Background: Meta-analyses have been inconclusive about the efficacy of cognitive behaviour therapies (CBTs) delivered in groups of patients with chronic fatigue syndrome (CFS) due to a lack of adequate studies. Methods: We conducted a pragmatic randomised controlled trial with 204 adult CFS patients from our routine clinical practice who were willing to receive group therapy. Patients were equally allocated to therapy groups of 8 patients and 2 therapists, 4 patients and 1 therapist or a waiting list control condition. Primary analysis was based on the intention-to-treat principle and compared the intervention group (n = 136) with the waiting list condition (n = 68). The study was open label. Results: Thirty-four (17%) patients were lost to follow-up during the course of the trial. Missing data were imputed using mean proportions of improvement based on the outcome scores of similar patients with a second assessment. Large and significant improvement in favour of the intervention group was found on fatigue severity (effect size = 1.1) and overall impairment (effect size = 0.9) at the second assessment. Physical functioning and psychological distress improved moderately (effect size = 0.5). Treatment effects remained significant in sensitivity and per-protocol analyses. Subgroup analysis revealed that the effects of the intervention also remained significant when both group sizes (i.e. 4 and 8 patients) were compared separately with the waiting list condition. Conclusions: CBT can be effectively delivered in groups of CFS patients. Group size does not seem to affect the general efficacy of the intervention which is of importance for settings in which large treatment groups are not feasible due to limited referral.

1.
Price JR, Mitchell E, Tidy E, Hunot V: Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev Online 2008;3:CD001027.
2.
Malouff JM, Thorsteinsson EB, Rooke SE, Bhullar N, Schutte NS: Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis. Clin Psychol Rev 2008;28:736-745.
3.
Castell BD, Kazantzis N, Moss-Morris RE: Cognitive behavioral therapy and graded exercise for chronic fatigue syndrome: a meta-analysis. Clin Psychol Sci Pract 2011;18:311-324.
4.
Bazelmans E, Prins JB, Lulofs R, van der Meer JWM, Bleijenberg G: Cognitive behaviour group therapy for chronic fatigue syndrome: a non-randomised waiting list controlled study. Psychother Psychosom 2005;74:218-224.
5.
O'Dowd H, Gladwell P, Rogers CA, Hollinghurst S, Gregory A: Cognitive behavioural therapy in chronic fatigue syndrome: a randomised controlled trial of an outpatient group programme. Health Technol Assess Winch Engl 2006;10:iii-iv, ix-x, 1-121.
6.
Núñez M, Fernández-Solà J, Nuñez E, Fernández-Huerta J-M, Godás-Sieso T, Gomez-Gil E: Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up. Clin Rheumatol 2011;30:381-389.
7.
Wiborg JF, Wensing M, Tummers M, Knoop H, Bleijenberg G: Implementing evidence-based practice for patients with chronic fatigue syndrome. Clin Psychol Psychother 2014;21:108-114.
8.
Knoop H, van der Meer JWM, Bleijenberg G: De effectiviteit van groepsbehandeling voor patiënten met het chronisch vermoeidheidsyndroom (The efficacy of group therapy for patients with chronic fatigue syndrome). Internal publication Radboud University Medical Center, 2006.
9.
Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A: The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 1994;121:953-959.
10.
Vercoulen JHMM, Swanink CMA, Fennis JFM, Galama JMD, van der Meer JWM, Bleijenberg G: Dimensional assessment of chronic fatigue syndrome. J Psychosom Res 1994;38:383-392.
11.
Prins JB, Bleijenberg G, Bazelmans E, Elving LD, de Boo TM, Severens JL, et al: Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial. Lancet 2001;357:841-847.
12.
Bergner M, Bobbitt RA, Carter WB, Gilson BS: The Sickness Impact Profile: development and final revision of a health status measure. Med Care 1981;19:787-805.
13.
Bleijenberg G, Prins JB, Bazelmans E: Cognitive-behavioral therapies; in Jason L, Fennel P, Taylor R (eds): Handbook of Chronic Fatigue Syndrome. New York, Wiley, 2003, pp 493-526.
14.
Knoop H, Bleijenberg G, Gielissen MFM, van der Meer JWM, White PD: Is a full recovery possible after cognitive behavioural therapy for chronic fatigue syndrome? Psychother Psychosom 2007;76:171-176.
15.
Dittner AJ, Wessely SC, Brown RG: The assessment of fatigue: a practical guide for clinicians and researchers. J Psychosom Res 2004;56:157-170.
16.
Stewart AL, Hays RD, Ware JE Jr: The MOS short-form general health survey. Reliability and validity in a patient population. Med Care 1988;26:724-735.
17.
Arrindell WA, Ettema JHM: SCL-90: Handleiding bij een multidimensionele psychopathologie-indicator. Lisse, Swets Test-Service, 1986.
18.
Heins MJ, Knoop H, Prins JB, Stulemeijer M, van der Meer JWM, Bleijenberg G: Possible detrimental effects of cognitive behaviour therapy for chronic fatigue syndrome. Psychother Psychosom 2010;79:249-256.
19.
White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, DeCesare JC, et al: Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 2011;377:823-836.
20.
Nijhof SL, Bleijenberg G, Uiterwaal CSPM, Kimpen JLL, van de Putte EM: Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial. Lancet 2012;379:1412-1418.
21.
Van Breukelen GJP: ANCOVA versus change from baseline had more power in randomized studies and more bias in nonrandomized studies. J Clin Epidemiol 2006;59:920-925.
22.
Cohen J: Statistical Power Analysis for the Behavioral Sciences. New York, Academic Press, 1988.
23.
White IR, Horton NJ, Carpenter J, Pocock SJ: Strategy for intention to treat analysis in randomised trials with missing outcome data. BMJ 2011;342:d40.
24.
Schreurs KMG, Veehof MM, Passade L, Vollenbroek-Hutten MMR: Cognitive behavioural treatment for chronic fatigue syndrome in a rehabilitation setting: effectiveness and predictors of outcome. Behav Res Ther 2011;49:908-913.
25.
White PD, Goldsmith K, Johnson AL, Chalder T, Sharpe M; PACE Trial Management Group: Recovery from chronic fatigue syndrome after treatments given in the PACE trial. Psychol Med 2013;43:1-9.
26.
Cairns R, Hotopf M: A systematic review describing the prognosis of chronic fatigue syndrome. Occup Med Oxf Engl 2005;55:20-31.
27.
Wiborg JF, Knoop H, Frank LE, Bleijenberg G: Towards an evidence-based treatment model for cognitive behavioral interventions focusing on chronic fatigue syndrome. J Psychosom Res 2012;72:399-404.
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