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Cognitive Behavioural Therapy for chronic fatigue and CFS: outcomes from a specialist clinic in the UK

Research output: Contribution to journalArticlepeer-review

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

Original languageEnglish
JournalJournal of the Royal Society of Medicine
Accepted/In press30 Jul 2020


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Cognitive Behavioural Therapy (CBT) is commonly used to treat Chronic Fatigue Syndrome (CFS) and has been shown to be effective for reducing fatigue and improving physical functioning. Most of the evidence on the effectiveness of CBT for CFS is from randomized control trials (RCTs) but there are only a few studies in naturalistic treatment settings. Our aim was to examine the effectiveness of CBT for CFS in a naturalistic setting and examine what factors, if any, predicted outcome.
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.
Data was available for 995 patients receiving CBT for CFS at an outpatient clinic in the UK.
Participants were referred consecutively to a specialist unit for Chronic Fatigue or CFS.
Main outcome measures
Patients were assessed throughout their treatment using self-report measures including the Chalder Fatigue Scale, Short Form Health Survey (SF-36), Hospital Anxiety and Depression
Scale (HADS), Global Improvement and Satisfaction.
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).
Patients fatigue, physical functioning and social adjustment all significantly improved following CBT for CFS in a naturalistic outpatient setting. These findings support the growing evidence from previous RCTs and suggests that CBT could be an effective treatment in routine treatment settings.

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