermore, group cognitive behavioral therapy (GCBT) is emerging as promising treatment for the condition.The aim of the present study was to explore further the effectiveness of GCBT in a routine clinical setting and to investigate associated positive psychological effects related to GCBT. Methods: In this pragmatic, non-randomized, controlled trial, 28 people acted as their own waiting list control by completing a range of measures 8 weeks prior to taking part in the GCBT. The intervention consisted of 8 consecutive weeks of 2.5-hour sessions. Results: Repeated measures analysis of covariance revealed significant improvements in physical fatigue (F = 28.31, P &lt; .01, effect size d = 0.52), mental fatigue (F = 7.72, P &lt; .01, effect size d = 0.22), and depressive symptoms (Beck depression inventory-fast screen for medical individuals [BDI-FS]: F = 11.43, P &lt; .01, effect size d = 0.30; hospital anxiety and depression scale [HADS-D]: F = 16.72, P &lt; .01, effect size d = 0.38) compared with the waiting list. Improvements in quality of life (F = 7.56, P &lt; .01, effect size d = 0.23), hope (F = 15.15, P &lt; .01, effect size d = 0.36), and optimism (F = 8.17, P &lt; .01, effect size d = 0.23) were also identified, but no change was reported for anxiety levels. Global outcome measures revealed that the majority of the individuals found the treatment beneficial and were satisfied with the results. Conclusion: GCBT is a beneficial and cost-effective treatment that individuals find amenable in routine clinical practice for CFS. Additionally we have described important effects emerged on positive psychological dimensions such as hope and optimism potentially enhancing the overall benefit. 

Retracted: No

PubPeer comments:
 The study is open-label and the primary outcome is subjective, hence the study is exposed to bias. However, it is the patient cohort which cause the greatest concern. In 2015, National Academy of Medicine (NAM, former IOM) published their u201cBeyond Myalgic Encephalomyelitis Chronic Fatigue Syndrome: Redefining an Illnessu201d. Among other, the NAM-report state that post-exertional malaise (PEM) is a hallmark of ME, and a mandatory symptom for the ME-diagnosis. The consequences of NAMu2019 conclusion is that case criteria including PEM as a mandatory symptom (like CCC, ICC or SEID) have to be used in recruiting study participants. https: www.nap.edu catalog 19012 beyond-myalgic-encephalomyelitischronic-fatigue-syndrome-redefining-an-illness This paper does not use diagnostic criteria were PEM is a mandatory symptom, as described by NAM. Consequently, the study does not necessarily include ME-patients, and for that reason do not have any relevance in understanding the disease, treatment, and care of ME-patients. Summary: This study suffers from great bias due to poor study design and caused by the use of improper case criteria, the patients are a very heterogeneous group not necessarily suffering from ME. For others intending to study ME and ME-patients, citing this paper should be done with caution! ,