van Kessel Kirsten, Moss-Morris Rona, Willoughby Ernest, Chalder Trudie, Johnson Malcolm H, Robinson Elizabeth
School of Psychology, University of Southampton, Highfield Southampton, SO17 1 BJ, UK.
Psychosom Med. 2008 Feb;70(2):205-13. doi: 10.1097/PSY.0b013e3181643065. Epub 2008 Feb 6.
The purpose of this study was to assess the efficacy of cognitive behavior therapy (CBT) as a treatment for multiple sclerosis (MS) fatigue.
A randomized controlled design was used where 72 patients with MS fatigue were randomly assigned to eight weekly sessions of CBT or relaxation training (RT). RT was designed to control for therapist time and attention. Participants were assessed before and after treatment, and at 3 and 6 months posttreatment. The primary outcome was the Fatigue Scale. Secondary outcomes included measures of stress, mood, and fatigue-related impairment.
Analysis was by intention-to-treat. A group by time interaction showed that the CBT group reported significantly greater reductions in fatigue across the 8 months compared with the RT group (p < .02). Calculated effect sizes for fatigue from baseline to the end of treatment were 3.03 [95% confidence interval, 2.22-3.68] for the CBT group and 1.83 [95% confidence interval, 1.26-2.34] for the RT group. Results also indicted that both groups showed clinically significant decreases in fatigue defined as fatigue levels equivalent or less than those reported by a non-fatigued healthy comparison group. There were no significant interactions between group and any of the secondary outcome variables, with both groups showing improvements over time on all measures.
Both CBT and RT appear to be clinically effective treatments for fatigue in MS patients, although the effects for CBT are greater than those for RT. Even 6 months after treatment, both treatment groups reported levels of fatigue equivalent to those of the healthy comparison group.
本研究旨在评估认知行为疗法（CBT）治疗多发性硬化症（MS）疲劳的疗效。
采用随机对照设计，将72例MS疲劳患者随机分为接受8次每周一次的CBT治疗组或放松训练（RT）组。RT旨在控制治疗师的时间和注意力。在治疗前、治疗后以及治疗后3个月和6个月对参与者进行评估。主要结局指标为疲劳量表。次要结局指标包括压力、情绪和疲劳相关损伤的测量。
采用意向性分析。组间与时间的交互作用表明，与RT组相比，CBT组在8个月内报告的疲劳程度显著降低（p <.02）。CBT组从基线到治疗结束时疲劳的计算效应量为3.03 [95%置信区间，2.22 - 3.68]，RT组为1.83 [95%置信区间，1.26 - 2.34]。结果还表明，两组的疲劳程度均出现了临床上显著的下降，定义为疲劳水平等于或低于非疲劳健康对照组报告的水平。组间与任何次要结局变量之间均无显著交互作用，两组在所有测量指标上均随时间有所改善。
CBT和RT似乎都是治疗MS患者疲劳的临床有效方法，尽管CBT的效果大于RT。即使在治疗6个月后，两个治疗组报告的疲劳水平仍与健康对照组相当。
