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Ms. Deale and Colleagues Reply

To the Editor: We are pleased to have this opportunity to correct our oversight and draw attention to the trial of cognitive behavior therapy for chronic fatigue syndrome carried out by Dr. Sharpe and his colleagues in Oxford. This was the first randomized controlled trial to find cognitive behavior therapy superior to standard medical care alone, although the absence of an attention control left unanswered the question of nonspecific treatment factors (thought by some to be an important determinant of change in chronic fatigue symdrome). Another trial (1) found cognitive behavior therapy to be superior to a credible placebo treatment of relaxation (which controlled for therapist time, attention, and homework practice). In both trials, a combination of graded activity and cognitive restructuring was used, although the Oxford study had a cognitive emphasis and the London study had a behavioral emphasis. Nevertheless, the proportions of patients improved, and the pattern of improvement (with gains continuing during follow-up) were strikingly similar in both studies. We wholeheartedly agree with Dr. Sharpe's concluding comments.

REFERENCES

1. Lloyd A, Hickie C, Wakefield D: Immunologic and psychologic therapy for patients with chronic fatigue syndrome: a double blind, placebo controlled trial. Am J Med 1993: 94:197–203

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