Co-occurrence of severe fatigue and insomnia: implications for the outcome of cognitive behavioural therapies 2025 Rauwerda, Knoop et al

[Andy]

Abstract​

Background:
Cognitive behavioural therapy for fatigue (CBT-F) and insomnia (CBT-I) are effective therapies. Little is known on their effectiveness when severe fatigue and insomnia co-occur.

Aims:
This observational study investigated whether the co-occurrence of fatigue and insomnia influences the outcomes of CBT-F and CBT-I. Furthermore, it was determined if changes in fatigue and insomnia symptoms are associated, and how often the co-occurring symptom persists after CBT.

Method:
Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS, n = 241) received CBT-F and patients with insomnia disorder (n = 162) received CBT-I. Outcomes were fatigue severity assessed with the subscale of the Checklist Individual Strength (CIS-fat) and insomnia severity assessed with the Insomnia Severity Index (ISI). In each cohort, treatment outcomes of the subgroups with and without co-occurring symptoms were compared using ANCOVA. The association between changes in insomnia and fatigue severity were determined using Pearson’s correlation coefficient.

Results:
There were no differences in treatment outcomes between patients with and without co-occurring fatigue and insomnia (CBT-F: mean difference (95% CI) in CIS-fat-score 0.80 (−2.50–4.11), p = 0.63, d = 0.06; CBT-I: mean difference (95% CI) in ISI-score 0.26 (−1.83–2.34), p = 0.80, d = 0.05). Changes in severity of both symptoms were associated (CBT-F: r = 0.30, p < 0.001, CBT-I: r = 0.50, p < 0.001). Among patients no longer severely fatigued after CBT-F, 31% still reported insomnia; of those without clinical insomnia after CBT-I, 24% remained severely fatigued.

Conclusion:
CBT-F and CBT-I maintain their effectiveness when severe fatigue and insomnia co-occur. Changes in severity of both symptoms after CBT are associated, but the co-occurring symptom can persist after successfully treating the target symptom.

Open access

 

[Andy]

"Severe fatigue and insomnia are common symptoms in many long-term medical conditions (Budhiraja et al., Reference Budhiraja, Roth, Hudgel, Budhiraja and Drake2011; Menting et al., Reference Menting, Tack, Bleijenberg, Donders, Droogleever Fortuyn, Fransen, Goedendorp, Kalkman, Strik-Albers, van Alfen, van der Werf, Voermans, van Engelen and Knoop2018; Sarsour et al., Reference Sarsour, Morin, Foley, Kalsekar and Walsh2010).

Fatigue is the central feature of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is characterised by severe and persistent medically unexplained fatigue leading to functional impairment (Fukuda et al., Reference Fukuda, Straus, Hickie, Sharpe, Dobbins and Komaroff1994; Reeves et al., Reference Reeves, Lloyd, Vernon, Klimas, Jason, Bleijenberg, Evengard, White, Nisenbaum and Unger2003)."

 

[Utsikt]

More short term open label studies with subjective outcomes..

 

[Sean]

CBT for fatigue is "effective".

Not by any robust methodology it isn't.

 

[Spartacus]

CBT for fatigue is "effective".

Not by any robust methodology it isn't.

Maybe the therapy was so pointless and boring, it actually made the subjects fall asleep....

 

[Sean]

It is certainly effective at building their careers and empires.

And of course they use problematic and outdated criteria. (Fukuda, & Reeves)

 

[rvallee]

Cognitive behavioural therapy for fatigue (CBT-F) and insomnia (CBT-I) are effective therapies

Most psychobehavioral papers are nothing but marketing propaganda. Making false statements to open up papers, and the journals don't even care, they allow it. They make no attempts at being serious, and it beclowns everyone and every institution involved in not blocking this nonsense forever.

CBT-F and CBT-I maintain their effectiveness when severe fatigue and insomnia co-occur. Changes in severity of both symptoms after CBT are associated, but the co-occurring symptom can persist after successfully treating the target symptom.

Words and their meaning, why bother? "Effective". "Successfully treating". Words mean nothing in this discipline. All they built is the perfect pseudoscience about the last remaining great belief system. The fault for this is in feckless institutions incapable of stopping what is so obvious intellectually degenerate nonsense.

 

[Kiristar]

What scares me is how much of this BS gets posted here, it's an full on propaganda industry.

The more people read it in journals they trust the more they assume it must be valid, even if scientifically trained to question.

How can we ever win against such a better funded industry?

 

[Utsikt]

How can we ever win against such a better funded industry?

The hard way would be: getting proper science done and figuring out treatments that actually work.

 

[Sean]

They are conducting a brutal war of attrition against us by ruthlessly exploiting one resource in particular that they have in lavish abundance and we have very little of – sheer stamina.

An endless flooding of the zone with shit, knowing full well it takes an order of magnitude more effort and care and integrity to refute than it does to produce, and how costly it is to us to do it in the first instance, and then to have to keep doing.

It is very dirty dishonest cruel stuff. All because they can't handle both being so wrong, and having that exposed to the world by those lowly bolshie patients who just don't know their place.

 

[bobbler]

They are conducting a brutal war of attrition against us by ruthlessly exploiting one resource in particular that they have in lavish abundance and we have very little of – sheer stamina.

An endless flooding of the zone with shit, knowing full well it takes an order of magnitude more effort and care and integrity to refute than it does to produce, and how costly it is to us to do it in the first instance, and then to have to keep doing.

It is very dirty dishonest cruel stuff. All because they can't handle both being so wrong, and having that exposed to the world by those lowly bolshie patients who just don't know their place.

Yep and it seems it’s age old and well known as a tactic. Just watched episode 8 of the good wife and a key revelation of the episode is another lawyer telling Alicia about how Will used something similar (burying in paperwork, continuances etc instead of going to court) to wait out a child dying of lead poisoning in not paying a health insurance claim and called it ‘litigating the margins’ or something, all designed to exhaust the opposite snd reduce the payout.

This filibustering the literature with bs endless bs is an out of hand version of extorting the taxpayer massively for the same thing, repeated iterations of stuff that doesn’t work in the Hope no one will find the real stuff in the search engine buried under it all

 

[Trish]

Or perhaps they are so stuck in their mindset they simply have no idea how wrong they are and how worse than useless their so called research really is.