• Ridsdale, Leone
• Chalder, Trudie
• Ogden, J.
• Seed, Paul T.
• Godfrey, Emma

Abstract

Objectives To develop a brief measure of the therapy process and to use this measure to examine which therapeutic ingredients were associated with outcome in a sample of patients from a randomised controlled trial of cognitive behaviour therapy (CBT) versus counselling for patients with chronic fatigue in primary care. It was hypothesised that the two therapies would be clearly distinguishable and that in terms of process variables, the therapeutic alliance would be important in predicting outcome.Design The data for this study was collected alongside a randomised controlled trial (RCT) in primary care, and included audio-taped therapy sessions. These tapes were assessed by two independent raters using a newly devised measure in order to evaluate therapy process and its relationship to outcome.Methods Tapes from seventy-one patients participating in the RCT were assessed to form the basis of the process analysis. Outcome was self-reported fatigue symptoms at six months follow-up. Data reduction was achieved via a principal component analysis. Factors were entered into a multiple regression analysis to produce a final model of predictors of outcome.Results The process measure showed that although the treatments could be distinguished, there was some overlap between them. The key predictor of a good fatigue outcome was emotional processing, including the expression, acknowledgment and acceptance of emotional distress.ConclusionA new process measure was successfully developed which now warrants further testing. It was able to assess treatment adherence and unpack and distinguish the common factor which predicted outcome across therapy modalities. The findings lend preliminary support to the view that the specific techniques associated with particular “brand names” of therapy are not necessarily the “active ingredients” that help patient’s change within the primary care setting. Emotional processing predicted outcome for patients with chronic fatigue and therefore future research might explore this in more depth in order to understand better how it can be facilitated.

Topics

• fatigue