Cited by 491Fibromyalgia and Chronic Fatigue Syndrome ResearchLong-Term Effects of COVID-19Psychosomatic Disorders and Their Treatments

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Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial.

Alicia C. Deale, Trudie Chalder, I. M. Marks, Simon C. Wessely·1997·American Journal of Psychiatry

DOI 10.1176/ajp.154.3.408

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Abstract

OBJECTIVE: Cognitive behavior therapy for chronic fatigue syndrome was compared with relaxation in a randomized controlled trial. METHODS: Sixty patients with chronic fatigue syndrome were randomly assigned to 13 sessions of either cognitive behavior therapy (graded activity and cognitive restructuring) or relaxation. Outcome was evaluated by using measures of functional impairment, fatigue, mood, and global improvement. RESULTS: Treatment was completed by 53 patients. Functional impairment and fatigue improved more in the group that received cognitive behavior therapy. At final follow-up, 70% of the completers in the cognitive behavior therapy group achieved good outcomes (substantial improvement in physical functioning) compared with 19% of those in the relaxation group who completed treatment. CONCLUSIONS: Cognitive behavior therapy was more effective than a relaxation control in the management of patients with chronic fatigue syndrome. Improvements were sustained over 6 months of follow-up.

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Method
Measuring disability in patients with chronic fatigue syndrome: reliability and validity of the Work and Social Adjustment Scale
Cella, M., Sharpe, M., & Chalder, T. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2011.02.009 · Cited by 103
Evaluating a Web-Based Cognitive-Behavioral Therapy for Maladaptive Perfectionism in University Students
Radhu, N., Daskalakis, Z. J., Arpin-Cribbie, C. A., Irvine, J., & Ritvo, P. (2012) · Journal of American College Health · doi:10.1080/07448481.2011.630703 · Cited by 94
Symptom patterns in long-duration chronic fatigue syndrome.
Friedberg, F., Dechene, L., McKenzie, M., & Fontanetta, R. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(99)00077-x · Cited by 105
Guided self-instructions for people with chronic fatigue syndrome: randomised controlled trial
Knoop, H., van der Meer, J. W. M., & Bleijenberg, G. (2008) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.108.051292 · Cited by 98
Fatigue after treatment for malignant and benign bone and soft tissue tumors
Servaes, P., Verhagen, S. C. A. H. H. V. M., Schreuder, H. W. B., Veth, R. P. H., & Bleijenberg, G. (2003) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2003.03.001 · Cited by 97
Non-pharmacological treatment of chronic widespread musculoskeletal pain
Hassett, A. L., & Williams, D. A. (2011) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2011.01.005 · Cited by 109
A randomised controlled trial into the effects of food on ADHD
Pelsser, L. M. J., Frankena, K., Toorman, J., Savelkoul, H. F. J., Pereira, R. R., & Buitelaar, J. K. (2008) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-008-0695-7 · Cited by 96
“Although open randomised controlled trials are commonly used when blinding is difficult [6, 11, 24, 27, 28, 30, 33, 34], we recommend replication of this trial with blinded measurements by an independent observer [6].”
Chronic fatigue syndrome and fibromyalgia: Clinical assessment and treatment
Friedberg, F., & Jason, L. A. (2001) · Journal of Clinical Psychology · doi:10.1002/jclp.1040 · Cited by 92
Chronic fatigue syndrome: Reviewing the research findings
Johnson, S. K., DeLuca, J., & Natelson, B. H. (1999) · Annals of Behavioral Medicine · doi:10.1007/bf02884843 · Cited by 90
Cognitive-behavior therapy for medically unexplained symptoms: A critical review of the treatment literature
Nezu, A. M., Nezu, C. M., & Lombardo, E. R. (2001) · Behavior Therapy · doi:10.1016/s0005-7894(01)80035-6 · Cited by 90
Interventions for the Treatment, Management and Rehabilitation of Patients with Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis: An Updated Systematic Review
Chambers, D., Bagnall, A., Hempel, S., & Forbes, C. A. (2006) · Journal of the Royal Society of Medicine · doi:10.1177/014107680609901012 · Cited by 90
Predictors of response to treatment for chronic fatigue syndrome.
Bentall, R. P., Powell, P., Nye, F. J., & Edwards, R. H. T. (2002) · British Journal of Psychiatry · doi:10.1192/bjp.181.3.248 · Cited by 87
Fatigue among HIV‐infected patients in the era of highly active antiretroviral therapy
Henderson, M., Safa, F., Easterbrook, P., & Hotopf, M. H. (2005) · HIV Medicine · doi:10.1111/j.1468-1293.2005.00319.x · Cited by 87
Cognitive behaviour therapy for chronic fatigue syndrome in adults
Price, J., & Couper, J. W. (1998) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001027 · Cited by 87
Cognitive-behavioural therapy for patients with multiple somatoform symptoms—a randomised controlled trial in tertiary care
Bleichhardt, G. M., Timmer, B., & Rief, W. (2004) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(03)00630-5 · Cited by 85
“In agreement with our results, several studies on somatisation report a larger improvement in somatic symptoms and smaller to no change in psychopathologic measures, such as anxiety, depression, or psychological distress [32 – 34].”
Result
Fatigue after breast cancer and in chronic fatigue syndrome
Servaes, P., Prins, J. B., Verhagen, S. C. A. H. H. V. M., & Bleijenberg, G. (2002) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(02)00300-8 · Cited by 85
Treatments for chronic fatigue syndrome
Rimes, K. A., & Chalder, T. (2005) · Occupational Medicine · doi:10.1093/occmed/kqi015 · Cited by 85
Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)
Kim, D.-Y., Lee, J., Park, S.-Y., Kim, S., & Son, C. (2020) · Journal of Translational Medicine · doi:10.1186/s12967-019-02196-9 · Cited by 83
Efficacy of Cognitive Behavioral Therapy for Adolescents With Chronic Fatigue Syndrome: Long-term Follow-up of a Randomized, Controlled Trial
Knoop, H., Stulemeijer, M., de Jong, L. W. A. M., Fiselier, T. J. W., & Bleijenberg, G. (2008) · PEDIATRICS · doi:10.1542/peds.2007-1488 · Cited by 82
Family cognitive behaviour therapy for chronic fatigue syndrome: an uncontrolled study
Chalder, T. (2002) · Archives of Disease in Childhood · doi:10.1136/adc.86.2.95 · Cited by 82
Stigma and Chronic Fatigue Syndrome
Green, J., Romei, J., & Natelson, B. H. (1999) · Journal of Chronic Fatigue Syndrome · doi:10.1300/j092v05n02_04 · Cited by 79
Effects of exercise on cognitive and motor function in chronic fatigue syndrome and depression
Blackwood, S. K., MacHale, S. M., Power, M., Goodwin, G. M., & Lawrie, S. M. (1998) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.65.4.541 · Cited by 76
Differences in symptom severity and health status impairment between patients with pulmonary and pulmonary plus extrapulmonary sarcoidosis
Gvozdenović, B., Mihailović-Vučinić, V., Dudvarski-Ilić, A., Žugić, V., & Judson, M. A. (2008) · Respiratory Medicine · doi:10.1016/j.rmed.2008.05.001 · Cited by 75
“The scale was found to be both reliable and valid(5) and has shown sensitivity to treatment changes.(6)”
Method
Disability and Chronic Fatigue Syndrome
Ross, S. D., Estok, R. P., Frame, D., Stone, L. R., Ludensky, V. M., & Levine, C. B. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.10.1098 · Cited by 75
Cognitive-behaviour therapy for chronic fatigue syndrome: Comparison of outcomes within and outside the confines of a randomised controlled trial
Quarmby, L. M., Rimes, K. A., Deale, A. C., Wessely, S. C., & Chalder, T. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.08.019 · Cited by 71
“…development of a rationale, creation of a schedule of graded activity, establishment of a consistent sleep pattern and the introduction of cognitive strategies to modify unhelpful thoughts (a detailed description of the treatment protocol can be found in the original paper (Deale et al., 1997)).”
BackgroundMethodResultInfluential
A randomised, controlled, triple-blind trial of the efficacy of homeopathic treatment for chronic fatigue syndrome
Weatherley-Jones, E., Nicholl, J. P., Thomas, K. J., Parry, G. J., McKendrick, M. W., Green, S. T., Stanley, P., & Spj, L. (2004) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(03)00377-5 · Cited by 70
“There is evidence indicating that cognitive behavioural therapy (CBT), administered by skilled therapists in specialist centres, is more effective for adult outpatients with CFS than routine medical care or relaxation [7–10].”
BackgroundMethodInfluential
Chronic fatigue syndrome: identifying zebras amongst the horses
Harvey, S. B., & Wessely, S. C. (2009) · BMC Medicine · doi:10.1186/1741-7015-7-58 · Cited by 66
“Rather, it is the maintaining factors, such as dramatic fluctuations in levels of activity (so called 'boom and bust' cycles), that need to be addressed if recovery is to occur [27,28].”
Background
Psychological treatment outcomes in routine NHS services: a commentary on
Clark, D., Fairburn, C., & Wessely, S. (2007) · Psychological Medicine · doi:10.1017/s0033291707001869 · Cited by 66
“…another equally credible treatment when given to patients with the same problem by similar highly trained therapists (for some illustrative examples see Fairburn et al. 1993 ; Clark et al. 1994, 1998, 2006 ; Arntz & Van den Hout, 1996 ; Deale et al. 1997 ; Agras et al. 2000 ; Stangier et al. 2007).”
Background

Authors: Deale, A. C., Chalder, T., Marks, I. M., & Wessely, S. C.
Affiliations: King's College London (GB)
ORCID: Trudie Chalder
Simon C. Wessely
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 1997-03-01
Volume: 154
Issue: 3
Pages: 408-414
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/ajp.154.3.408
OpenAlex: W2122883493
Cited by: 491
References: 33
Citations by year: 2026: 4 · 2025: 6 · 2024: 5 · 2023: 2 · 2022: 9 · 2021: 8 · 2020: 6 · 2019: 10 · 2018: 4 · 2017: 5 · 2016: 10 · 2015: 11 · 2014: 8 · 2013: 14 · 2012: 22
FWCI: 26.78
Type: journal article
Language: en
Open access: closed
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Research Portal (King's College London) (submittedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords: chronic fatigue syndrome, cognitive behavioral therapy, relaxation training, graded activity, cognitive restructuring, functional disability, fatigue, mood, treatment outcomes, follow-up
MeSH terms: Adult, Female, Follow-Up Studies, Health Status, Humans, Male, Patient Dropouts, Personality Inventory, Psychiatric Status Rating Scales, Relaxation Therapy, Fatigue Syndrome, Chronic, Cognitive Behavioral Therapy, Treatment Outcome

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Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial.

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