Shorter communicationCognitive behavioural treatment for chronic fatigue syndrome in a rehabilitation setting: Effectiveness and predictors of outcome
Highlights
► We studied CBT with GET for CFS in the daily practice of a tertiary rehabilitation centre. ► It concerns an uncontrolled implementation study of an inpatient group therapy. ► Large effect sizes were found on fatigue and physical impairment. ► Clinically significant improvement was found in 34% of the patients at post-treatment and 31% at follow-up. ► CBT with GET for CFS is not only effective in RCT’s but also in daily practice.
Section snippets
Participants
All participants in the current study gave a written permission to use their data. Participants were consecutive CFS patients who were admitted to an inpatient multicomponent rehabilitation program in a large tertiary centre in the Netherlands in the period January 2005–September 2009. Inclusion criteria were: a confirmed diagnosis of CFS according to the CDC criteria; being older than 18 years; severe fatigue (Checklist Individual Strength-20 (CIS-20) subscale subjective fatigue ≥35); being
Effectiveness of treatment
From baseline to post-treatment the mean subjective fatigue (CIS subjective fatigue subscale), individual strength (CIS-total) and physical impairment (SF-36) scores improved with respectively 23%, 21.0% and 29.9%. These changes were statistically significant (p < 0.001) and indicated large treatment effects (Table 2). From post-treatment to 6-month follow-up mean subjective fatigue, individual strength and, physical impairment scores did not significantly change.
At post-treatment 33.8% (n
Discussion
A multidisciplinary program consisting of a combination of CBT and GET offered in a tertiary rehabilitation clinic seems to be effective for CFS patients. Mean subjective fatigue, individual strength and, physical impairment scores were significantly improved at post-treatment and 6-month follow-up. Pre-post effect sizes were large and comparable (effect size subjective fatigue) with or higher (effect size physical impairment) than the effect sizes found by Scheeres et al. (2008) in a
Acknowledgements
This work is part of the ZonMw project ‘chronisch vermoeidheidssyndroom’ (http://www.zonmw.nl/nl/onderwerpen/alle-programma-s/cvs/gehonoreerd-onderzoek/).
References (26)
- et al.
Cognitive behavior therapy for chronic fatigue syndrome: a multicentre randomized controlled trial
Lancet
(2001) - et al.
Cognitive behavior therapy for chronic fatigue syndrome: predictors of treatment outcome
- et al.
Cognitive-behaviour therapy for chronic fatigue syndrome: comparison of outcomes within and outside the confines of a randomized controlled trial
Behaviour Research and Therapy
(2007) - et al.
Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment
Journal of Psychosomatic Research
(2000) - et al.
Dimensional assessment of chronic fatigue syndrome
Journal of Psychosomatic Research
(1994) - et al.
The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: development of a model
Journal of PsychosomaticResearch
(1998) - et al.
Symptom checklist. Handleiding bij een multidimensionele psychopathologie-indicator SCL-90
(1986) - et al.
Predictors of response to treatment for chronic fatigue syndrome
British Journal of Psychiatry
(2002) - et al.
Cognitive behaviour therapy in chronic fatigue syndrome
Journal of Neurology Neurosurgery and Psychiatry
(1991) - et al.
Predictors of outcome in a fatigued population in primary care following a randomized controlled trial
Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences
(2003)
Statistical power analysis for the behavioral sciences
Predictors of outcome following treatment for chronic fatigue
British Journal of Psychiatry
Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial
American Journal of Psychiatry
Cited by (29)
Cognitive and emotional variables predicting treatment outcome of cognitive behavior therapies for patients with medically unexplained symptoms: A meta-analysis
2021, Journal of Psychosomatic ResearchCitation Excerpt :Another meta-analysis demonstrated that patients with comorbid mood disorder at baseline improved their physical functioning less over the course of therapy (r = −0.14, 95%-CI: −0.27, 0.00, k = 2, kmoderate/high quality = 2, I2 = 0%). A comorbid mood disorder at the beginning of the treatment did neither predict symptom intensity at a later follow-up after the end of therapy (p = .14) [57,58], nor the change of symptom intensity over the course of therapy (p = .73). Findings of studies that could not be included to the meta-analyses mentioned in this paragraph were in accordance with our meta-analytic results.
Prediction of long-term outcome after cognitive behavioral therapy for chronic fatigue syndrome
2019, Journal of Psychosomatic ResearchCitation Excerpt :We therefore expected that demographics did not predict long-term outcomes. Lower sense of control over fatigue at baseline and greater perceived negative consequences of CFS, both fatigue perpetuating factors according to the cognitive behavioral model of CFS, negatively predicted fatigue and physical functioning at short term FU [12,13]. We hypothesized that more deviant scores at post-treatment on cognitive-behavioral perpetuating factors (thought to maintain CFS symptoms) predicted more severe fatigue or lower physical functioning at LTFU.
Treatment expectations influence the outcome of multidisciplinary rehabilitation treatment in patients with CFS
2016, Journal of Psychosomatic ResearchCitation Excerpt :If there are still significant interactions, then the effects are presented for each group separately. Previous studies [22–26] in patients with CFS showed that depression, self-efficacy and duration of complaints were associated with outcome of treatment. In a sensitivity analysis, symptoms of depression, self-efficacy and duration of complaints were entered in the final model to analyse whether these factors influence the final model.
Same, same but different? Cognitive behavioural treatment approaches for paediatric CFS/ME and depression
2017, Behavioural and Cognitive PsychotherapyFatigue and Depression in Sick-Listed Chronic Low Back Pain Patients
2014, Pain Medicine (United States)Citation Excerpt :Further, reducing pain may in itself contribute to less fatigue, particularly night pain and pain interfering with sleep [39]. Also, addressing the fatigue directly in rehabilitation programs may give additional effects, as cognitive–behavioral therapy and graded exercise therapy have produced significant improvements in fatigue for patients with CFS [53,54]. The study has a few limitations that will now be considered.