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The British Journal of Psychiatry (2004) 184: 240-246
© 2004 The Royal College of Psychiatrists

Efficacy of cognitive-behavioural therapy by general practitioners for unexplained fatigue among employees

Randomised controlled trial

Marcus J. H. Huibers, PhD

Departments of Epidemiology and General Practice, Maastricht University and Department of Medical Psychology, UMC St Radboud Nijmegen

Anna J. H. M. Beurskens, PhD

Department of Epidemiology, Maastricht University

Constant P. van Schayck, PhD

Department of General Practice, Maastricht University

Ellen Bazelmans, MA

Department of Medical Psychology, UMC St Radboud Nijmegen

Job F. M. Metsemakers, MD PhD

Department of General Practice, Maastricht University

J Andre Knottnerus, MD PhD

Department of General Practice, Maastricht University

Gijs Bleijenberg, PhD

Department of Medical Psychology, UMC St Radboud Nijmegen, The Netherlands

Correspondence: M. J. H. Huibers, Department of Medical, Clinical and Experimental Psychology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. Tel: +3143 388 1487; fax: +31 43 388 4155; e-mail: m.huibers{at}dmkep.unimaas.nl

Declaration of interest None. Funding detailed in Acknowledgements.

Background Fatigue is a common complaint that may lead to long-term sick leave and work disability.

Aims To assess the efficacy of cognitive-behavioural therapy by general practitioners for unexplained, persistent fatigue among employees.

Method A randomised controlled trial, using a pre-randomisation design in primary care, investigated 151 employees on sick leave with fatigue. Participants in the experimental group were offered five to seven 30 min sessions of cognitive-behavioural therapy by a general practitioner; those in the control group were offered no treatment. Main outcome measures (fatigue severity, self-reported absenteeism, registered absenteeism and clinical recovery) were assessed at 4 months, 8 months and 12 months.

Results At baseline, 44% ofthe patients already met research criteria for chronic fatigue syndrome. There was no significant difference between the experimental group and the control group on primary or secondary outcomes at any point.

Conclusions Cognitive-behavioural therapy by general practitioners for unexplained, persistent fatigue did not prove to be an effective intervention. Since these doctors were unable to deliver this therapy effectively under ideal circumstances, it is unlikely that doctors in routine practice would be more successful in doing so.


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