Long-term efficacy of cognitive–behavioral therapy by general practitioners for fatigue: A 4-year follow-up study
Abstract
Objective In an earlier study, we found that cognitive-behavioral therapy (CBT) delivered by general practitioners (GPs) for fatigue among employees on sick leave was not effective after 12 months. In this study we aim to assess the long-term efficacy of CBT by GPs for fatigue. It was hypothesized that the intervention could prevent deterioration as well as relapse of fatigue complaints and relapse into absenteeism in the long term.Methods Patients who participated in the original randomized controlled trial were followed up 4 years later. Fatigue and absenteeism were the main outcomes.Results Fatigue and absenteeism were high in the intervention and control groups at the 4-year follow-up. There was no significant difference between the intervention group and the control group on fatigue and absenteeism. The intervention group however tended toward less-favorable outcomes as compared with the control group.Conclusions Like that of chronic fatigue syndrome, the prognosis of less-advanced fatigue is rather poor. CBT delivered by GPs is not effective in the long term.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
At follow-ups longer than 12 months post-treatment, two studies reported non-significant effects on fatigue severity: g = 0.12 (95% CI -0.23 to 0.47) and g = -0.21 (95% CI -0.47 to 0.05).
“For follow-ups longer than 12 months post-treatment, two studies provided information on fatigue severity: [45] reported a ~ 3.5-year follow-up to [46] (g = 0.12, 95%CI -0.23 to 0.47), and [47] reported a two-year follow-up to [42] (g = -0.21, 95%CI -0.47 to 0.05).”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [45]
Cites
(1992) · PubMed · Cited by 33,716 · see citing works
The MOS 36-ltem Short-Form Health Survey (SF-36): I. Conceptual Framework and Item Selection
Ware, J. E., & Sherbourne, C. D. (1992) · Medical Care · doi:10.1097/00005650-199206000-00002 · Cited by 30,033 · see citing works
The Chronic Fatigue Syndrome: A Comprehensive Approach to Its Definition and Study
Fukuda, K., Straus, S. E., Hickie, I., Sharpe, M. C., Dobbins, J. G., Komaroff, A., & and International Chronic Fatigue Syndrome Study Group. (1994) · Annals of Internal Medicine · doi:10.7326/0003-4819-121-12-199412150-00009 · Cited by 4,969 · cited 1× · see citing works
“Patients were classified as potential CFS cases (CFS-like cases) if they met the following research criteria, which were based on the CDC criteria for CFS [ 17 ]: a CIS score of 40 or higher, a self-reported duration of fatigue complaints of 6 months or more, an SF-36 score on physical functioning of 60 or lower, and…”
MethodSCL-90: an outpatient psychiatric rating scale--preliminary report.
Derogatis, L. R., Lipman, R. S., & Covi, L. (1973) · PubMed · Cited by 3,815 · see citing works
Aaronson, N. K., Muller, M., Cohen, P. D. A., Essink-Bot, M.-L., Fekkes, M., Sanderman, R., Sprangers, M. A. G., te Velde, A., & Verrips, E. (1998) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(98)00097-3 · Cited by 2,276 · see citing works
Chronic Fatigue Syndrome: A Review
Afari, N., & Buchwald, D. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.2.221 · Cited by 697 · see citing works
[Chronic fatigue syndrome: a review].
Carlo-Stella, N., Lorusso, L., Candura, S. M., & Cuccia, M. (2004) · PubMed · Cited by 549 · see citing works
Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial
Prins, J. B., Bleijenberg, G., Bazelmans, E., Elving, L. D., de Boo, T. M., Severens, J. L., van der Wilt, G. J., Spinhoven, P., & van der Meer, J. W. (2001) · The Lancet · doi:10.1016/s0140-6736(00)04198-2 · Cited by 531 · see citing works
Self-citationFatigue among working people: validity of a questionnaire measure
Beurskens, A. J. H. M., Bültmann, U., Kant, I., Vercoulen, J. H. M. M., Bleijenberg, G., & Swaen, G. M. H. (2000) · Occupational and Environmental Medicine · doi:10.1136/oem.57.5.353 · Cited by 526 · see citing works
Self-citationInterventions for the Treatment and Management of Chronic Fatigue Syndrome: A Systematic Review
Whiting, P., Bagnall, A.-M., Sowden, A. J., Cornell, J. E., Mulrow, C. D., & Ramírez, G. (2001) · JAMA · doi:10.1001/jama.286.11.1360 · Cited by 509 · see citing works
Randomized consent designs for clinical trials: An update
Zelen, M. (1990) · Statistics in Medicine · doi:10.1002/sim.4780090611 · Cited by 289 · see citing works
Longitudinal study of outcome of chronic fatigue syndrome
Wilson, A., Hickie, I. B., Lloyd, A. R., Hadži-Pavlović, D., Boughton, C. R., Dwyer, J., & Wakefield, D. (1994) · BMJ · doi:10.1136/bmj.308.6931.756 · Cited by 269 · see citing works
The Checklist Individual Strength
Jh, V. (1999) · Medical Entomology and Zoology · Cited by 253 · see citing works
Twisk, J. W. R., & Proper, K. I. (2004) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2003.07.009 · Cited by 210 · see citing works
Prognosis in chronic fatigue syndrome: a prospective study on the natural course.
Vercoulen, J. H. M. M., Swanink, C. M. A., Fennis, J. F. M., Galama, J. M. D., van der Meer, J. W., & Bleijenberg, G. (1996) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.60.5.489 · Cited by 210 · see citing works
Self-citationRidsdale, L., Godfrey, E. L., Chalder, T., Seed, P. T., King, M., Wallace, P., & Wessely, S. C. (2001) · Research Portal (King's College London) · Cited by 106 · see citing works
Chronic fatigue in the community: ‘A question of attribution’
Chalder, T., Power, M., & Wessely, S. C. (1996) · Psychological Medicine · doi:10.1017/s0033291700037818 · Cited by 102 · see citing works
Huibers, M. J. H., Beurskens, A. J. H. M., Van Schayck, C. P., Bazelmans, E., Metsemakers, J. F. M., Knottnerus, J. A., & Bleijenberg, G. (2004) · British Journal of Psychiatry · doi:10.1192/bjp.184.3.240 · Cited by 98 · cited 3× · see citing works
“Based on a clinical difference on the CIS, the original sample size was calculated to require 75 patients per group [6].”
BackgroundMethodSelf-citationHuibers, M. J. H., Beurskens, A. J. H. M., Prins, J. B., Kant, I., Bazelmans, E., van Schayck, O. C. P., Knottnerus, J. A., & Bleijenberg, G. (2003) · Occupational and Environmental Medicine · doi:10.1136/oem.60.suppl_1.i26 · Cited by 96 · see citing works
Self-citationRidsdale, L., Darbishire, L., & Seed, P. T. (2004) · Psychological Medicine · doi:10.1017/s0033291703001247 · Cited by 73 · see citing works
Prospective Study of the Prognosis of Unexplained Chronic Fatigue in a Clinic-Based Cohort
Schmaling, K. B., Fiedelak, J. I., Katon, W. J., Bader, J. O., & Buchwald, D. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000088587.29901.69 · Cited by 55 · see citing works
The prognosis of different fatigue diagnostic labels: a longitudinal survey
Hamilton, W. T., Gallagher, A. M., Thomas, J. M., & White, P. D. (2005) · Family Practice · doi:10.1093/fampra/cmi021 · Cited by 50 · see citing works
Predictors of outcome in fatigued employees on sick leave
Huibers, M. J. H., Bleijenberg, G., van Amelsvoort, L. G. P. M., Beurskens, A. J. H. M., van Schayck, O. C. P., Bazelmans, E., & Knottnerus, J. A. (2004) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2004.03.015 · Cited by 42 · see citing works
Self-citationAn alternative trial design to overcome validity and recruitment problems in primary care research
Huibers, M. J. H. (2004) · Family Practice · doi:10.1093/fampra/cmh219 · Cited by 36 · see citing works
Self-citationCan General Practitioners Manage Chronic Fatigue Syndrome?
Whitehead, L., & Campion, P. D. (2002) · Journal of Chronic Fatigue Syndrome · doi:10.1300/j092v10n01_05 · Cited by 30 · see citing works
A Qualitative Analysis of the Failure of CBT for Chronic Fatigue Conducted by General Practitioners
Bazelmans, E., Huibers, M. J. H., & Bleijenberg, G. (2004) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465804001882 · Cited by 8 · see citing works
Self-citation
Flagged first, then by citations
1 of the 27 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Fink, P., & Rosendal, M. (2008) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e3282f51254 · Cited by 105 · see citing works
Rebergen, D. S., Bruinvels, D. J., Bezemer, P. D., van der Beek, A. J., & van Mechelen, W. (2009) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e3181990d32 · Cited by 87 · see citing works
Enhanced care by generalists for functional somatic symptoms and disorders in primary care
Rosendal, M., Blankenstein, A. H., Morriss, R. K., Fink, P., Sharpe, M., & Burton, C. D. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008142.pub2 · Cited by 77 · see citing works
Leaviss, J., Davis, S., Ren, S., Hamilton, J., Scope, A., Booth, A., Sutton, A., Parry, G. D., Buszewicz, M., Moss-Morris, R. E., et al. (2020) · Health Technology Assessment · doi:10.3310/hta24460 · Cited by 67 · see citing works
Chalder, T. (2013) · doi:10.1002/9781118528563.wbcbt23 · Cited by 63 · see citing works
Cost-Effectiveness of Guideline-Based Care for Workers with Mental Health Problems
Rebergen, D. S., Bruinvels, D. J., van Tulder, M. W., van der Beek, A. J., & van Mechelen, W. (2009) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e3181990d8e · Cited by 54 · see citing works
Arnett, S., & Clark, I. A. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.04.004 · Cited by 49 · see citing works
Chronic fatigue syndrome – A neuroimmunological model
Arnett, S., Alleva, L. M., Korossy-Horwood, R., & Clark, I. A. (2011) · Medical Hypotheses · doi:10.1016/j.mehy.2011.03.030 · Cited by 40 · see citing works
Prognosis of fatigue. A systematic review
Nijrolder, I., van der Horst, H. E., & van der Windt, D. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.11.001 · Cited by 38 · see citing works
Associations of fatigue and depression among fatigued employees over time: A 4-year follow-up study
Huibers, M. J. H., Leone, S. S., van Amelsvoort, L. G. P. M., Kant, I., & Knottnerus, J. A. (2007) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.02.014 · Cited by 32 · see citing works
Self-citationMaas genannt Bermpohl, F., Kucharczyk-Bodenburg, A.-C., & Martin, A. (2024) · International Journal of Behavioral Medicine · doi:10.1007/s12529-023-10254-2 · Cited by 29 · see citing works
“For follow-ups longer than 12 months post-treatment, two studies provided information on fatigue severity: [45] reported a ~ 3.5-year follow-up to [46] ( g = 0.12, 95%CI -0.23 to 0.47), and [47] reported a two-year follow-up to [42] ( g = -0.21, 95%CI -0.47 to 0.05).”
InfluentialEMDR as a Therapeutic Treatment for Chronic Fatigue Syndrome (CFS)
Royle, L. (2008) · Journal of EMDR Practice and Research · doi:10.1891/1933-3196.2.3.226 · Cited by 20 · see citing works
Blakeman, P., & FORD, L. (2011) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2011.01818.x · Cited by 14 · see citing works
[Asthenia, mental fatigue and cognitive dysfunction].
Titova, N., Bezdolny, Y. N., & Katunina, E. (2023) · Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova · doi:10.17116/jnevro202312305138 · Cited by 9 · see citing works
Huibers, M. J. H., Leone, S. S., Kant, I., & Knottnerus, J. A. (2006) · Occupational and Environmental Medicine · doi:10.1136/oem.2005.023176 · Cited by 10 · see citing works
Self-citationNater, U. M., Heim, C. M., & Raison, C. L. (2012) · Handbook of clinical neurology · doi:10.1016/b978-0-444-52002-9.00034-6 · Cited by 8 · see citing works
Shiri, R., Varje, P., & Toppinen‐Tanner, S. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112140 · Cited by 6 · see citing works
Hultqvist, J., Bjerkeli, P. J., Hensing, G. K. E., & Holmgren, K. E. (2021) · Work · doi:10.3233/wor-205029 · Cited by 4 · see citing works
Rick, J., Carroll, C. P., Hillage, J., Pilgrim, H., & Jagger, N. (2008) · Cited by 3 · see citing works
Somatizaciones en Atención Primaria. Oportunidades de intervención.
Muñoz, M. M., Tomás, M. B., de Oliver, J. S. P., Collado, E. D., & Capafons, A. (2018) · INFORMACIO PSICOLOGICA · doi:10.14635/ipsic.2018.115.9 · Cited by 1 · see citing works
Davidsen, A. S., Overbeck, G., & Kousgaard, M. B. (2019) · Counselling and Psychotherapy Research · doi:10.1002/capr.12270 · Cited by 1 · see citing works
Fatigue in Primary Care : Course, Prognosis and Diagnoses
Nijrolder, I. (2009) · Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam)
- Authors
- Leone, S. S., Huibers, M. J. H., Kant, I., van Amelsvoort, L. G. P. M., van Schayck, C. P., Bleijenberg, G., & Knottnerus, J. A.
- Affiliations
- Maastricht University (NL)
- Radboud University Medical Center (NL)
- Corresponding author
- Leone, Stephanie S.
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2006-11
- Volume
- 61
- Issue
- 5
- Pages
- 601-607
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W2144544411
- Cited by
- 22
- References
- 27
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 1 · 2013: 2 · 2012: 2
- FWCI
- 1.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
- Keywords
- cognitive behavioral therapy, fatigue, general practitioners, long-term efficacy, absenteeism, sick leave, relapse, chronic fatigue syndrome, workplace health promotion
- MeSH terms
- Absenteeism, Adult, Family Practice, Fatigue, Female, Follow-Up Studies, Humans, Internal-External Control, Male, Middle Aged, Prognosis, Rehabilitation, Vocational, Cognitive Behavioral Therapy, Sick Leave, Secondary Prevention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
