Cognitive behavioral therapy positively affects fatigue in patients with multiple sclerosis: Results of a randomized controlled trial

Lizanne E. van den Akker; Heleen Beckerman; Emma H. Collette; Jos W.R. Twisk; Gijs Bleijenberg; Joost Dekker; Hans Knoop; Vincent de Groot; V. de Groot; H. Beckerman; A. Malekzadeh; L. E. Van Den Akker; M. Looijmans; S. A. Sanches; Joost Dekker; E. H. Collette; B. W. Van Oosten; C. E. Teunissen; M. A. Blankenstein; I. C.J.M. Eijssen; M. Rietberg; M. Heine; O. Verschuren; G. Kwakkel; J. M.A. Visser-Meily; I. G.L. Van De Port; E. Lindeman; L. J.M. Blikman; J. Van Meeteren; J. B.J. Bussmann; H. J. Stam; R. Q. Hintzen; H. G.A. Hacking; E. L. Hoogervorst; S. T.F.M. Frequin; H. Knoop; B. A. De Jong; G. Bleijenberg; F. A.J. De Laat; M. C. Verhulsdonck; E. Th L. van Munster; C. J. Oosterwijk; G. J. Aarts

doi:10.1177/1352458517709361

Cognitive behavioral therapy positively affects fatigue in patients with multiple sclerosis: Results of a randomized controlled trial

Lizanne E. van den Akker^*
, Heleen Beckerman
, Emma H. Collette
, Jos W.R. Twisk
, Gijs Bleijenberg
, Joost Dekker
, Hans Knoop
, Vincent de Groot
, V. de Groot
, H. Beckerman
, A. Malekzadeh
, L. E. Van Den Akker
, M. Looijmans
, S. A. Sanches
, Joost Dekker
, E. H. Collette
, B. W. Van Oosten
, C. E. Teunissen
, M. A. Blankenstein
, I. C.J.M. Eijssen

M. Rietberg, M. Heine, O. Verschuren, G. Kwakkel, J. M.A. Visser-Meily, I. G.L. Van De Port, E. Lindeman, L. J.M. Blikman, J. Van Meeteren, J. B.J. Bussmann, H. J. Stam, R. Q. Hintzen, H. G.A. Hacking, E. L. Hoogervorst, S. T.F.M. Frequin, H. Knoop, B. A. De Jong, G. Bleijenberg, F. A.J. De Laat, M. C. Verhulsdonck, E. Th L. van Munster, C. J. Oosterwijk, G. J. Aarts,

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

1 Citation (Scopus)

Abstract

Background: Fatigue is a common symptom in multiple sclerosis (MS) and often restricts societal participation. Cognitive behavioral therapy (CBT) may alleviate MS-related fatigue, but evidence in literature is inconclusive. Objective: To evaluate the effectiveness of CBT to improve MS-related fatigue and participation. Methods: In a multi-center, assessor-masked, randomized controlled trial, participants with severe MS related fatigue were assigned to CBT or control treatment. CBT consisted of 12 individual sessions with a psychologist trained in CBT, the control treatment consisted of three consultations with a MS nurse, both delivered over 16 weeks. Assessments were at baseline, 8, 16 (i.e. post-intervention), 26, and 52 weeks post-baseline. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed according to the intention-to-treat principle, using mixed-model analysis. Results: Between 2011 and 2014, 91 patients were randomized (CBT: n = 44; control: n = 47). Between group analysis showed a positive post-intervention effect for CBT on CIS20r fatigue (T16: −6.7 (95% confidence interval (CI) = −10.7; −2.7) points) that diminished during follow-up (T52: 0.5 (95% CI = −3.6; 4.4)). No clinically relevant effects were found on societal participation. Conclusion: Severe MS-related fatigue can be reduced effectively with CBT in the short term. More research is needed on how to maintain this effect over the long term.

Original language	English
Pages (from-to)	1542-1553
Number of pages	12
Journal	Multiple Sclerosis Journal
Volume	23
Issue number	11
DOIs	https://doi.org/10.1177/1352458517709361
Publication status	Published - 1 Oct 2017

Keywords

MS nurse
Multiple sclerosis
cognitive behavior therapy
fatigue
participation
randomized controlled trial
rehabilitation medicine

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van den Akker, L. E., Beckerman, H., Collette, E. H., Twisk, J. W. R., Bleijenberg, G., Dekker, J., Knoop, H., de Groot, V., de Groot, V., Beckerman, H., Malekzadeh, A., Van Den Akker, L. E., Looijmans, M., Sanches, S. A., Dekker, J., Collette, E. H., Van Oosten, B. W., Teunissen, C. E., Blankenstein, M. A. (2017). Cognitive behavioral therapy positively affects fatigue in patients with multiple sclerosis: Results of a randomized controlled trial. Multiple Sclerosis Journal, 23(11), 1542-1553. https://doi.org/10.1177/1352458517709361

@article{8bbc451dc17f4be794f09b2ff5977551,

title = "Cognitive behavioral therapy positively affects fatigue in patients with multiple sclerosis: Results of a randomized controlled trial",

abstract = "Background: Fatigue is a common symptom in multiple sclerosis (MS) and often restricts societal participation. Cognitive behavioral therapy (CBT) may alleviate MS-related fatigue, but evidence in literature is inconclusive. Objective: To evaluate the effectiveness of CBT to improve MS-related fatigue and participation. Methods: In a multi-center, assessor-masked, randomized controlled trial, participants with severe MS related fatigue were assigned to CBT or control treatment. CBT consisted of 12 individual sessions with a psychologist trained in CBT, the control treatment consisted of three consultations with a MS nurse, both delivered over 16 weeks. Assessments were at baseline, 8, 16 (i.e. post-intervention), 26, and 52 weeks post-baseline. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed according to the intention-to-treat principle, using mixed-model analysis. Results: Between 2011 and 2014, 91 patients were randomized (CBT: n = 44; control: n = 47). Between group analysis showed a positive post-intervention effect for CBT on CIS20r fatigue (T16: −6.7 (95\% confidence interval (CI) = −10.7; −2.7) points) that diminished during follow-up (T52: 0.5 (95\% CI = −3.6; 4.4)). No clinically relevant effects were found on societal participation. Conclusion: Severe MS-related fatigue can be reduced effectively with CBT in the short term. More research is needed on how to maintain this effect over the long term.",

keywords = "MS nurse, Multiple sclerosis, cognitive behavior therapy, fatigue, participation, randomized controlled trial, rehabilitation medicine",

author = "\{van den Akker\}, \{Lizanne E.\} and Heleen Beckerman and Collette, \{Emma H.\} and Twisk, \{Jos W.R.\} and Gijs Bleijenberg and Joost Dekker and Hans Knoop and \{de Groot\}, Vincent and \{de Groot\}, V. and H. Beckerman and A. Malekzadeh and \{Van Den Akker\}, \{L. E.\} and M. Looijmans and Sanches, \{S. A.\} and Joost Dekker and Collette, \{E. H.\} and \{Van Oosten\}, \{B. W.\} and Teunissen, \{C. E.\} and Blankenstein, \{M. A.\} and Eijssen, \{I. C.J.M.\} and M. Rietberg and M. Heine and O. Verschuren and G. Kwakkel and Visser-Meily, \{J. M.A.\} and \{Van De Port\}, \{I. G.L.\} and E. Lindeman and Blikman, \{L. J.M.\} and \{Van Meeteren\}, J. and Bussmann, \{J. B.J.\} and Stam, \{H. J.\} and Hintzen, \{R. Q.\} and Hacking, \{H. G.A.\} and Hoogervorst, \{E. L.\} and Frequin, \{S. T.F.M.\} and H. Knoop and \{De Jong\}, \{B. A.\} and G. Bleijenberg and \{De Laat\}, \{F. A.J.\} and Verhulsdonck, \{M. C.\} and \{van Munster\}, \{E. Th L.\} and Oosterwijk, \{C. J.\} and Aarts, \{G. J.\}",

note = "Publisher Copyright: {\textcopyright} 2017, {\textcopyright} The Author(s), 2017.",

year = "2017",

month = oct,

day = "1",

doi = "10.1177/1352458517709361",

language = "English",

volume = "23",

pages = "1542--1553",

journal = "Multiple Sclerosis Journal",

issn = "1352-4585",

publisher = "SAGE Publications Ltd",

number = "11",

}

van den Akker, LE, Beckerman, H, Collette, EH, Twisk, JWR, Bleijenberg, G, Dekker, J, Knoop, H, de Groot, V, de Groot, V, Beckerman, H, Malekzadeh, A, Van Den Akker, LE, Looijmans, M, Sanches, SA, Dekker, J, Collette, EH, Van Oosten, BW, Teunissen, CE, Blankenstein, MA, Eijssen, ICJM, Rietberg, M, Heine, M , Verschuren, O, Kwakkel, G, Visser-Meily, JMA, Van De Port, IGL, Lindeman, E, Blikman, LJM, Van Meeteren, J, Bussmann, JBJ, Stam, HJ, Hintzen, RQ, Hacking, HGA, Hoogervorst, EL, Frequin, STFM, Knoop, H, De Jong, BA, Bleijenberg, G, De Laat, FAJ, Verhulsdonck, MC, van Munster, ETL, Oosterwijk, CJ, Aarts, GJ 2017, 'Cognitive behavioral therapy positively affects fatigue in patients with multiple sclerosis: Results of a randomized controlled trial', Multiple Sclerosis Journal, vol. 23, no. 11, pp. 1542-1553. https://doi.org/10.1177/1352458517709361

TY - JOUR

T1 - Cognitive behavioral therapy positively affects fatigue in patients with multiple sclerosis

T2 - Results of a randomized controlled trial

AU - van den Akker, Lizanne E.

AU - Beckerman, Heleen

AU - Collette, Emma H.

AU - Twisk, Jos W.R.

AU - Bleijenberg, Gijs

AU - Dekker, Joost

AU - Knoop, Hans

AU - de Groot, Vincent

AU - de Groot, V.

AU - Beckerman, H.

AU - Malekzadeh, A.

AU - Van Den Akker, L. E.

AU - Looijmans, M.

AU - Sanches, S. A.

AU - Dekker, Joost

AU - Collette, E. H.

AU - Van Oosten, B. W.

AU - Teunissen, C. E.

AU - Blankenstein, M. A.

AU - Eijssen, I. C.J.M.

AU - Rietberg, M.

AU - Heine, M.

AU - Verschuren, O.

AU - Kwakkel, G.

AU - Visser-Meily, J. M.A.

AU - Van De Port, I. G.L.

AU - Lindeman, E.

AU - Blikman, L. J.M.

AU - Van Meeteren, J.

AU - Bussmann, J. B.J.

AU - Stam, H. J.

AU - Hintzen, R. Q.

AU - Hacking, H. G.A.

AU - Hoogervorst, E. L.

AU - Frequin, S. T.F.M.

AU - Knoop, H.

AU - De Jong, B. A.

AU - Bleijenberg, G.

AU - De Laat, F. A.J.

AU - Verhulsdonck, M. C.

AU - van Munster, E. Th L.

AU - Oosterwijk, C. J.

AU - Aarts, G. J.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background: Fatigue is a common symptom in multiple sclerosis (MS) and often restricts societal participation. Cognitive behavioral therapy (CBT) may alleviate MS-related fatigue, but evidence in literature is inconclusive. Objective: To evaluate the effectiveness of CBT to improve MS-related fatigue and participation. Methods: In a multi-center, assessor-masked, randomized controlled trial, participants with severe MS related fatigue were assigned to CBT or control treatment. CBT consisted of 12 individual sessions with a psychologist trained in CBT, the control treatment consisted of three consultations with a MS nurse, both delivered over 16 weeks. Assessments were at baseline, 8, 16 (i.e. post-intervention), 26, and 52 weeks post-baseline. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed according to the intention-to-treat principle, using mixed-model analysis. Results: Between 2011 and 2014, 91 patients were randomized (CBT: n = 44; control: n = 47). Between group analysis showed a positive post-intervention effect for CBT on CIS20r fatigue (T16: −6.7 (95% confidence interval (CI) = −10.7; −2.7) points) that diminished during follow-up (T52: 0.5 (95% CI = −3.6; 4.4)). No clinically relevant effects were found on societal participation. Conclusion: Severe MS-related fatigue can be reduced effectively with CBT in the short term. More research is needed on how to maintain this effect over the long term.

AB - Background: Fatigue is a common symptom in multiple sclerosis (MS) and often restricts societal participation. Cognitive behavioral therapy (CBT) may alleviate MS-related fatigue, but evidence in literature is inconclusive. Objective: To evaluate the effectiveness of CBT to improve MS-related fatigue and participation. Methods: In a multi-center, assessor-masked, randomized controlled trial, participants with severe MS related fatigue were assigned to CBT or control treatment. CBT consisted of 12 individual sessions with a psychologist trained in CBT, the control treatment consisted of three consultations with a MS nurse, both delivered over 16 weeks. Assessments were at baseline, 8, 16 (i.e. post-intervention), 26, and 52 weeks post-baseline. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed according to the intention-to-treat principle, using mixed-model analysis. Results: Between 2011 and 2014, 91 patients were randomized (CBT: n = 44; control: n = 47). Between group analysis showed a positive post-intervention effect for CBT on CIS20r fatigue (T16: −6.7 (95% confidence interval (CI) = −10.7; −2.7) points) that diminished during follow-up (T52: 0.5 (95% CI = −3.6; 4.4)). No clinically relevant effects were found on societal participation. Conclusion: Severe MS-related fatigue can be reduced effectively with CBT in the short term. More research is needed on how to maintain this effect over the long term.

KW - MS nurse

KW - Multiple sclerosis

KW - cognitive behavior therapy

KW - fatigue

KW - participation

KW - randomized controlled trial

KW - rehabilitation medicine

UR - https://www.scopus.com/pages/publications/85043398714

U2 - 10.1177/1352458517709361

DO - 10.1177/1352458517709361

M3 - Article

AN - SCOPUS:85043398714

SN - 1352-4585

VL - 23

SP - 1542

EP - 1553

JO - Multiple Sclerosis Journal

JF - Multiple Sclerosis Journal

IS - 11

ER -

Cognitive behavioral therapy positively affects fatigue in patients with multiple sclerosis: Results of a randomized controlled trial

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