On 2013 Nov 16, Ellen M Goudsmit commented:

This paper does not report the data from the motion sensing device used (Van Essen and De Winter). These showed no significant differences between the groups after treatment. Thus any improvement can not be attributed to increases in activity as was later supported by Wiborg and several other papers from this team (see comment Kindlon, T). A letter discussing the data by Goudsmit was rejected for publication by the Lancet.

The reasons for the documented improvements remain unclear. Of note is that all the trials used a broadly-defined samples (i.e., selected using the Oxford or CDC criteria) and there is no data on the effect of CBT on symptoms other than fatigue and sleep. There has been no trial of CBT on patients with acute onset post-viral syndromes.

The current protocols for CBT promoted for CFS are aimed primarily at increasing activity. There is evidence that pacing, an alternative strategy to manage activity is of help in stabilising the condition and avoiding exertion-related exacerbations. This strategy can be used alongside CBT or any other intervention (for review, see Goudsmit et al).

1. Van Essen M, de Winter LJM. Cognitieve gedragstherapie by het chronisch vermoeidheidssyndroom (cognitive behavior therapy for chronic fatigue syndrome). (Report No. 02/111, Appendix B). Amstelveen, Netherlands: College voor Zorgverzekeringen (CVZ). 2002.

2. Goudsmit, EM., Jason, LA, Nijs, J and Wallman, KE. Pacing as a strategy to improve energy management in myalgic encephalomyelitis/chronic fatigue syndrome: A consensus document. Disability and Rehabilitation, 2012, 34, 13, 1140-1147. doi: 10.3109/09638288.2011.635746.

On 2013 Oct 24, Tom Kindlon commented:

Actometer data from this trial was published in 2010 - no improvements were found in this objective outcome measure for the CBT group over controls

Subjective improvements following cognitive behavioural therapy (CBT) for chronic fatigue syndrome (CFS) do not necessarily mean objective improvements were obtained.

This trial is an example of this.

Nine years after this paper was published, the mean (standard deviations) for the CBT and Control groups were released:¹ 67.4 (21.8) and 64.5 (19.7) before treatment and 68.8 (25.2) and 64.9 (21.7) at the second assessment. Different devices can be used to measure activity levels; for the actometers used in this study, healthy controls were previously found to have a mean Actometer score of 91 (S.D.=25).² That study found that the mean Actometer score of tested CFS patients was 66 (S.D.=22).²

References:

1 Wiborg JF, Knoop H, Stulemeijer M, Prins JB, Bleijenberg G. How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity. Psychol Med. 2010 Jan 5:1-7.

2 Van der Werf SP, Prins JB, Vercoulen JH, van der Meer JW, Bleijenberg G (2000). Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment. Journal of Psychosomatic Research 49, 373-379.

On 2013 Oct 24, Tom Kindlon commented:

Actometer data from this trial was published in 2010 - no improvements were found in this objective outcome measure for the CBT group over controls

Subjective improvements following cognitive behavioural therapy (CBT) for chronic fatigue syndrome (CFS) do not necessarily mean objective improvements were obtained.

This trial is an example of this.

Nine years after this paper was published, the mean (standard deviations) for the CBT and Control groups were released:¹ 67.4 (21.8) and 64.5 (19.7) before treatment and 68.8 (25.2) and 64.9 (21.7) at the second assessment. Different devices can be used to measure activity levels; for the actometers used in this study, healthy controls were previously found to have a mean Actometer score of 91 (S.D.=25).² That study found that the mean Actometer score of tested CFS patients was 66 (S.D.=22).²

References:

1 Wiborg JF, Knoop H, Stulemeijer M, Prins JB, Bleijenberg G. How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity. Psychol Med. 2010 Jan 5:1-7.

2 Van der Werf SP, Prins JB, Vercoulen JH, van der Meer JW, Bleijenberg G (2000). Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment. Journal of Psychosomatic Research 49, 373-379.

On 2013 Nov 16, Ellen M Goudsmit commented:

This paper does not report the data from the motion sensing device used (Van Essen and De Winter). These showed no significant differences between the groups after treatment. Thus any improvement can not be attributed to increases in activity as was later supported by Wiborg and several other papers from this team (see comment Kindlon, T). A letter discussing the data by Goudsmit was rejected for publication by the Lancet.

The reasons for the documented improvements remain unclear. Of note is that all the trials used a broadly-defined samples (i.e., selected using the Oxford or CDC criteria) and there is no data on the effect of CBT on symptoms other than fatigue and sleep. There has been no trial of CBT on patients with acute onset post-viral syndromes.

The current protocols for CBT promoted for CFS are aimed primarily at increasing activity. There is evidence that pacing, an alternative strategy to manage activity is of help in stabilising the condition and avoiding exertion-related exacerbations. This strategy can be used alongside CBT or any other intervention (for review, see Goudsmit et al).

1. Van Essen M, de Winter LJM. Cognitieve gedragstherapie by het chronisch vermoeidheidssyndroom (cognitive behavior therapy for chronic fatigue syndrome). (Report No. 02/111, Appendix B). Amstelveen, Netherlands: College voor Zorgverzekeringen (CVZ). 2002.

2. Goudsmit, EM., Jason, LA, Nijs, J and Wallman, KE. Pacing as a strategy to improve energy management in myalgic encephalomyelitis/chronic fatigue syndrome: A consensus document. Disability and Rehabilitation, 2012, 34, 13, 1140-1147. doi: 10.3109/09638288.2011.635746.