Intended for healthcare professionals


Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial

BMJ 1996; 312 doi: (Published 06 January 1996) Cite this as: BMJ 1996;312:22
  1. Michael Sharpe, clinical tutora,
  2. Keith Hawton, senior clinical lecturera,
  3. Sue Simkin, research assistanta,
  4. Christina Surawy, research clinical psychologista,
  5. Ann Hackmann, research clinical psychologista,
  6. Ivana Klimes, consultant psychologista,
  7. Tim Peto, consultant physicianb,
  8. David Warrell, professor of tropical medicine and infectious diseasesb,
  9. Valerie Seagroatt, statisticianc
  1. a University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
  2. b Nuffield Department of Medicine, John Radcliffe Hospital, Oxford
  3. c Unit of Health Care Epidemiology, University of Oxford
  1. Correspondence to: Dr Sharpe.
  • Accepted 1 November 1995


Objective: To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with the chronic fatigue syndrome.

Design: Randomised controlled trial with final assessment at 12 months.

Setting: An infectious diseases outpatient clinic.

Subjects: 60 consecutively referred patients meeting consensus criteria for the chronic fatigue syndrome.

Interventions: Medical care comprised assessment, advice, and follow up in general practice. Patients who received cognitive behaviour therapy were offered 16 individual weekly sessions in addition to their medical care.

Main outcome measures: The proportions of patients (a) who achieved normal daily functioning (Karnofsky score 80 or more) and (b) who achieved a clinically significant improvement in functioning (change in Karnofsky score 10 points or more) by 12 months after randomisation.

Results: Only two eligible patients refused to participate. All randomised patients completed treatment. An intention to treat analysis showed that 73% (22/30) of recipients of cognitive behaviour therapy achieved a satisfactory outcome as compared with 27% (8/30) of patients who were given only medical care (difference 47 percentage points; 95% confidence interval 24 to 69). Similar differences were observed in subsidiary outcome measures. The improvement in disability among patients given cognitive behaviour therapy continued after completion of therapy. Illness beliefs and coping behaviour previously associated with a poor outcome changed more with cognitive behaviour therapy than with medical care alone.

Conclusion: Adding cognitive behaviour therapy to the medical care of patients with the chronic fatigue syndrome is acceptable to patients and leads to a sustained reduction in functional impairment.

Key messages

  • Key messages

  • There is no generally accepted form of treatment

  • New findings show that patients referred to hospital for the chronic fatigue syndrome have a better outcome if they are given a course of cognitive behaviour therapy than if they receive only basic medical care

  • Clinical improvement with cognitive behaviour therapy may be slow but often continues after treatment has ended

  • Cognitive behaviour therapy should be considered as an option for patients presenting with the chronic fatigue syndrome


  • Funding The study was funded by the Wellcome Trust. A pilot study was funded by the research committee of the Oxford Regional Health Authority.

  • Conflict of interest None.

  • Accepted 1 November 1995
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