Efficacy of web-based cognitive-behavioural therapy for chronic fatigue syndrome: randomised controlled trial

Br J Psychiatry. 2018 Feb;212(2):112-118. doi: 10.1192/bjp.2017.22.


Background: Face-to-face cognitive-behavioural therapy (CBT) leads to a reduction of fatigue in chronic fatigue syndrome (CFS). Aims To test the efficacy of internet-based CBT (iCBT) for adults with CFS.

Method: A total of 240 patients with CFS were randomised to either iCBT with protocol-driven therapist feedback or with therapist feedback on demand, or a waiting list. Primary outcome was fatigue severity assessed with the Checklist Individual Strength (Netherlands Trial Register: NTR4013).

Results: Compared with a waiting list, intention-to-treat (ITT) analysis showed a significant reduction of fatigue for both iCBT conditions (protocol-driven feedback: B = -8.3, 97.5% CI -12.7 to -3.9, P < 0.0001; feedback on demand: B = -7.2, 97.5% CI -11.3 to -3.1, P < 0.0001). No significant differences were found between both iCBT conditions on all outcome measures (P = 0.3-0.9). An exploratory analysis revealed that feedback-on-demand iCBT required less therapist time (mean 4 h 37 min) than iCBT with protocol-driven feedback (mean 6 h 9 min, P < 0.001) and also less than face-to-face CBT as reported in the literature.

Conclusions: Both iCBT conditions are efficacious and time efficient. Declaration of interest None.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cognitive Behavioral Therapy / methods*
  • Fatigue Syndrome, Chronic / therapy*
  • Female
  • Humans
  • Internet*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Telemedicine / methods*
  • Young Adult

Associated data

  • NTR/NTR4013