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Cognitive behaviour therapy for the Chronic Fatigue Syndrome (CFS): a randomized controlled trial

  [ 79 votes ]   [ Discuss This Article ] • January 6, 1996

OBJECTIVE--To evaluate the acceptability and efficacy of
adding cognitive behaviour therapy to the medical care of
patients presenting with the chronic fatigue syndrome.

DESIGN--Randomised controlled trial with final assessment at
12 months.

SETTING--An infectious diseases outpatient clinic.

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

INTERVENTIONS--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.

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

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.

CONCLUSION--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, Hawton K, Simkin S, Surawy C, Hackmann A, Klimes I, Peto
T, Warrell D, Seagroatt V

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