A new study published online in the Lancet presents the results of a comprehensive research project examing the benefits of cognitive behaviour therapy and graded exercise therapy in the treatment of chronic fatigue syndrome. Despite ongoing controversy over its nature, cause and treatment, chronic fatigue syndrome (CFS) is believed to affect millions of people worldwide. Generally defined by a persistent fatigue unrelated to exertion, not substantially relieved by rest and accompanied by the presence of other specific symptoms for a minimum of six months, the disease (or diseases) appears multi-systemic in nature and is classified by the World Health Organization as a disorder of the nervous system. There is currently no reliable diagnostic test or biomarker.
To examine the comparative benefits of four different treatments in treating CFS patients, a prospective research project was launched by a team of researchers from the University of London and the University of Edinburgh. Known as the PACE study (Pacing, Graded Activity, Cognitive Behaviour Therapy: a Randomized Evaluation), the project was designed as a parallel-group randomized trial comparing the relative benefits of cognitive behaviour therapy (CBT), graded exercise therapy (GET), adaptive pacing therapy (APT), and standardised specialist medical care (SSMC). SSMC typically involves providing patients with information on their condition and advice on coping strategies. APT focuses on helping patients structure their activities to match their reduced energy levels.
Using a sample of 640 patients meeting Oxford criteria for CFS, the study participants were randomly assigned to treatment groups receiving SSMC alone or SSMC in conjunction with one of the other three treatments. Patients in the parallel treatment groups received monthly individual therapy sessions as well as group therapy sessions every three months. Approximately 75 per cent of the study participants were women with a mean age of 38 years. Average duration of CFS symptoms was 32 months. Results after one year have shown that those participants who received CBT and GET in conjunction with conventional medical care showed moderate improvement over the participants in the other two groups. Over 60 per cent of patients reported reduced fatigue and improved functioning while 30 per cent reported no change. Despite the preliminary nature of the results, the study authors emphasize that it provides robust evidence of the value of CBT and GET in treating chronic fatigue patients. The results also show that adaptive pacing strategies, often advocated by patient groups, have no apparent benefit in treating CFS.
In an accompanying Lancet editorial, Dr. Gijs Bleijenberg and Dr. Hans Knoop of Radboud University Nijmegen (Netherlands) Medical Centre stated that, "Although the PACE trial shows that recovery from chronic fatigue syndrome is possible, there is clearly room for improvement with both interventions (cognitive behaviour therapy and graded exercise therapy)" They also emphasize that CBT and GET provide symptom relief only but do not address the underlying cause of CFS.