To measure changes in causal attribution in chronic fatigue syndrome. The cause of chronic fatigue syndrome (CFS) is still unknown. Behavioral, cognitive and affective factors may play a major role in perpetuating fatigue.

175 patients fulfilling Fukuda CFS criteria participated in a six-month CBT associated with GET based on adaptive pacing strategy, in a group setting. Causal attribution was measured with the Causal Attribution List (CAL). Therapy didn’t aim change in causal attribution. All patients were included in a prospective outcome study at the university outpatient Chronic Fatigue Reference Center (UCL), with multidimensional assessments at baseline and after treatment: Checklist Individual Strength (CIS); Short Form General Health Survey (SF36), Causal Attribution List (CAL).

At baseline, SFC patients were more likely to attribute their fatigue to physical than psychosocial causes (p< 0.001). After treatment, fatigue severity and behavioural consequences (CIS) and the most factors of health-related quality of live (SF36) improved significantly (p< 0,001). After treatment, patients had more causal attributions (CAL) than at baseline (p< 0,001). Correlation analyses indicated that improvement of subjective fatigue (CIS-severity, SF36-vitality) was not correlated significantly neither with physical or psychosocial causal attributions scores at baseline, nor with individual changes of physical or psychosocial causal attributions after treatment.

Causal reattribution is not necessary in chronic fatigue syndrome CBT. In our study (n=175) improvement of subjective fatigue is not correlated with changes in causal attribution. The advantages of abstention from causal reattribution in psychosomatics will be discussed.