Family Cognitive Behaviour Therapy Improves Functioning of Adolescents with Chronic Fatigue

By Harvey McConnell

A Doctor’s Guide (DG) Review of :”Family cognitive behaviour therapy for chronic fatigue syndrome: an uncontrolled study,” from the Archives of Disease in Childhood

Family focused cognitive behaviour therapy helps improve functioning and reduce fatigue in adolescents with chronic fatigue syndrome.

The benefits of family-focused cognitive behaviour therapy were maintained after six months of follow up, according to an uncontrolled study.

Trudie Chalder, MD, and colleagues at the academic department of psychological medicine, Guy’s, King’s and St Thomas’ School of Medicine, in London, United Kingdom, conducted a pilot study to determine the effectiveness of cognitive behaviour therapy (CBT) in 11-18 years olds with chronic fatigue syndrome (CSF).

Dr. Chalder points out, “Chronic fatigue syndrome, sometimes known as myalgic encephalomyelitis (ME), is a condition characterised by physical and mental fatigue, which is made worse by exercise, and is associated with profound disability.”

Muscle pain, headache, sore throat, and increased somnolence are typical syndrome characteristics in children, and disability can be profound. Children referred to specialist centres often have had long periods of time away from school, accompanied by impairment in social and leisure activities. Loss of peer relationships is frequent.

Few studies have examined the natural history of CFS in children. Although a systematic review has suggested that the prognosis is better in children than adults, with the majority of children showing clinical improvements at two years, “this is far from satisfactory given the impact on educational, physical, and social development. Left untreated, a substantial minority may develop long-term psychological and physical disabilities,” the clinicians noted.

“The subjective, heterogeneous nature of CFS makes it likely that a complex interaction of physiological, cognitive, behavioral, affective, and social factors are responsible for both its development and maintenance.” Research supporting this model is, however, scare.

Dr. Chalder and colleagues enrolled 20 girls and three boys with CSF and mean age of 15 years. Most of the adolescents had had symptoms for approximately two years and believed the syndrome was triggered by a viral infection.

The adolescents and their families participated in a CBT program designed to engage the young adults, with the help of their families, in their own rehabilitation. Both parties met for an hourly face-to-face session every two weeks, for up to 15 sessions. Follow-up was at three months, six months, and one year to assess progress and deal with any remaining issues. The aims of this treatment approach were establish a sleep routine, encourage social and leisure activities, reduce fatigue, and enable the adolescents to return to school.

Dr. Chalder and colleagues found that among the 20 adolescents who finished treatment, 18 had completed all measures at six months follow-up. Fifteen (83 percent) of the 18 adolescents improved according to predetermined criterion (fatigue scores <4 and attending school 75 percent of the time). In fact, all 20 adolescents returned to school at six months follow-up and 95 percent were at school full time. Substantial improvements in social adjustment, depression, and fear were also noted. "We attempt to normalise the experience of somatic symptoms and encourage children and their families not to catastrophise in response to them," the researchers write. "Contrary to popular belief it is not necessary to directly challenge individuals' or families' beliefs about the aetiology of the illness."

They conclude, “To our knowledge, the current study is the first of this size to evaluate the effectiveness of cognitive behaviour therapy for adolescents with CFS, delivered within the context of the family.”

The study findings prompted the researchers to evaluate the benefits of family therapy in a randomised, controlled study, which is currently underway.

Reference:

Archives Of Disease In Childhood 2002;86:95-97. “Family cognitive behaviour therapy for chronic fatigue syndrome: an uncontrolled study”

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