Cognitive behavioural therapy for chronic fatigue and chronic fatigue syndrome: outcomes from a specialist clinic in the UK.

James Adamson,Trudie Chalder,Alastair Santhouse,Simon Wessely,Sheila Ali

doi:10.1177/0141076820951545

Abstract

ObjectivesCognitive behavioural therapy is commonly used to treat chronic fatigue syndrome and has been shown to be effective for reducing fatigue and improving physical functioning. Most of the evidence on the effectiveness of cognitive behavioural therapy for chronic fatigue syndrome is from randomised control trials, but there are only a few studies in naturalistic treatment settings. Our aim was to examine the effectiveness of cognitive behavioural therapy for chronic fatigue syndrome in a naturalistic setting and examine what factors, if any, predicted outcome.DesignUsing linear mixed effects analysis, we analysed patients' self-reported symptomology over the course of treatment and at three-month follow-up. Furthermore, we explored what baseline factors were associated with improvement at follow-up.SettingData were available for 995 patients receiving cognitive behavioural therapy for chronic fatigue syndrome at an outpatient clinic in the UK.ParticipantsParticipants were referred consecutively to a specialist unit for chronic fatigue or chronic fatigue syndrome.Main outcome measuresPatients were assessed throughout their treatment using self-report measures including the Chalder Fatigue Scale, 36-item Short Form Health Survey, Hospital Anxiety and Depression Scale and Global Improvement and Satisfaction.ResultsPatients’ fatigue, physical functioning and social adjustment scores significantly improved over the duration of treatment with medium to large effect sizes (|d| = 0.45–0.91). Furthermore, 85% of patients self-reported that they felt an improvement in their fatigue at follow-up and 90% were satisfied with their treatment. None of the regression models convincingly predicted improvement in outcomes with the best model being (R2 = 0.137).ConclusionsPatients’ fatigue, physical functioning and social adjustment all significantly improved following cognitive behavioural therapy for chronic fatigue syndrome in a naturalistic outpatient setting. These findings support the growing evidence from previous randomised control trials and suggest that cognitive behavioural therapy could be an effective treatment in routine treatment settings.

Highlights

Fatigue is a ubiquitous symptom that is normally distributed in the population.[1]
Chronic fatigue syndrome is associated with marked disability and is associated with reduced participation in social activities, sickness absence and unemployment.[4,5]
All participants were treated for chronic fatigue syndrome at the National Persistent Physical Symptoms Research and Treatment Unit

Summary

Introduction

Fatigue is a ubiquitous symptom that is normally distributed in the population.[1]. For some people, fatigue becomes chronic and starts to affect quality of life. The most widely applied case definition is the Centre for Disease Control criteria.[6] According to Fukuda et al, to meet criteria for a diagnosis of chronic fatigue syndrome, an individual must have self-reported persistent or relapsing fatigue for at least six months, of new or definite onset, that is severe enough to impair occupational, educational, social or personal activities. They must report four or more of the following symptoms: impaired memory or concentration, sore throat, tender cervical or axillary lymph nodes, muscle pain, multi-joint pain, headaches, unrefreshing sleep and post-exertional malaise lasting for more than one day. These symptoms should last six or more consecutive months and not predate the fatigue.[2]

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Results

Conclusion