Cognitive Behavioural Therapy for Fatigue Reduction in Paediatric Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Systematic Review and Meta-Analysis

Abstract

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a condition primarily characterised by severe fatigue. In children and adolescents, the condition can have additional profound negative consequences, including increased school absences, psychiatric comorbidities, and significant family burden. Effective treatment to reduce symptoms and other negative consequences is therefore critical. While a gold standard of treatment does not currently exist, numerous studies have demonstrated cognitive behavioural therapy (CBT) to be effective in reducing fatigue severity. The present study conducted a systematic review and meta-analysis to determine the efficacy of different CBT methods in reducing fatigue severity in paediatric patients diagnosed with CFS/ME. Ten studies with a pooled sample of 363 children and adolescents were identified through a search of the Embase, PsychInfo, and PubMed databases. Reporting quality of the included studies was examined using the QualSyst tool. Using a random-effects model, standardised mean differences in fatigue severity scores between pre- and post-CBT were calculated. Heterogeneity, risk of bias, and subgroup analysis of CBT delivery format (including standard, family-focused, and remote) were also investigated. CBT was found to have a large effect in reducing fatigue severity, and no significant difference was found between different therapy delivery formats. However, significant heterogeneity suggests limitations in drawing conclusions from these results. CBT should be recommended to paediatric CFS/ME patients in the form which is most appropriate for the individual. Determining the aetiology of the condition is crucial in order to further develop and improve treatment options.