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Introduction
Patients with chronic fatigue syndrome (CFS) have severe fatigue lasting longer than 6 months. The fatigue is not the result of a known organic disease or ongoing exertion, not alleviated by rest and leads to substantial functional impairment (Fukuda et al. 1994; Reeves et al. 2003). Several systematic reviews and controlled trials have shown that cognitive behaviour therapy (CBT) leads to a significant reduction in symptoms and disabilities in patients with CFS (Malouff et al. 2008; Price et al. 2008; White et al. 2011). CBT is aimed at cognitions and behaviours assumed to perpetuate the fatigue. It is a safe treatment and a subgroup of patients fully recovers (Knoop et al. 2007; Heins et al. 2010; White et al. 2011).
CBT for CFS is an intensive treatment, with 13-16 sessions depending on the protocol used (Sharpe et al. 1996; Prins et al. 2001; Quarmby et al. 2007; Scheeres et al. 2008b ). There is evidence that not all patients need such intensive treatment. Knoop et al. (2008) showed, in a randomized controlled trial (RCT), that a minimal intervention for CFS, guided self-instruction, leads to a significant decrease in fatigue and disabilities. For a subgroup of patients, the minimal intervention sufficed. If the minimal intervention was not successful, patients needed substantially fewer sessions of additional CBT, compared to patients who were referred directly for regular CBT (Tummers et al. 2010). The minimal intervention consisted of a booklet with instructions, based on the protocol of CBT for CFS, and 2-weekly email contact with a therapist.
Guided self-instruction was delivered at a tertiary university hospital with the guidance of qualified cognitive behavioural therapists, who had extensive experience in treating patients with CBT for CFS. In The Netherlands, there is a lack of treatment capacity for patients with CFS (Gezondheidsraad, 2005). To increase treatment capacity it is necessary to offer evidence-based treatments for CFS outside specialized treatment settings. The objective of this study was to test whether the minimal intervention was also effective when delivered at a community-based mental health centre (MHC). An MHC in the southwest of The Netherlands was chosen as the clinical practice setting. This centre had not previously treated CFS patients. Psychiatric nurses, novices with respect to...