Online CBT is an effective treatment for chronic fatigue syndrome in adolescents, according to small RCT


Existing trials have shown that cognitive behavioural therapy is a promising treatment for chronic fatigue syndrome. The availability of CBT is patchy, so there is an increasing body of research investigating whether internet-based treatment is a viable alternative.

A new small randomised controlled trial conducted by researchers from the Netherlands has been published in the Lancet. The authors have developed a web treatment programme that specifically targets adolescents with chronic fatigue syndrome. It’s called Fatigue In Teenagers on the interNET or FITNET for short.

The trial randomised 135 adolescents to either FITNET or usual care (normally individual or group psychotherapy and exercise therapy) and measured a number of outcomes (school attendance, fatigue severity, and physical functioning) for a 6-month follow-up period. They conducted an intention to treat analysis.

The trial reports that FITNET was significantly more effective than usual care:

  • 75% of patients receiving FITNET achieved full school attendance, compared with 16% of the control group (relative risk 4·8, 95% CI 2·7—8·9; p<0·0001)
  • 85% of FITNET patients reported absence of severe fatigue, compared to 27% of controls (3·2, 2·1—4·9; p<0·0001)
  • 78% of FITNET patients reported normal physical functioning, compared with 20% of controls (3·8, 2·3—6·3; p<0·0001)
  • No serious adverse events were reported

It’s worth mentioning that the response to usual care (standard psychotherapy) is lower than has been reported in previous trials. It’s also important to note that this is a small single trial, so the results should be interpreted with caution.

The researchers are excited by the findings and very positive about their intervention. They concluded:

FITNET offers a readily accessible and highly effective treatment for adolescents with chronic fatigue syndrome. The results of this study justify implementation on a broader scale.

Dr Sanne L Nijhof MD,Prof Gijs Bleijenberg PhD,Cuno SPM Uiterwaal PhD,Prof Jan LL Kimpen PhD,Elise M van de Putte PhD. Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial. The Lancet – 1 March 2012. DOI: 10.1016/S0140-6736(12)60025-7. [Abstract]

Chronic fatigue syndrome, NHS Choices.

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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