Skip to main content Accessibility help

Cognitive Behaviour Therapy for Chronic Fatigue Syndrome in Adults: Face to Face versus Telephone Treatment - A Randomized Controlled Trial

  • Mary Burgess (a1), Manoharan Andiappan (a2) and Trudie Chalder (a3)


Background: Previous research has shown that face to face cognitive behaviour therapy (CBT) is an effective treatment for chronic fatigue syndrome (CFS)/Myalgic Encephalomyelitis (ME). However, some patients are unable to travel to the hospital for a number of reasons. Aims: The aim of this study was to assess whether face to face CBT was more effective than telephone CBT (with face to face assessment and discharge appointment) for patients with CFS. Method: Patients aged 18–65 were recruited from consecutive referrals to the Chronic Fatigue Syndrome (CFS) Research and Treatment Unit at The South London and Maudsley NHS Trust in London. Participants were randomly allocated to either face to face CBT or telephone CBT by a departmental administrator. Blinding of participants and care givers was inappropriate for this trial. A parallel-groups randomised controlled trial was used to compare the two treatments. The primary outcomes were physical functioning and fatigue. Results: Significant improvements in the primary outcomes of physical functioning and fatigue occurred and were maintained to one year follow-up after discharge from treatment. Improvements in social adjustment and global outcome were noted and patient satisfaction was similar in both groups. Conclusions: Results from this study indicate that telephone CBT with two face to face appointments is a mild to moderately effective treatment for CFS and may be offered to patients where face to face treatment is not a viable option. Despite these encouraging conclusions, dropout was relatively high and therapists should be aware of this potential problem.


Corresponding author

Reprint requests to Mary Burgess, Chronic Fatigue Syndrome Research and Treatment Unit, First Floor, Mapother House, De Crespigny Park, Camberwell, London SE5 8AZ, UK. E-mail:


Hide All
Bentall, R. P., Powell, P., Nye, F. J. and Edwards, R. H. (2002). Predictors of response to treatment for chronic fatigue syndrome. British Journal of Psychiatry, 181, 248252.
Burgess, M. and Chalder, T. (2001). Telephone cognitive behaviour therapy for chronic fatigue syndrome in secondary care: a case series. Behavioural and Cognitive Psychotherapy, 29, 447458.
Cella, M. and Chalder, T. (2010). Measuring fatigue in clinical and community settings. Journal of Psychosomatic Research, 69, 1722.
Cella, M., Sharpe, M. and Chalder, T. (2011). Measuring disability in patients with chronic fatigue syndrome: reliability and validity of the Work and Social Adjustment Scale. Journal of Psychosomatic Research. doi:10.1016/j.jpsychores.2011.02.009
Cella, M., Stahl, D., Reme, S. E. and Chalder, T. (2011) Therapist effects in routine psychotherapy practice: an account from Chronic Fatigue Syndrome. Psychotherapy Research, 21, 168178.
Chalder, T., Berelowitz, G., Hirsch, S., Pawilikowska, T., Wallace, P., Wessely, S., et al. (1993). Development of a fatigue scale. Journal of Psychosomatic Research, 37, 147153.
Chambers, D., Bagnall, A. M., Hempel, S. and Forbes, C. (2006). Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. Journal of the Royal Society of Medicine, 99, 506520.
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
Deale, A., Chalder, T., Marks, I. and Wessely, S. (1997). Cognitive behaviour therapy for chronic fatigue syndrome: a randomized controlled trial. American Journal of Psychiatry, 15, 408414.
Fukuda, K., Straus, S., Hickie, I., Sharpe, M. C., Dobbins, J. G. and Komaroff, A. (1994). Chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic fatigue syndrome study group. Annals of Internal Medicine, 121, 953959.
Joyce, J., Hotopf, M. and Wessely, S. (1997). The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. Quarterly Journal of Medicine, 90, 223233.
Leach, L. and Christensen, H. (2006). A systematic review of telephone-based interventions for mental disorders. Journal of Telemedicine and Telecare, 12, 122129.
Lovell, K., Cox, D., Haddock, G., Jones, C., Raines, D., Garvey, R., et al. (2006). Telephone administered cognitive behaviour therapy for treatment of obsessive compulsive disorder: randomised controlled non-inferiority trial. British Medical Journal doi:10.1136/bmj.38940.355602.80.
Mundt, J. C., Marks, I. M., Shear, K. and Griest, J. H. (2002). The work and social adjustment scale: a simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461464.
National Institute for Health and Clinical Excellence (NICE) (2007). Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy). NICE Clinical Guideline, 53. London: NICE.
Pocock, S. J. (1995). Clinical Trials: a practical approach. Chichester: Wiley.
Price, J. R., Mitchell, E., Tidy, E. and Hunot, V. (2008). Cognitive behaviour therapy for chronic fatigue syndrome in adults: Cochrane review. Cochrane Database of Systematic Reviews, Issue 3. Art. No: CD001027. DOl: 10. 1002/1465 1858. CD001027. Pub2.
Prins, J., Bleijenberg, G., Bazelmans, E., Elving, L., de Boo, T., Severens, J., et al. (2001). Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial. The Lancet, 357, Issue 9259, 841847.
Quarmby, L., Rimes, K.A., Deale, A., Wessely, S. and Chalder, T. (2007). Cognitive-behaviour therapy for chronic fatigue syndrome: comparison of outcomes within and outside the confines of a randomised controlled trial. Behaviour Research and Therapy, 45, 10851094.
Schmaling, K. B., Smith, W. R. and Buchwald, D. S. (2000). Significant other responses are associated with fatigue and functional status among patients with chronic fatigue syndrome. Psychosomatic Medicine, 62, 444450.
Sharpe, M. C., Archard, L. C., Banatvala, J. E., Borysiewicz, L. K., Clare, A. W., David, A., et al. (1991). A report-chronic fatigue syndrome: guidelines for research. Journal of the Royal Society of Medicine, 84, 118121.
Sharpe, M. and Chalder, T. (1994). In Illis, L. S. , L. S. (Ed.) Management of Chronic Fatigue Syndrome: neurological rehabilitation (pp. 282294). Oxford: Blackwell.
Sharpe, M., Hawton, K., Simkin, S., Surawy, C., Hackmann, A., Klimes, I., et al. (1996). Cognitive behaviour therapy for chronic fatigue syndrome: a randomized controlled trial. British Medical Journal, 312, 2226
Stewart, A., Hays, R. and Ware, J. (1988). The MOS Short Form General Health Survey: reliability and validity in a patient population. Medical Care, 26, 724732.
Wessely, S., David, A., Butler, S. and Chalder, T. (1989). Management of chronic (post-viral) fatigue syndrome. Journal of Royal College of General Practitioners, 39, 2629.
White, P. D., Goldsmith, K. A., Johnson, A. L., Potts, L., Walwyn, R., DeCesare, J. C., et al. (2011). Comparison of adaptive pacing, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. The Lancet, 377, 823836.
Whiting, P., Bagnall, A. M., Snowdon, A. J., Cornell, J. E. and Mulrow, C. D. (2001). Interventions for the treatment and management of chronic fatigue syndrome. JAMA, 286, 13601368.
Zigmond, A. and Snaith, R. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavia, 87, 361370.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
  • EISSN: 1469-1833
  • URL: /core/journals/behavioural-and-cognitive-psychotherapy
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Cognitive Behaviour Therapy for Chronic Fatigue Syndrome in Adults: Face to Face versus Telephone Treatment - A Randomized Controlled Trial

  • Mary Burgess (a1), Manoharan Andiappan (a2) and Trudie Chalder (a3)
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *