Cognitive-behavioural therapy combined with music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents: a randomised controlled trial

Sadaf Malik, Tarjei Tørre Asprusten, Maria Pedersen, Julie Mangersnes, Gro Trondalen, Betty van Roy, Eva Skovlund, Vegard Bruun Wyller, Sadaf Malik, Tarjei Tørre Asprusten, Maria Pedersen, Julie Mangersnes, Gro Trondalen, Betty van Roy, Eva Skovlund, Vegard Bruun Wyller

Abstract

Background: Cognitive-behavioural therapy (CBT) is effective in chronic fatigue (CF) syndrome. However, CBT has not been investigated in postinfectious CF, nor is it known whether addition of therapeutic elements from other disciplines might be useful. We explored combined CBT and music therapy intervention for CF following Epstein-Barr virus (EBV) infection in adolescents.

Methods: Adolescents (12-20 years old) participating in a postinfectious cohort study who developed CF 6 months after an acute EBV infection were eligible for the present study. A combined CBT and music therapy programme (10 therapy sessions and related homework) was compared with care as usual in a randomised controlled design. Therapists and participants were blinded to outcome evaluation. Endpoints included physical activity (steps/day), symptom scores, recovery rate and possible harmful effects, but the study was underpowered regarding efficacy. Total follow-up time was 15 months. Power analyses suggested that 120 participants would be needed in order to detect a moderate effect size.

Results: A total of 91 individuals with postinfectious CF were eligible, and a total of 43 were included (21 intervention group, 22 control group). Concern regarding school absence due to therapy sessions was the main reason for declining participation. Seven individuals left the study during the first 3 months, leaving 15 in the intervention group and 21 in the control group at 3 months follow-up. No harmful effects were recorded, and compliance with appointment was high. In intention-to-treat analyses, the primary endpoint (number of steps/day) did not differ significantly between the intervention group and the control group (difference (95% CI) =-1298 (-4874 to 2278)). Secondary outcome measures were also not significantly different among the two groups.

Conclusion: An intervention study of combined CBT and music therapy in postinfectious CF is feasible. A fully powered trial is needed to evaluate efficacy; participants' concern regarding school absence should be properly addressed to secure recruitment.

Trial registration number: ClinicalTrials ID: NCT02499302, registered July 2015.

Keywords: adolescent health.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow chart of study participants. CFQ, Chalder Fatigue Questionnaire; EBV, Epstein-Barr virus; RCT, randomised controlled trial.
Figure 2
Figure 2
Graphical depiction of the 10 therapy sessions in the mental training programme. CBT, cognitive–behavioural therapy.
Figure 3
Figure 3
Development of steps/day and fatigue score over time in the intervention group (red) and the control group (blue), based on imputed data sets. The grey area represent the time period in which the mental training programme was provided. EBV, Epstein-Barr virus.

References

    1. Hickie I, Davenport T, Wakefield D, et al. . Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ 2006;333:575. 10.1136/
    1. Katz BZ, Shiraishi Y, Mears CJ, et al. . Chronic fatigue syndrome after infectious mononucleosis in adolescents. Pediatrics 2009;124:189–93. 10.1542/peds.2008-1879
    1. Institute of Medicine Beyond myalgic Encephalomyelitis/Chronic fatigue syndrome: redefining an illness. Washington, DC: The National Academies Press, 2015.
    1. Royal College of Paediatrics and Child Health Evidence based guidelines for the management of CFS/ME (chronic fatigue syndrome/myalgic encephalopathy) in children and young adults. London: Royal College of Paediatrics and Child Health, 2004.
    1. White PD, Goldsmith KA, Johnson AL, et al. . Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 2011;377:823–36. 10.1016/S0140-6736(11)60096-2
    1. Nijhof SL, Bleijenberg G, Uiterwaal CSPM, et al. . Effectiveness of Internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial. Lancet 2012;379:1412–8. 10.1016/S0140-6736(12)60025-7
    1. Abrahams HJG, Gielissen MFM, Donders RRT, et al. . The efficacy of Internet-based cognitive behavioral therapy for severely fatigued survivors of breast cancer compared with care as usual: a randomized controlled trial. Cancer 2017;123:3825–34. 10.1002/cncr.30815
    1. Menting J, Tack CJ, van Bon AC, et al. . Web-Based cognitive behavioural therapy blended with face-to-face sessions for chronic fatigue in type 1 diabetes: a multicentre randomised controlled trial. Lancet Diabetes Endocrinol 2017;5:448–56. 10.1016/S2213-8587(17)30098-0
    1. Cella M, Chalder T, White PD. Does the heterogeneity of chronic fatigue syndrome moderate the response to cognitive behaviour therapy? an exploratory study. Psychother Psychosom 2011;80:353–8. 10.1159/000327582
    1. Rimes KA, Wingrove J. Mindfulness-based cognitive therapy for people with chronic fatigue syndrome still experiencing excessive fatigue after cognitive behaviour therapy: a pilot randomized study. Clin Psychol Psychother 2013;20:107–17. 10.1002/cpp.793
    1. Viner R, Gregorowski A, Wine C, et al. . Outpatient rehabilitative treatment of chronic fatigue syndrome (CFS/ME). Arch Dis Child 2004;89:615–9. 10.1136/adc.2003.035154
    1. Crawley EM, Gaunt DM, Garfield K, et al. . Clinical and cost-effectiveness of the lightning process in addition to specialist medical care for paediatric chronic fatigue syndrome: randomised controlled trial. Arch Dis Child 2018;103:155–64. 10.1136/archdischild-2017-313375
    1. Stubhaug B, Lier HO, Aßmus J, et al. . A 4-day Mindfulness-Based cognitive behavioral intervention program for CFS/ME. an open study, with 1-year follow-up. Front Psychiatry 2018;9:720. 10.3389/fpsyt.2018.00720
    1. Bradt J, Dileo C, Potvin N. Music for stress and anxiety reduction in coronary heart disease patients. Cochrane Database Syst Rev 2013;12:CD006577. 10.1002/14651858.CD006577.pub3
    1. Bradt J, Shim M, Goodill SW, Dileo C. Dance/movement therapy for improving psychological and physical outcomes in cancer patients. Cochrane Database Syst Rev 2015;1:CD007103. 10.1002/14651858.CD007103.pub3
    1. Torres E. Group Music and Imagery (GMI) for Treating Fibromyalgia : Grocke D, Moe T, Guided Imagery & Music (GIM) and Music Imagery Methods for Individual and Group Therapy. London: Jessica Kingsley, 2015: 267–76.
    1. Beck BD. Guided imagery and music (GIM) with adults on sick leave suffering from work-related stress Aalborg University; 2012.
    1. Pedersen M, Asprusten TT, Godang K, et al. . Predictors of chronic fatigue in adolescents six months after acute Epstein-Barr virus infection: a prospective cohort study. Brain Behav Immun 2019;75:94–100. 10.1016/j.bbi.2018.09.023
    1. Chalder T, Berelowitz G, Pawlikowska T, et al. . Development of a fatigue scale. J Psychosom Res 1993;37:147–53. 10.1016/0022-3999(93)90081-P
    1. Grant PM, Ryan CG, Tigbe WW, et al. . The validation of a novel activity monitor in the measurement of posture and motion during everyday activities. Br J Sports Med 2006;40:992–7. 10.1136/bjsm.2006.030262
    1. Tanaka M, Fukuda S, Mizuno K, et al. . Reliability and validity of the Japanese version of the Chalder fatigue scale among youth in Japan. Psychol Rep 2008;103:682–90. 10.2466/pr0.103.3.682-690
    1. Loge JH, Ekeberg O, Kaasa S. Fatigue in the general Norwegian population: normative data and associations. J Psychosom Res 1998;45:53–65. 10.1016/s0022-3999(97)00291-2
    1. Klepstad P, Loge JH, Borchgrevink PC, et al. . The Norwegian brief pain inventory questionnaire: translation and validation in cancer pain patients. J Pain Symptom Manage 2002;24:517–25. 10.1016/s0885-3924(02)00526-2
    1. Engel JM, Kartin D, Carter GT, et al. . Pain in youths with neuromuscular disease. Am J Hosp Palliat Care 2009;26:405–12. 10.1177/1049909109346165
    1. Akerstedt T, Ingre M, Broman J-E, et al. . Disturbed sleep in shift workers, day workers, and insomniacs. Chronobiol Int 2008;25:333–48. 10.1080/07420520802113922
    1. Pedersen M, Ekstedt M, Småstuen MC, et al. . Sleep-Wake rhythm disturbances and perceived sleep in adolescent chronic fatigue syndrome. J Sleep Res 2017;26:595–601. 10.1111/jsr.12547
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–70. 10.1111/j.1600-0447.1983.tb09716.x
    1. Mihalca AM, Pilecka W. The factorial structure and validity of the hospital anxiety and depression scale (HADS) in Polish adolescents. Psychiatr Pol 2015;49:1071–88. 10.12740/PP/38139
    1. Reinfjell T, Diseth TH, Veenstra M, et al. . Measuring health-related quality of life in young adolescents: reliability and validity in the Norwegian version of the pediatric quality of life inventory 4.0 (PedsQL) generic core scales. Health Qual Life Outcomes 2006;4:61. 10.1186/1477-7525-4-61
    1. Walker LS, Greene JW. The functional disability inventory: measuring a neglected dimension of child health status. J Pediatr Psychol 1991;16:39–58. 10.1093/jpepsy/16.1.39
    1. Claar RL, Walker LS. Functional assessment of pediatric pain patients: psychometric properties of the functional disability inventory. Pain 2006;121:77–84. 10.1016/j.pain.2005.12.002
    1. Department of Pediatrics, Akershus University Hospital Mental intervention for chronic fatigue syndrome (CFS/ME) following acute Epstein-Barr virus infection. treatment manual for the intervention part of the CEBA-project; 2015.
    1. Tee J, Kazantzis N. Collaborative empiricism in cognitive therapy: a definition and theory for the relationship construct. Clin Psychol Sci Prac 2011;18:47–61. 10.1111/j.1468-2850.2010.01234.x
    1. Sulheim D, Fagermoen E, Winger A, et al. . Disease mechanisms and clonidine treatment in adolescent chronic fatigue syndrome: a combined cross-sectional and randomized clinical trial. JAMA Pediatr 2014;168:351–60. 10.1001/jamapediatrics.2013.4647
    1. Von Hippel PT. How many imputations do you need? A two-stage calculation using a quadratic rule. Sociological Methods & Research 2018.
    1. Larun L, Brurberg KG, Odgaard-Jensen J, et al. . Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev 2016;2:CD003200. 10.1002/14651858.CD003200.pub4
    1. Clark LV, Pesola F, Thomas JM, et al. . Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial. Lancet 2017;390:363–73. 10.1016/S0140-6736(16)32589-2
    1. Kindlon T. Do graded activity therapies cause harm in chronic fatigue syndrome? J Health Psychol 2017;22:1146–54. 10.1177/1359105317697323
    1. Vink M, Vink-Niese A. Graded exercise therapy for myalgic Encephalomyelitis/Chronic fatigue syndrome is not effective and unsafe. Re-analysis of a cochrane review. Health Psychol Open 2018;5:2055102918805187. 10.1177/2055102918805187
    1. Trondalen G, Mangersnes J, Bonde LO, et al. . Music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents. Music & Med 2020;12:84–91.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner