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EDITOR,—We addressed a clinical question of practical importance to ourselves and our colleagues—namely, could we improve the disability and fatigue of patients referred to a hospital clinic with severe medically unexplained fatigue (the chronic fatigue syndrome)? The available evidence indicated that the prognosis for these patients was poor1 and (contrary to S A Chilton's suggestion) that there were no treatments of proved and accepted effectiveness.2 3 We chose cognitive behaviour therapy because it is effective in related conditions4 and because (for reasons given in the paper) we did not agree with Charles Shepherd's suggestion that its application to …

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