Chronic fatigue in general practice: is counselling as good as cognitive behaviour therapy? A UK randomised trial

Background: Fatigue is a common symptom for which patients consult their do ctors in primary care, with usual medical management the majority of patien ts report that their symptoms persist and become chronic. There is little e vidence for the effectiveness of any fatigue management in primary care. Aim: To compare the effectiveness of cognitive behaviour therapy (CBT) with counselling for patients with chronic fatigue and to describe satisfaction with care. Design of study: Randomised trial with parallel group design. Setting: Ten general practices located in London and the South Thames regio n of the united Kingdom recruited patients to the trial between 1996 and 19 98. Patients came from a wide range of socioeconomic backgrounds and lived in urban, suburban, and rural areas. Method: Data were collected before randomisation, after treatment; and sir months later Patients were offered sir sessions of up to one hour each of e ither CBT or counselling. Outcomes include self-report of fatigue symptoms sir months later, anxiety and depression, symptom attributions, social adju stment and patients' satisfaction with care. Results: One hundred and sixty patients with chronic fatigue entered the tr ial; 45 (28%) met research criteria for chronic fatigue syndrome; 129 compl eted follow-up. All patients met Chalder et al's standard criteria for fati gue. Mean fatigue scores were 23 on entry tar baseline) and 15 at sir month s' follow-up. Sixty-one (47%) patients no longer met standard criteria for fatigue after sir months. There was no significant difference in effect bet ween the two therapies on fatigue (1.04 [95% CI = -1.7 to 3.7]), anxiety an d depression or social adjustment outcomes for all patients and for the sub group with chronic fatigue syndrome. Use of antidepressants and consultatio ns with the doctor decreased after therapy but there were no differences be tween groups. Conclusion: Counselling and CBT were equivalent in effect for patients with chronic fatigue in primary care. The choice between therapies can therefor e depend on other considerations, such as cost and accessibility.