CBT improved severe fatigue after COVID-19, Dutch trial finds
After randomization, patients with severe fatigue three to 12 months after COVID-19 infection benefited from cognitive behavioral therapy (CBT) compared to usual care.
Cognitive behavioral therapy (CBT) was effective for patients with severe fatigue following COVID-19, a Dutch trial found.
The multicenter trial included 114 patients who were severely fatigued three to 12 months following COVID-19, randomized 1:1 to either usual care or 17 weeks of CBT targeting seven perpetuating factors of fatigue. The seven factors were 1) a disrupted sleep-wake pattern, 2) unhelpful beliefs about fatigue, 3) a low or unevenly distributed activity level, 4) perceived low social support, 5) problems with psychological processing of COVID-19, 6) fears and worries regarding COVID-19, and 7) poor coping with pain. Most patients had not been hospitalized and were self-referred. Results were published by Clinical Infectious Diseases on May 8.
On the primary outcome, the fatigue severity subscale of the Checklist Individual Strength, the patients who received CBT scored significantly better than those getting usual care (−8.8 [95% CI, −11.9 to −5.8]; P<0.001; effect size, 0.69). The difference was found both immediately after CBT (−9.3; 95% CI, −13.3 to −5.3) and at six months (−8.4; 95% CI, −13.1 to −3.7). Studied secondary outcomes included the proportion of patients meeting criteria for severe and/or chronic fatigue, physical and social functioning, somatic symptoms, and problems concentrating, and all favored CBT. Eight adverse events were recorded during CBT and 20 during usual care; none were serious.
“This study provides first evidence for the positive effect of CBT in patients with severe post-COVID-19 fatigue,” said the study authors. Although the high number of self-referrals among study participants could have biased the outcomes, it also suggests that CBT is acceptable and feasible for at least a group of patients with symptoms after COVID-19. CBT also appears to be safe for such patients, they noted.
“Of note, applying a cognitive-behavioral approach to the treatment of post-COVID-19 fatigue does neither imply that its cause is psychological nor does it negate a possible somatic cause,” the study authors said, adding that although a majority of the patients improved with the intervention, a substantial number of patients remained severely fatigued. “Research into other treatment approaches is warranted,” they said.