Cognitive-behavior therapy in chronic fatigue syndrome: Is improvement related to increased physical activity?

This multiple case study of cognitive-behavioral treatment (CBT) for chronic fatigue syndrome (CFS) compared self-report and behavioral outcomes. Eleven relatively high-functioning participants with CFS received 6-32 sessions of outpatient graded-activity oriented CBT. Self-report outcomes included measures of fatigue impact, physical function, depression, anxiety, and global change. Behavioral outcomes included actigraphy and the 6-minute walking test. Global change ratings were very much improved (n52), much improved (n52), improved (n55), and no change (n52). Of those reporting improvement, clinically significant actigraphy increases (n53) and decreases (n54) were found, as well as no significant change (n52). The nature of clinical improvement in CBT trials for high-functioning CFS patients may be more ambiguous than that postulated by the cognitive-behavioral model.