Cognitive behaviour therapy for the chronic fatigue syndrome: a randomized controlled trial.
OBJECTIVE
To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with the chronic fatigue syndrome.


METHODS
Randomised controlled trial with final assessment at 12 months.


METHODS
An infectious diseases outpatient clinic.


METHODS
60 consecutively referred patients meeting consensus criteria for the chronic fatigue syndrome.


METHODS
Medical care comprised assessment, advice, and follow up in general practice. Patients who received cognitive behaviour therapy were offered 16 individual weekly sessions in addition to their medical care.


METHODS
The proportions of patients (a) who achieved normal daily functioning (Karnofsky score 80 or more) and (b) who achieved a clinically significant improvement in functioning (change in Karnofsky score 10 points or more) by 12 months after randomisation.


RESULTS
Only two eligible patients refused to participate. All randomised patients completed treatment. An intention to treat analysis showed that 73% (22/30) of recipients of cognitive behaviour therapy achieved a satisfactory outcome as compared with 27% (8/30) of patients who were given only medical care (difference 47 percentage points; 95% confidence interval 24 to 69). Similar differences were observed in subsidiary outcome measures. The improvement in disability among patients given cognitive behaviour therapy continued after completion of therapy. Illness beliefs and coping behaviour previously associated with a poor outcome changed more with cognitive behaviour therapy than with medical care alone.


CONCLUSIONS
Adding cognitive behaviour therapy to the medical care of patients with the chronic fatigue syndrome is acceptable to patients and leads to a sustained reduction in functional impairment.
Sharpe
M
M
University Department of Psychiatry, Warneford Hospital, Oxford.
Hawton
K
K
Simkin
S
S
Surawy
C
C
Hackmann
A
A
Klimes
I
I
Peto
T
T
Warrell
D
D
Seagroatt
V
V
D000223:Adaptation, Psychological; D000328:Adult; D001294:Attitude to Health; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000150:complications; D015673:Fatigue Syndrome, Chronic / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D016896:Treatment Outcome