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Implementing a minimal intervention for chronic fatigue syndrome in a mental health centre: a randomized controlled trial

Published online by Cambridge University Press:  21 February 2012

M. Tummers ,
H. Knoop ,
A. van Dam  and
G. Bleijenberg
M. Tummers*
Affiliation:
Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, The Netherlands
H. Knoop
Affiliation:
Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, The Netherlands
A. van Dam
Affiliation:
GGZ Westelijk Noord Brabant, Institute for Mental Health, The Netherlands
G. Bleijenberg
Affiliation:
Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, The Netherlands
*
*Address for correspondence: M. Tummers, M.Sc., Radboud University Nijmegen Medical Centre, Expert Centre for Chronic Fatigue, 4628, PO Box 9101, 6500 HB Nijmegen, The Netherlands. (Email: [email protected])
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Abstract

Background

Cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) is an effective but intensive treatment, requiring trained therapists. A minimal intervention based on CBT for CFS, guided self-instruction, was shown to be an effective treatment when delivered in a tertiary treatment centre. Implementing this intervention in a community-based mental health centre (MHC) will increase the treatment capacity for CFS patients. This study evaluated the effectiveness of guided self-instruction for CFS implemented in an MHC, delivered by nurses.

Method

One hundred and twenty-three patients were randomly assigned to either guided self-instruction (n=62) or a waiting list (n=61). Randomization was computer generated, with allocation by numbered sealed envelopes. Group allocation was open to all those involved. Patients fulfilled US Centers for Disease Control and Prevention (CDC) criteria for CFS. Primary outcome variables were fatigue severity and physical and social functioning, measured with the Checklist Individual Strength (CIS) and the Medical Outcomes Survey Short Form-36 (SF-36) respectively.

Results

After 6 months, patients who followed guided self-instruction reported a significantly larger decrease in fatigue compared to the waiting list [mean difference –8.1, 95% confidence interval (CI) −3.8 to −12.4, controlled effect size 0.70]. There was no significant difference in physical and social functioning. However, post-hoc analyses showed a significant decrease in fatigue and physical disabilities following the intervention in a subgroup of patients with physical disabilities at baseline (SF-36 physical functioning ⩽70).

Conclusions

Implementation of guided self-instruction in a community-based MHC was partially successful. The minimal intervention can be effectively implemented for CFS patients with physical impairments.

Keywords

Chronic fatigue syndromecognitive behaviour therapyimplementationminimal interventionrandomized controlled trial
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 10 , October 2012 , pp. 2205 - 2215
Copyright
Copyright © Cambridge University Press 2012

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