March 1, 2012

expert reaction to internet-based cognitive behavioural treatments for adolescents with CFS

The Lancet published research into the the effectiveness of a web-based program of cognitive behavioural therapy that appeared to reduce symptoms of chronic fatigue syndrome.

Professor Anthony Cleare, Consultant Psychiatrist, Institute of Psychiatry, Kings College London, said:

“Although the effectiveness of cognitive behavioural therapy for chronic fatigue syndrome is now beyond doubt, the lack of suitably trained therapists can limit the number of patients that can benefit.

“That an internet based therapy is so effective is very good news for patients who either cannot access a therapist, or who prefer therapy delivered over the internet. Indeed, the internet may be a particularly attractive medium for adolescents who have grown up accustomed to using it regularly.

“No one would suggest that the internet can replace face to face therapy, but this study suggests that it can certainly be a highly effective alternative in some patients.

“It is especially pleasing that such a large proportion of patients were able to return to full time schooling, since prolonged school absence can have profound long term effects on an individual.”

Dr Esther Crawley, Clinical lead, Bath specialist paediatric CFS/ME service, and Senior Lecturer, University of Bristol, said:

“CFS/ME in adolescents is an important, disabling and relatively common condition, but few affected teenagers in the UK have access to specialist support or help. Providing treatment and support via the internet is an attractive option for those treating adolescents, as it has the potential to improve access using a medium that is familiar to young people.

“Results from this well-conducted trial show a substantial improvement in school attendance, fatigue and physical function in those that accessed the FITNET internet-based intervention, compared to those that received usual care. A higher proportion of children in the FITNET arm described themselves as “completely recovered”. However, it is not entirely clear what treatment was given to adolescents randomized to the “usual care” arm, and how this compares to treatment offered in the UK. Participants in the FITNET arm probably received much more input from therapists than is currently available in the NHS: adolescents and their parents logged in 255 times on average, and the therapists provided an average 28 e-consults. Internet-based treatment may not be the right approach for all adolescents and, if implemented in the UK, should probably be one of several approaches available.”

Simon Wessely, Professor of Psychological Medicine, Institute of Psychiatry, King’s College London, said:

“This trial adds to the existing body of evidence that confirms that, as things stand today, CBT is the current best and safest treatment option for people with CFS. It’s not perfect, but not many things in medicine are. The next challenge is to ensure that every CFS sufferer in Britain can obtain the treatment, should they want it.”

‘Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial’ by Nijhof, S. et al., published in The Lancet on Thursday 1st March.