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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

Published online by Cambridge University Press:  12 March 2019

Anthonie Janse Open the ORCID record for Anthonie Janse [Opens in a new window] ,
Arno van Dam ,
Coby Pijpers ,
Jan F. Wiborg ,
Gijs Bleijenberg ,
Marcia Tummers ,
Jos Twisk ,
Stephanie Nikolaus  and
Hans Knoop
Anthonie Janse
Affiliation:
Expert Centre for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU Medical Centre, Amsterdam, The Netherlands Academic Medical Centre (AMC), University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, The Netherlands
Arno van Dam
Affiliation:
GGZ Westelijk Noord-Brabant, Institute for Mental Health Care, Roosendaal, The Netherlands
Coby Pijpers
Affiliation:
GGZ Westelijk Noord-Brabant, Institute for Mental Health Care, Roosendaal, The Netherlands
Jan F. Wiborg
Affiliation:
Expert Centre for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU Medical Centre, Amsterdam, The Netherlands
Gijs Bleijenberg
Affiliation:
Radboud University Medical Centre, Nijmegen, The Netherlands
Marcia Tummers
Affiliation:
Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
Jos Twisk
Affiliation:
Department of Methodology and Applied Biostatistics, Vrije Universiteit, Amsterdam, The Netherlands
Stephanie Nikolaus
Affiliation:
Expert Centre for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU Medical Centre, Amsterdam, The Netherlands
Hans Knoop*
Affiliation:
Expert Centre for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU Medical Centre, Amsterdam, The Netherlands Academic Medical Centre (AMC), University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, The Netherlands
*
*Corresponding author. Email: hans.knoop@amc.uva.nl
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Abstract

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 syndromecognitive behavioural therapyimplementationminimal interventionstepped care
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 47 , Issue 5 , September 2019 , pp. 548 - 558
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

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