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Original research
Cognitive–behavioural therapy combined with music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents: a feasibility study
  1. Sadaf Malik1,
  2. Tarjei Tørre Asprusten1,2,
  3. Maria Pedersen3,
  4. Julie Mangersnes1,
  5. Gro Trondalen4,
  6. Betty van Roy1,
  7. Eva Skovlund5,
  8. Vegard Bruun Wyller1,2
  1. 1 Pediatrics, Akershus University Hospital, Lørenskog, Norway
  2. 2 Clinical Medicine, University of Oslo, Oslo, Norway
  3. 3 Department of Pediatrics and Adolescent Medicine, Drammen Hospital, Drammen, Norway
  4. 4 Center for Music and Health, Norwegian College of Music, Oslo, Norway
  5. 5 Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
  1. Correspondence to Professor Vegard Bruun Wyller; v.b.b.wyller{at}


Background Cognitive–behavioural therapy (CBT) is effective in chronic fatigue syndrome. However, CBT has not been investigated in postinfectious chronic fatigue (CF), nor is it known whether addition of therapeutic elements from other disciplines might be feasible. We studied the feasibility of a 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 feasibility 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.

Results A total of 43 individuals with postinfectious CF were included (21 intervention group, 22 control group). 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, number of steps/day tended to decrease (difference=−1158, 95% CI −2642 to 325), whereas postexertional malaise tended to improve (difference=−0.4, 95% CI −0.9 to 0.1) in the intervention group at 3 months. At 15 months’ follow-up, there was a trend towards higher recovery rate in the intervention group (62% vs 37%).

Conclusion An intervention study of combined CBT and music therapy in postinfectious CF is feasible, and appears acceptable to the participants. The tendencies towards positive effects on patients’ symptoms and recovery might justify a full-scale clinical trial.

Trial registration number NCT02499302.

  • adolescents
  • chronic fatigue
  • chronic fatigue syndrome
  • Epstein-Barr virus infection
  • music therapy
  • cognitive–behavioural therapy

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  • Contributors SM, TTA, MP and JM collected clinical data, contributed to study design and participated in data analyses. GT and BvR contributed to study design. ES supervised the statistical analyses. VBW conceived the study, contributed to study design and participated in data analyses. All authors contributed to data interpretation and drafting of the manuscript.

  • Funding This study was supported by the Health South-East Hospital Trust, Norway.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Norwegian National Committee for Ethics in Medical Research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The data sets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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