Effectiveness of stepped care for chronic fatigue syndrome: A randomized noninferiority trial.
Abstract
OBJECTIVE: In this randomized noninferiority study, the effectiveness and efficiency of stepped care for chronic fatigue syndrome (CFS) was compared to care as usual. Stepped care was formed by guided self-instruction, followed by cognitive behavior therapy (CBT) if the patient desired it. Care as usual encompassed CBT after a waiting period. METHOD: A total of 171 CFS patients were randomly allocated to stepped care or care as usual. Patients in both conditions were assessed 3 times: at baseline, after guided self-instruction or the waiting period, and after CBT. The primary outcome variables were fatigue severity (Checklist Individual Strength) and disabilities (Sickness Impact Profile and Medical Outcomes Survey Short Form-36). RESULTS: An intention to treat analysis showed that stepped care (N = 84) for CFS is noninferior to care as usual (N = 85). Both conditions were equivalent in reducing fatigue severity, reducing disabilities, and increasing physical functioning. The treatment results of both conditions were in accordance with those of previous randomized controlled trials testing the effectiveness of CBT for CFS. The total therapist time needed to treat a patient was significantly less in the stepped care condition. CONCLUSIONS: Stepped care is as effective as CBT and is more time efficient for the therapist.
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Patient characteristics such as fatigue severity or comorbid psychopathology could determine whether a patient is able and willing to participate in CBT.
“Furthermore, patient characteristics like fatigue severity or comorbid psychopathology could determine whether a patient is able and willing to participate in CBT (e.g., [20]).”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [20]
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- Authors
- Tummers, M., Knoop, H., & Bleijenberg, G.
- Affiliations
- Radboud University Medical Center (NL)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2010-10
- Volume
- 78
- Issue
- 5
- Pages
- 724-731
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W2167262553
- Cited by
- 57
- References
- 31
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 4 · 2019: 7 · 2018: 2 · 2017: 5 · 2016: 6 · 2015: 4 · 2014: 3 · 2013: 4 · 2012: 6
- FWCI
- 3.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- chronic fatigue syndrome, stepped care, cognitive behavioral therapy, non-inferiority, fatigue severity, disability, physical function, usual care
- MeSH terms
- Adult, Disability Evaluation, Female, Humans, Male, Middle Aged, Netherlands, Prognosis, Self Care, Sick Role, Fatigue Syndrome, Chronic, Cognitive Behavioral Therapy
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