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. 2001 Jan;51(462):19–24.

Chronic fatigue in general practice: is counselling as good as cognitive behaviour therapy? A UK randomised trial.

L Ridsdale 1, E Godfrey 1, T Chalder 1, P Seed 1, M King 1, P Wallace 1, S Wessely 1; Fatigue Trialists' Group1
PMCID: PMC1313894  PMID: 11271868

Abstract

BACKGROUND: Fatigue is a common symptom for which patients consult their doctors in primary care. With usual medical management the majority of patients report that their symptoms persist and become chronic. There is little evidence for the effectiveness of any fatigue management in primary care. AIM: To compare the effectiveness of cognitive behaviour therapy (CBT) with counselling for patients with chronic fatigue and to describe satisfaction with care. DESIGN OF STUDY: Randomised trial with parallel group design. SETTING: Ten general practices located in London and the South Thames region of the United Kingdom recruited patients to the trial between 1996 and 1998. Patients came from a wide range of socioeconomic backgrounds and lived in urban, suburban, and rural areas. METHOD: Data were collected before randomisation, after treatment, and six months later. Patients were offered six sessions of up to one hour each of either CBT or counselling. Outcomes include: self-report of fatigue symptoms six months later, anxiety and depression, symptom attributions, social adjustment and patients' satisfaction with care. RESULTS: One hundred and sixty patients with chronic fatigue entered the trial, 45 (28%) met research criteria for chronic fatigue syndrome; 129 completed follow-up. All patients met Chalder et al's standard criteria for fatigue. Mean fatigue scores were 23 on entry (at baseline) and 15 at six months' follow-up. Sixty-one (47%) patients no longer met standard criteria for fatigue after six months. There was no significant difference in effect between the two therapies on fatigue (1.04 [95% CI = -1.7 to 3.7]), anxiety and depression or social adjustment outcomes for all patients and for the subgroup with chronic fatigue syndrome. Use of antidepressants and consultations with the doctor decreased after therapy but there were no differences between groups. CONCLUSION: Counselling and CBT were equivalent in effect for patients with chronic fatigue in primary care. The choice between therapies can therefore depend on other considerations, such as cost and accessibility.

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Selected References

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  1. Chalder T., Berelowitz G., Pawlikowska T., Watts L., Wessely S., Wright D., Wallace E. P. Development of a fatigue scale. J Psychosom Res. 1993;37(2):147–153. doi: 10.1016/0022-3999(93)90081-p. [DOI] [PubMed] [Google Scholar]
  2. Chisholm D., Godfrey E., Ridsdale L., Chalder T., King M., Seed P., Wallace P., Wessely S., Fatigue Trialists' Group Chronic fatigue in general practice: economic evaluation of counselling versus cognitive behaviour therapy. Br J Gen Pract. 2001 Jan;51(462):15–18. [PMC free article] [PubMed] [Google Scholar]
  3. Churchill R., Dewey M., Gretton V., Duggan C., Chilvers C., Lee A. Should general practitioners refer patients with major depression to counsellors? A review of current published evidence. Nottingham Counselling and Antidepressants in Primary Care (CAPC) Study Group. Br J Gen Pract. 1999 Sep;49(446):738–743. [PMC free article] [PubMed] [Google Scholar]
  4. Corney R. H. Counselling in general practice--does it work? Discussion paper. J R Soc Med. 1990 Apr;83(4):253–257. doi: 10.1177/014107689008300416. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Deale A., Chalder T., Marks I., Wessely S. Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial. Am J Psychiatry. 1997 Mar;154(3):408–414. doi: 10.1176/ajp.154.3.408. [DOI] [PubMed] [Google Scholar]
  6. Friedli K., King M. B., Lloyd M., Horder J. Randomised controlled assessment of non-directive psychotherapy versus routine general-practitioner care. Lancet. 1997 Dec 6;350(9092):1662–1665. doi: 10.1016/s0140-6736(97)05298-7. [DOI] [PubMed] [Google Scholar]
  7. Frison L., Pocock S. J. Repeated measures in clinical trials: analysis using mean summary statistics and its implications for design. Stat Med. 1992 Sep 30;11(13):1685–1704. doi: 10.1002/sim.4780111304. [DOI] [PubMed] [Google Scholar]
  8. Fukuda K., Straus S. E., Hickie I., Sharpe M. C., Dobbins J. G., Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994 Dec 15;121(12):953–959. doi: 10.7326/0003-4819-121-12-199412150-00009. [DOI] [PubMed] [Google Scholar]
  9. Greenland S., Finkle W. D. A critical look at methods for handling missing covariates in epidemiologic regression analyses. Am J Epidemiol. 1995 Dec 15;142(12):1255–1264. doi: 10.1093/oxfordjournals.aje.a117592. [DOI] [PubMed] [Google Scholar]
  10. Hollis S., Campbell F. What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ. 1999 Sep 11;319(7211):670–674. doi: 10.1136/bmj.319.7211.670. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Howie J. G., Heaney D. J., Maxwell M., Walker J. J., Freeman G. K., Rai H. Quality at general practice consultations: cross sectional survey. BMJ. 1999 Sep 18;319(7212):738–743. doi: 10.1136/bmj.319.7212.738. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Jerrett W. A. Lethargy in general practice. Practitioner. 1981 May;225(1355):731–737. [PubMed] [Google Scholar]
  13. Lloyd A. R., Hickie I., Brockman A., Hickie C., Wilson A., Dwyer J., Wakefield D. Immunologic and psychologic therapy for patients with chronic fatigue syndrome: a double-blind, placebo-controlled trial. Am J Med. 1993 Feb;94(2):197–203. doi: 10.1016/0002-9343(93)90183-p. [DOI] [PubMed] [Google Scholar]
  14. Morrell D. C. Symptom interpretation in general practice. J R Coll Gen Pract. 1972 May;22(118):297–309. [PMC free article] [PubMed] [Google Scholar]
  15. Powell R., Dolan R., Wessely S. Attributions and self-esteem in depression and chronic fatigue syndromes. J Psychosom Res. 1990;34(6):665–673. doi: 10.1016/0022-3999(90)90111-g. [DOI] [PubMed] [Google Scholar]
  16. Ridsdale L., Evans A., Jerrett W., Mandalia S., Osler K., Vora H. Patients who consult with tiredness: frequency of consultation, perceived causes of tiredness and its association with psychological distress. Br J Gen Pract. 1994 Sep;44(386):413–416. [PMC free article] [PubMed] [Google Scholar]
  17. Ridsdale L., Evans A., Jerrett W., Mandalia S., Osler K., Vora H. Patients with fatigue in general practice: a prospective study. BMJ. 1993 Jul 10;307(6896):103–106. doi: 10.1136/bmj.307.6896.103. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Ridsdale L., Mandalia S., Evans A., Jerrett W., Osler K. Tiredness as a ticket of entry. The role of patients' beliefs and psychological symptoms in explaining frequent attendance. General Practice Fatigue Group. Scand J Prim Health Care. 1999 Jun;17(2):72–74. doi: 10.1080/028134399750002674. [DOI] [PubMed] [Google Scholar]
  19. Senn S. J. Covariate imbalance and random allocation in clinical trials. Stat Med. 1989 Apr;8(4):467–475. doi: 10.1002/sim.4780080410. [DOI] [PubMed] [Google Scholar]
  20. Sharpe M. C., Archard L. C., Banatvala J. E., Borysiewicz L. K., Clare A. W., David A., Edwards R. H., Hawton K. E., Lambert H. P., Lane R. J. A report--chronic fatigue syndrome: guidelines for research. J R Soc Med. 1991 Feb;84(2):118–121. doi: 10.1177/014107689108400224. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Sharpe M., Hawton K., Simkin S., Surawy C., Hackmann A., Klimes I., Peto T., Warrell D., Seagroatt V. Cognitive behaviour therapy for the chronic fatigue syndrome: a randomized controlled trial. BMJ. 1996 Jan 6;312(7022):22–26. doi: 10.1136/bmj.312.7022.22. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Zigmond A. S., Snaith R. P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x. [DOI] [PubMed] [Google Scholar]

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