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

Abstract

Objectives Cognitive 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. Design Using 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. Setting Data were available for 995 patients receiving cognitive behavioural therapy for chronic fatigue syndrome at an outpatient clinic in the UK. Participants Participants were referred consecutively to a specialist unit for chronic fatigue or chronic fatigue syndrome. Main outcome measures Patients 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. Results Patients’ 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). Conclusions Patients’ 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.

Cognitive behaviour therapy for chronic fatigue syndrome: Authors' reply, naturalistic outcomes paper

“…We previously reported on routine clinical outcomes after cognitive behaviour therapy for chronic fatigue syndrome in an NHS clinic. 1 We found that fatigue, physical functioning and social adjustment all significantly improved, providing some evidence that results from randomised controlled trials can be extrapolated to everyday clinical settings.…”

Response to Adamson et al. (2020): ‘Cognitive behavioural therapy for chronic fatigue and chronic fatigue syndrome: Outcomes from a specialist clinic in the UK’

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In a paper by Adamson et al (2020), published in the October issue of the Journal of the Royal Society of Medicine, the authors interpret their data as revealing significant improvements following cognitive behavioural therapy (CBT) in a large sample of patients with chronic fatigue syndrome (CFS) and chronic fatigue (CF). In our view, their conclusions are misplaced and unwarranted.

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CFS patients remain severely disabled after specialist treatment with CBT in the UK

“…Adamson et al. 1 concluded that cognitive behavioural therapy is an effective treatment for chronic fatigue syndrome because fatigue and physical functioning scores improved significantly and 90% were happy with it.…”