Web Therapy Helps With Chronic Fatigue Syndrome

Internet Behavioral Treatment Highly Effective for Teens With Chronic Fatigue Syndrome

Medically Reviewed by Laura J. Martin, MD on February 29, 2012
From the WebMD Archives

Feb. 29, 2012 -- Internet-based behavioral therapy appears to be a highly effective new tool for the treatment of teenagers with chronic fatigue syndrome (CFS), according to a new study from the Netherlands.

After just six months of treatment, the self-reported recovery rate among teens with CFS whose behavioral therapy was delivered via the web was eight times higher than among teens who got traditional face-to-face behavioral therapy.

And the improvement in symptoms persisted over an additional six months of follow-up.

Earlier research has shown Internet-delivered behavioral therapy to be effective for the treatment of depression, but the study is the first to explore its use for chronic fatigue syndrome.

Researcher Sanne L. Nijhof, MD, of the University Medical Center Utrecht in the Netherlands, says teens may be particularly responsive to web-based behavioral treatments because they have grown up using the Internet.

“Most teens eat, sleep, and breathe the Internet, so it is not terribly surprising that they would embrace a therapy delivered in this way,” she says.

Shortage of Trained CFS Therapists

Chronic fatigue syndrome is a complex condition characterized by intense, unrelenting fatigue, combined with other symptoms that can include muscle or joint pain, lymph node tenderness, and headache.

The condition is much less common in teens than adults, but by some estimates as many as 1 in 100 adolescents suffers from it.

While the cause of CFS is not known, talk therapy has been shown to be effective for relieving symptoms in both adults and teens.

But a shortage of specialized behavioral therapists qualified to deliver the treatment has limited its use.

The study by Nijhof and colleagues included 135 teenagers who had CFS symptoms for close to two years before enrollment.

Sixty-eight teens received the Internet-delivered behavioral therapy, which was developed by the research team, and 67 received individual and group behavioral therapy or an exercise-based therapy that has also been shown to be effective for treating chronic fatigue syndrome symptoms.

The web-based treatment lasted an average of 26 weeks and included a 21-module educational component and regular email interactions between patients and specially trained therapists. Parents were also asked to interact with the therapists.

Patients were able to log in and send emails to their therapists at any time. Therapists had a set time to respond, but were also available by email and telephone during emergencies.

Treatment progression was monitored by regular email contacts between therapists, patients, and their parents.

‘Web-Based Therapy More Accessible’

Questionnaires were used to measure improvements in fatigue and other aspects of patient well-being, and school records were reviewed to assess school attendance.

The answers revealed that at six months:

  • Eighty-five percent of teens whose treatment was delivered online reported no longer having severe fatigue symptoms, compared to 27% of teens treated with usual care.
  • Seventy-eight percent of the web-treated teens reported normal physical function at six months, compared to 20% of the teens treated with usual care.
  • Seventy-five percent of the teens whose therapy was Internet-based were no longer missing school, compared to 16% of the others.

Web-based behavioral therapy may have important advantages over traditional therapy in situations where flexible treatment times are needed and when there are barriers to delivering face-to-face care.

“What is exciting about this trial is that these researchers have made the delivery of an effective treatment for CFS more convenient, more accessible, and possibly more cost-effective,” says longtime chronic fatigue researcher Peter D. White, MD, of St. Bartholomew’s and the London School of Medicine and Dentistry.

White tells WebMD that the greater accessibility and more frequent interaction with therapists may explain the better results for Internet-delivered treatment.

Patients sent their therapists an average of 66 emails over the course of treatment, and therapists sent an average 29 email “consults” per patient.

He adds that if greater accessibility improves outcomes, an Internet-based treatment strategy may be as effective in adults as it is in teens.

“It is important to repeat this study in adults,” he says.

Show Sources


Nijhof, S. The Lancet, March 1, 2012.

Sanne L. Nijhof, MD, department of pediatrics, University Medical Center Utrecht, Netherlands.

Peter D. White, MD, St. Bartholomew’s and The London School of Medicine and Dentistry, London, U.K.

News release, The Lancet.

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