Chronic Fatigue Self-Management in Primary Care: A Randomized Trial
Open accessAbstract
OBJECTIVE: To assess the efficacy of brief fatigue self-management (FSM) for medically unexplained chronic fatigue (UCF) and chronic fatigue syndrome (CFS) in primary care. METHODS: A randomized controlled design was used wherein 111 patients with UCF or CFS were randomly assigned to two sessions of FSM, two sessions of symptom monitoring support (attention control; AC), or a usual care control condition (UC). Participants were assessed at baseline and at 3 and 12 months after treatment. The primary outcome, the Fatigue Severity Scale, measured fatigue impact on functioning. Analysis was by intention to treat (multiple imputation) and also by per protocol. RESULTS: A group × time interaction across the 15-month trial showed significantly greater reductions in fatigue impact in the FSM group in comparison with the AC group (p < .023) and the UC group (p < .013). Medium effect sizes for reduced fatigue impact in the FSM group were found in comparison with the AC group (d = 0.46) and the UC group (d = 0.40). The per-protocol analysis revealed large effect sizes for the same comparisons. Clinically significant decreases in fatigue impact were found for 53% of participants in the FSM condition, 14% in the AC condition, and 17% in the UC condition. Dropout rates at the 12-month follow-up were high (42%-53%), perhaps attributable to the burden of monthly telephone calls to assess health care use. CONCLUSION: A brief self-management intervention for patients with UCF or CFS seemed to be clinically effective for reducing the impact of fatigue on functioning. Trial Registration clinicaltrials.gov Identifier: NCT00997451.
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Psychological functioning was measured using the Beck Depression Inventory (BDI) and Beck Depression Inventory-II (BDI-II) scale in eight studies.
“Psychological functioning was measured using the Beck Depression Inventory (BDI) and Beck Depression Inventory-II (BDI-II) scale [124] in eight studies”
From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [94]
The Method (Assessments and Outcome Measures; page unavailable) says this trial measured depressive symptoms with the BDI-II. It does not establish that both the BDI and BDI-II were used across eight studies; its Results use “BDI” as shorthand for the depression measure. (LLM, conf=0.86)
Experimental — accuracy not yet measuredFriedberg et al.'s chronic fatigue self-management intervention revealed no significant changes in SF-36PF scores by time, treatment group, or diagnostic group (p>0.05).
“No significant changes in scores by time, treatment group, or diagnostic group were revealed (p>0.05)”
From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [94]
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MethodSelf-citation
Flagged first, then by citations
Cited by
Sorted by citations
Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., & Schreurs, K. M. G. (2016) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2015.1098724 · Cited by 737 · see citing works
“Of the 87 articles, 67 were excluded for the following reasons: no acceptance- and mindfulness-based intervention (Coleman, 2011; Cramer et al., 2013; Curtis, Osadchuk, & Katz, 2011; Elinoff, Lynn, Ochiai, & Hallquist, 2009; Elomaa, Williams, & Kalso, 2009; Evans et al., 2011; Friedberg et al., 2013; Hirschfeld et al.…”
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“…2010 111) –0.15 (–0.42 to 0.13) CBTLI IBS (Moss-Morris, 2010130) –0.27 (–0.76 to 0.21) Different point estimates, but overlapping CIsChronic fatigue (Friedberg, 2013 151) 0.18 (–0.26 to 0.63) Depression OP MUS/somatoform (Kolk, 2004104) –0.31 (–0.77 to 0.15) Different point estimates, but…”
InfluentialA Comprehensive Update of the Current Understanding of Chronic Fatigue Syndrome
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“Self-management interventions, requiring patient education and frequent self-assessment, may be effective in reducing fatigue (63).”
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“Since the control groups in [36], i.e., the symptom monitoring support and TAU, were not comparable, TAU was excluded.”
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“This was the lowest score on the SF-36 PF among published CFS behavioral self-management studies which ranged from 50 to 72 [4,7,20,45] and compares to a median score of 95 in the general US population, ages 45–54, the age range”
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“Although global improvements (and related symptomatic changes) (Friedberg et al., 2013) were relatively modest at the 3-month followup assessment, our qualitative data appeared to provide early indications of self-management skills that were beginning to work.”
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“All three groups were assessed at baseline and 12-month follow-up [23].”
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“…fatigue have been investigated, such as pharmaceutical therapies, alternative medicine, graded exercise therapy, acceptance and commitment therapy, psychoed-ucation therapy and self-management strategies (Castro-Marrero et al., 2017; Friedberg et al., 2013; Noor et al., 2021; Rowe, 2023).”
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“offers a promising alternative to traditional multi-session CBT (6–16 visits required) delivered by experienced therapists [19], a group-based CBT training [24], or a modified two-session CBT training plus a self-help booklet [45].”
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“…attention deficit hyperactivity disorder (Bussing et al., 2016; Christiansen et al., 2014), irritable bowel syndrome (Eugenio et al., 2012), chronic fatigue syndrome (Meng, Friedberg, & Castora-Binkley, 2014, Friedberg et al., 2013), and fibromyalgia (Bourgault et al., 2015; Hamnes et al., 2012).”
Beems, M. E. C., Toonders, S. A. J., van Westrienen, P. E., Veenhof, C., & Pisters, M. F. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.109785 · Cited by 3 · see citing works
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Uplifts and hassles are related to worsening in chronic fatigue syndrome: a prospective study
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“Uplifts can be a focus of behavioral management [12] if the clinician collaboratively identifies with the patient pleasant, enjoyable, low-effort activities that are often lacking in the lives of individuals with debilitating CFS [33, 34].”
BackgroundSelf-citationSelf-management and ambulatory monitoring in chronic fatigue syndrome: future directions
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“[4] Furthermore, behavioral self-management trials in CFS and unexplained chronic fatigue have reported clinically significant improvements in fatigue and fatigue impact on functioning for 25–53% of participants.[5] However, these findings also indicate that a large proportion of patients do not benefit from these int…”
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The burden of Sjögren's syndrome, dryness and fatigue
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Diary-based outcome predictors in a self-management trial in chronic fatigue syndrome
Adamowicz, J. L., & Caikauskaite, I. (2016) · Fatigue Biomedicine Health & Behavior · doi:10.1080/21641846.2016.1217666
“© 2016 IACFS/ME”
BackgroundInfluentialSelf-citationChronic Fatigue and Postinfective Fatigue Syndromes
Lloyd, A. R. (2016) · ASM Press eBooks · doi:10.1128/9781555819439.ch18
Effects of Dendrobium officinale on chronic fatigue in rats: Modulation of tryptophan metabolism
Yan, M., Shi, M., Li, C., Yu, B., Zhou, H., Su, J., Yu, J., Lv, G., & Chen, S. (2026) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2026.121527
- Authors
- Friedberg, F., Napoli, A., Coronel, J., Adamowicz, J., Seva, V., Caikauskaite, I., Ngan, M. C., Chang, J., & Meng, H.
- Affiliations
- Stony Brook University (US)
- University of South Florida (US)
- Corresponding author
- Friedberg, Fred
- Venue
- Psychosomatic Medicine
- Published
- 2013-09
- Volume
- 75
- Issue
- 7
- Pages
- 650-657
- ISSN
- 0033-3174 (ISSN-L)
- PMC
- PMC3785003
- OpenAlex
- W2318232454
- Cited by
- 30
- References
- 41
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 3 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 5 · 2017: 4 · 2016: 7 · 2015: 1 · 2014: 4
- FWCI
- 2.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Nursing Research (R01NR010229)
- National Center for Research Resources (M01RR010710, MO1 RR10710)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- chronic fatigue syndrome, fatigue self-management, brief intervention, symptom monitoring, attentional control, Fatigue Severity Scale, primary care, telephone follow-up, dropout
- MeSH terms
- Activities of Daily Living, Adult, Attention, Counseling, Female, Humans, Male, Medical Records, Patient Dropouts, Primary Health Care, Psychiatric Status Rating Scales, Self Care, Severity of Illness Index, Time Factors, Fatigue Syndrome, Chronic, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Practice Patterns, Nurses', Intention to Treat Analysis
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