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

Anthonie Janse, Arno van Dam, Coby Pijpers, Jan F. Wiborg, Gijs Bleijenberg, Marcia Tummers, Jos Twisk, Stephanie Nikolaus, Hans Knoop

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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
Number of pages11
JournalBehavioural and cognitive psychotherapy
Issue number5
Publication statusPublished - 1 Sept 2019


  • chronic fatigue syndrome
  • cognitive behavioural therapy
  • implementation
  • minimal intervention
  • stepped care

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