Ridsdale, L; Godfrey, E; Chalder, T; Seed, P; King, M; Wallace, P; Wessely, S. Chronic fatigue in general practice: is counselling as good as cognitive behaviour therapy? A UK randomised Trial. BRITISH JOURNAL OF GENERAL PRACTICE, 2001,  51 (462), 19-24.


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 socio-economic backgrounds and lived in urban, suburban, and rural areas. Fifty-eight per cent had a history of anxiety and depression (from medical notes. About a half attributed their fatigue to (mainly) physical causes.

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 included 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 (minimum three months) entered the trial; 45 (28%) met CDC ‘94 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.

The 45 patients with CFS had a baseline fatigue score of 27.5 that is similar to the scores documented in other studies.  The results indicated a “non-significant trend in favour of counselling”.

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.

 

Comment

The results of this study are consistent with those of others, including Goudsmit and Ho-Yen (1996) who studied patients with post-infectious CFS.  The continued tendency to focus on fatigue and emotional distress is unfortunate.

Finally, the fatigue scores at follow-up remained relatively high.  However, this could be as a result of the limited number of therapy sessions (mean for both groups minus drop-outs was 5.1).


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