COGNITIVE-BEHAVIOR THERAPY FOR THE CHRONIC-FATIGUE-SYNDROME - A RANDOMIZED CONTROLLED TRIAL

The objective of the study was to evaluate the acceptability and effic acy of adding cognitive behaviour therapy to the medical care of patie nts presenting with the chronic fatigue syndrome. A randomised control led trial with final assessment at 12 months was carried nut in an inf ectious diseases outpatient clinic. 60 consecutively referred patients meeting consensus criteria for the chronic fatigue syndrome were incl uded in the study. Medical care comprised assessment, advice and follo w-up in general practice. Patients who received cognitive behaviour th erapy were offered 16 individual weekly sessions in addition to their medical carl. Main outcome measures were: the proportions of patients (a) who achieved normal daily functioning (Karnofsky score 80 or more) and (b) who achieved a clinically significant improvement in function ing (change in Karnofsky score 10 points or more) 12 months after rand omisation. Only two eligible patients refused to participate, All rand omised patients completed treatment. An intention to treat analysis sh owed that 73% (22/30) of recipients of cognitive behaviour therapy ach ieved a satisfactory outcome as compared with 27% (8/30) of patients w ho were given only medical care (difference of 47 percentage points: 9 5% confidence interval 24 to 69). Similar differences were observed in subsidiary outcome measures. The improvement in disability among pati ents given cognitive behaviour therapy continued after completion of t herapy. Illness beliefs and coping behaviour previously associated wit h a poor outcome changed more with cognitive behaviour therapy than wi th medical care alone. We conclude that adding cognitive behaviour the rapy to the medical care of patients with the chronic fatigue syndrome is acceptable to patients and leads to a sustained reduction in funct ional impairment.