Implementation of stepped care for patients with chronic fatigue syndrome in community-based mental health care: Outcomes at post-treatment and long-term follow-up

A. Janse, A. van Dam, C. Pijpers, J. Wiborg, G. Bleijenberg, M. Tummers, J. Twisk, S. Nikolaus, H. Knoop*

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background:
Cognitive behavioural therapy (CBT) is an evidence-based treatment for chronic fatigue syndrome (CFS). Stepped care for CFS, consisting of a minimal intervention followed by face-to-face CBT, was found efficacious when tested in a CFS specialist centre. Stepped care implemented in a community-based mental health centre (MHC) has not yet been evaluated.
Aims:
(1) To test the effectiveness of stepped care for CFS implemented in a MHC at post-treatment and at long-term follow-up; and (2) compare post-treatment outcomes of implemented stepped care with treatment outcomes of a CFS specialist centre.
Method:
An uncontrolled study was used to test effectiveness of stepped care implemented in a MHC (n = 123). The outcomes of implemented care were compared with the outcomes of specialist care reported in previous studies (n = 583). Data on outcomes from implemented stepped care were gathered at post-treatment and at long-term follow-up. Mixed models were used as method of analysis.
Results:
Fatigue decreased and physical functioning increased significantly following implemented stepped care (both p < .001). The follow-up was completed by 94 patients (78%) within 1–6 years after treatment. Treatment effects were sustained to follow-up. Patients in the MHC showed less improvement directly following stepped care compared with patients in a CFS specialist centre (p < .01).
Conclusion:
Implemented stepped care for CFS is effective with sustained treatment gains at long-term follow-up. There is room for improvement when compared with outcomes of a CFS specialist centre. Some suggestions are made on how to improve stepped care.
Original languageEnglish
Pages (from-to)548-558
JournalBehavioural and Cognitive Psychotherapy
Volume47
Issue number5
DOIs
Publication statusPublished - 2019

Keywords

  • ACCESS
  • COGNITIVE-BEHAVIOR THERAPY
  • DISORDERS
  • PAIN
  • RECOVERY
  • SF-36
  • chronic fatigue syndrome
  • cognitive behavioural therapy
  • implementation
  • minimal intervention
  • stepped care

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