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

Behav Cogn Psychother. 2019 Sep;47(5):548-558. doi: 10.1017/S1352465819000110. Epub 2019 Mar 12.


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.

Keywords: chronic fatigue syndrome; cognitive behavioural therapy; implementation; minimal intervention; stepped care.

Publication types

  • Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Cognitive Behavioral Therapy*
  • Community Mental Health Centers*
  • Fatigue / psychology
  • Fatigue / therapy
  • Fatigue Syndrome, Chronic / psychology
  • Fatigue Syndrome, Chronic / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Mental Health
  • Middle Aged
  • Treatment Outcome
  • Young Adult