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Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial.
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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“CBT has been adapted and tested with CFS patients yielding superior results compared to standard medical treatment, relaxation, and adaptive pacing therapy (Sharpe et al., 1996; Deale et al., 1997; White et al., 2011), with moderate effect sizes (d = 0.48) (Malouff et al., 2008).”
From The relationship between improvement in insomnia severity and long-term outcomes in the treatment of chronic fatigue (2018) · cites this paper as Deale et al., 1997
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“2011) and has been used in previous treatment trials of CFS (Deale et al. 1997; Quarmby et al. 2007).”
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“When psychiatric diagnoses were assessed in CBT trials, their effect on treatment outcome was not reported (Sharpe et al, 1996), significant differences in improvement were not found (Deale et al, 1997) and poor outcome was associated with psychiatric history (Bonner et al, 1994).”
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“Cognitive behaviour therapy (CBT), effective in syndromes such as fatigue (Sharpe et al., 1996; Deale et al., 1997; Deale et al., 2001), is not a part of the routine training of general practitioners and is time consuming.”
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“%) refused RCT participation and 0 of 30 refused CBT after randomization in Deale et al. (1997).”
BackgroundInfluentialChronic fatigue syndrome and occupational health
Mounstephen, A., & Sharpe, M. (1997) · Occupational Medicine · doi:10.1093/occmed/47.4.217 · Cited by 35
A Twin Study of the Etiology of Prolonged Fatigue and Immune Activation
Hickie, I. B., Bansal, A. S., Kirk, K. M., Lloyd, A. R., & Martin, N. G. (2001) · Twin Research · doi:10.1375/1369052012209 · Cited by 35
Cognitive Behavior Therapy for Functional Somatic Complaints
Sharpe, M. (1997) · Psychosomatics · doi:10.1016/s0033-3182(97)71443-9 · Cited by 35
Cognitive behavioral therapy-related increases in cortical inhibition in problematic perfectionists
Radhu, N., Daskalakis, Z. J., Guglietti, C. L., Farzan, F., Barr, M. S., Arpin-Cribbie, C. A., Fitzgerald, P. B., & Ritvo, P. (2012) · Brain Stimulation · doi:10.1016/j.brs.2011.01.006 · Cited by 30
Therapist effects in routine psychotherapy practice: An account from chronic fatigue syndrome
Cella, M., Stahl, D. R., Rème, S. E., & Chalder, T. (2011) · Psychotherapy Research · doi:10.1080/10503307.2010.535571 · Cited by 35
“Demographic and clinical characteristics of the CFS patients considered are similar to previous research on this client population (e.g. Deale et al., 1997).”
MethodDittner, A. J., Hodsoll, J., Rimes, K. A., Russell, A. J., & Chalder, T. (2018) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12836 · Cited by 31
“CGI Improvement rated by participants showed little association with changes in ADHD medication for each group at 30 or 42 weeks.”
InfluentialInterventions for the treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis
Bagnall, A. (2002) · BMJ Quality & Safety · doi:10.1136/qhc.11.3.284 · Cited by 33
“18 Four randomised controlled trials evaluated weekly or biweekly sessions of CBT. CBT was compared with routine medical care in one trial (n=60), 19 with relaxation in a second trial (n=60), 20 and with natural course (control) in a third (n=270).”
Price, J. R. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(99)00070-7 · Cited by 32
Treatment of fatigue in fibromyalgia
Guymer, E. K., & Clauw, D. J. (2002) · Rheumatic Disease Clinics of North America · doi:10.1016/s0889-857x(01)00007-2 · Cited by 35
“Two of the studies demonstrated the efficacy of CBT [35,36], and one study found no benefit [37].”
ResultDiagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Smith, M. E. B., Nelson, H. D., Haney, E. M., Pappas, M., Daeges, M., Wasson, N., & McDonagh, M. S. (2014) · doi:10.23970/ahrqepcerta219 · Cited by 33
Ridsdale, L., Hurley, M., King, M., McCrone, P., & Donaldson, N. (2012) · Psychological Medicine · doi:10.1017/s0033291712000256 · Cited by 32
“Chronic fatigue is a remitting and relapsing condition clinically, and it may be that a longer course of treatment or a booster dose is needed to achieve sustained improvement (Deale et al. 1997 ; Fulcher & White, 1997).”
BackgroundPredicting Fatigue in Patients Using Home Parenteral Nutrition: A Longitudinal Study
Waal, G. H., Bazelmans, E., van Achterberg, T., Jansen, J. B. �. �., Sauerwein, H. P., Wanten, G. J. A., & Schoonhoven, L. (2010) · International Journal of Behavioral Medicine · doi:10.1007/s12529-010-9116-7 · Cited by 32
“For CFS patients, CBT has been proven to be successful in reducing fatigue complaints [40, 51–53].”
Method
Metadata
- Authors
- Deale, A. C., Chalder, T., Marks, I. M., & Wessely, S. C.
- Affiliations
- King's College London (GB)
- Venue
- American Journal of Psychiatry
- Published
- 1997-03-01
- Volume
- 154
- Issue
- 3
- Pages
- 408-414
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- 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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