The British Journal of Psychiatry (2004) 184: 240-246

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@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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