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Adolescent health
Cognitive–behavioural therapy combined with music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents: a randomised controlled trial
  1. Sadaf Malik1,
  2. Tarjei Tørre Asprusten2,3,
  3. Maria Pedersen4,
  4. Julie Mangersnes1,
  5. Gro Trondalen5,
  6. Betty van Roy1,
  7. Eva Skovlund6,
  8. Vegard Bruun Wyller1,2
  1. 1 Pediatrics, Akershus University Hospital, Oslo, Norway
  2. 2 Institutt for klinisk medisin, Universitetet i Oslo, Oslo, Norway
  3. 3 Barne- og Ungdomsklinikken, Akershus Universitetssykehus HF, Lorenskog, Norway
  4. 4 Department of Pediatrics and Adolescent Medicine, Drammen Hospital, Drammen, Norway
  5. 5 Center for Music and Health, Norwegian College of Music, Oslo, Norway
  6. 6 Department of Public Health and Nursing, NTNU—Norwegian University of Science and Technology, Trondheim, Norway
  1. Correspondence to Professor Vegard Bruun Wyller; v.b.b.wyller{at}medisin.uio.no

Abstract

Background Cognitive–behavioural therapy (CBT) is effective in chronic fatigue (CF) syndrome. However, CBT has not been investigated in postinfectious CF, nor is it known whether addition of therapeutic elements from other disciplines might be useful. We explored 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 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. Power analyses suggested that 120 participants would be needed in order to detect a moderate effect size.

Results A total of 91 individuals with postinfectious CF were eligible, and a total of 43 were included (21 intervention group, 22 control group). Concern regarding school absence due to therapy sessions was the main reason for declining participation. 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, the primary endpoint (number of steps/day) did not differ significantly between the intervention group and the control group (difference (95% CI) =–1298 (–4874 to 2278)). Secondary outcome measures were also not significantly different among the two groups.

Conclusion An intervention study of combined CBT and music therapy in postinfectious CF is feasible. A fully powered trial is needed to evaluate efficacy; participants’ concern regarding school absence should be properly addressed to secure recruitment.

Trial registration number ClinicalTrials ID: NCT02499302, registered July 2015.

  • adolescent health
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjpo-2020-000797

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    Footnotes

    • 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 statistical analyses. VBW conceived of 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, grant ID 2017123.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by The Norwegian National Committee for Ethics in Medical Research. Participation was based upon informed consent from all participants and (if younger than 16 years) their parents/guardians.

    • Provenance and peer review Not commissioned; externally peer-reviewed. This is an amended, republished version of a retracted paper: http://dx.doi.org/10.1136/bmjpo-2019-000620.

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