Chronic fatigue syndrome (CFS) is a chronic, complex illness characterized by overwhelming fatigue that can cause considerable distress and disability. According to the CDC, people with CFS most often function at a substantially lower level of activity than they were capable of before the onset of illness. People with chronic fatigue syndrome report various nonspecific symptoms, including weakness, muscle pain, impaired memory and/or mental concentration, insomnia, and post-exertional fatigue lasting more than 24 hours. In some cases, CFS can persist for years.
Some estimates suggest it may affect as many as 1 in 100 of the population globally. There is no widely accepted explanation for the disease and patients are currently offered a variety of different treatments.
Chronic fatigue syndrome (CFS) is defined by a person having severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis; and having four or more of the following symptoms: substantial impairment in short-term memory or concentration; sore throat; tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new type, pattern or severity; unrefreshing sleep; and post-exertional malaise lasting more than 24 hours. The symptoms must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue.
Cognitive behavior therapy is effective in treating the symptoms of chronic fatigue syndrome, according to a recent systematic review carried out by Cochrane Researchers.
Cognitive behavior therapy (CBT) uses psychological techniques to balance negative thoughts that may impair recovery with more realistic alternatives. In treating CFS, these techniques are combined with a gradual increase in activity levels.
The researchers looked at data from 15 studies involving a total of 1,043 patients with CFS. The studies compared the effects of CBT with those of usual care and other psychological therapies and suggest that in both cases CBT is more effective at reducing the severity of symptoms, provided patients persist with treatment.
Further research is required to determine whether CBT is more beneficial than other forms of treatment, such as exercise and relaxation therapies. The researchers also suggest that CBT could be more effective if used as part of a combination treatment approach.
“CFS is a challenging illness for patients, and there is ongoing controversy about its causes. There remain unanswered questions, but the available evidence is clear – CBT can help many people with CFS”, says lead researcher Jonathan Price, who works at the University of Oxford in the UK.
Reference:
Price JR, Mitchell E, Tidy E, Hunot V. (2008). Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001027. DOI: 10.1002/14651858.CD001027.pub2.
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5 Responses to “Cognitive Behavior Therapy Helps Chronic Fatigue” (Pingbacks/trackbacks not shown below)
Elisha Goldstein, Ph.D. at 10:35 am on
July 15th, 2008
This doesn’t suprise me. As a Psychologist in West Los Angeles, I have worked with people who have chronic fatigue and chronic pain.
Using CBT techniques combined with mindfulness (the ability to intentionally pay attention to the present moment, without judgment) is enormously helpful for becoming more aware of how negative thinking can spiral one down into more fatigue and a great perception of stress and pain, hence, greater suffering.
In my practice and online group, I have done a lot of work integrating mindfulness into daily life for relief around stress, anxiety, and depression. Both the research and my personal experience show the ability to cultivate a nonjudgmental present moment awareness of ourselves to be very effective. It also opens the person up to what is good that may be missed when in an uncomfortable place from stress, pain, or illness. Worth exploring.
Jon at 3:24 pm on
July 15th, 2008
Although Cognitive Behavior Therapy (CBT) is widely recommended for patients with
ME/CFS, it is far from clear whether cognitive behavior therapy is helpful for most
patients. The rationale for using CBT in ME/CFS is that inaccurate beliefs (that etiology is physical) and ineffective coping (activity avoidance) maintain and perpetuate CFS morbidity (Deale et al, 1997;Sharpe et al, 1996). However, it has never been proven
that these illness beliefs contribute to morbidity in CFS. Where correlations do exist it is possible, even likely, that beliefs in physical etiology are correct and that activity avoidance is necessary for the more severely ill (Lloyd et al, 1993;Ray et al, 1995).
Of the 6 reported studies using CBT in “ME/CFS” two selected patients as defined
by the Oxford (Deale et al, 1997;Sharpe et al, 1996) one using the Australian criteria
(Lloyd et al, 1993) and one using the Fukuda criteria “with the exception of the criterion
requiring four of eight additional symptoms to be present” (Prins et al, 2001). These
methods of patient selection allow for considerable heterogeneity and inclusion of psychiatrically ill patients with fatigue. Therefore, the results may not be applicable to the average Fukuda or Canadian defined patient. Of the remaining two studies using valid selection criteria, one found no benefit of CBT (Friedberg & Krupp, 1994). The only study reporting benefit (improved functional capacity and decreased fatigue) was conducted in adolescents (Stulemeijer et al, 2005).
It is important to note that no CBT study has reported that patients have been improved enough to return to work nor have they reported changes in the physical symptoms
of CFS eg. muscle pain, fever, lymphadenopathy, headache or orthostatic intolerance. Furthermore, clinical experience suggests that trying to convince a patient with ME/CFS that s/he does not have a physical disorder and should not rest when tired leads to conflict in the doctor-patient relationship and poor outcome for the patients. Therefore it would be prudent to await further research before recommending this CBT approach.
Despite the fact that worsening of symptoms after exercise is a compulsory criteria
for diagnosis of ME/CFS, graded exercise programs have often prescribed for such
patients. Presumably these recommendations are made on the assumption that exercise
will be accompanied by improved aerobic capacity, increased anaerobic threshold and
improved exercise tolerance. However, in patients with ME/CFS, neither exercise tolerance nor fitness has been shown to improve with exercise programs. This may be connected with abnormal responses to exercise in people with ME/CFS. The resting heart
rate of patients is elevated, and maximum oxygen uptake is reduced compared with
healthy sedentary controls (Riley et al, 1990;Farquhar et al, 2002;Fulcher & White,
1997;De Becker et al, 2000). SPECT scan brain analysis indicates worsening of hypoperfusion
(Goldstein, 1993) and decreased cerebral blood flow (Peterson et al, 1994) after
exercise. Decreased cognition (Blackwood et al, 1998a;LaManca et al, 1998), decreased
pain threshold (Whiteside et al, 2004a;Whiteside et al, 2004b) and reduced maximal muscle contraction (Paul et al, 1999) are also reported.
According to the recent Cochrane Collaboration metanalysis (Edmonds et al, 2004) there are five studies on exercise and ME/CFS that are methodologically sound. However three of these studies used the Oxford criteria for patient selection which requiring only fatigue of 6 months duration for diagnosis. One of these excluded patients with sleep disrupted sleep (Fulcher & White, 1997) meaning that virtually all patients seen in clinical practice would be excluded. There are two studies using valid diagnostic criteria and both report improved fatigue by self report (Chalder Fatigue Scale) (Wallman et al, 2004;Moss-Morris et al, 2005). Neither of these report follow-ups past 12 weeks. Neither report on core physical symptoms of ME/CFS such as pain, unrefreshing sleep, infective, autonomic, neurological or endocrine symptoms. It is unclear whether these findings are applicable to severely ill patients as none of these patients are well enough to participate in studies. It will require more study on a broader group of patients, reporting all symptoms to discern if graded exercise affects the core symptoms of ME/CFS.
From- ‘Chronic Fatigue Syndrome - Assessment and Treatment of Patients with ME/CFS:
Clinical Guidelines for Psychiatrists’ by Eleanor Stein MD FRCP(C)
Be a Part of the Conversation! Comment on this Entry Now:
This doesn’t suprise me. As a Psychologist in West Los Angeles, I have worked with people who have chronic fatigue and chronic pain.
Using CBT techniques combined with mindfulness (the ability to intentionally pay attention to the present moment, without judgment) is enormously helpful for becoming more aware of how negative thinking can spiral one down into more fatigue and a great perception of stress and pain, hence, greater suffering.
In my practice and online group, I have done a lot of work integrating mindfulness into daily life for relief around stress, anxiety, and depression. Both the research and my personal experience show the ability to cultivate a nonjudgmental present moment awareness of ourselves to be very effective. It also opens the person up to what is good that may be missed when in an uncomfortable place from stress, pain, or illness. Worth exploring.
Although Cognitive Behavior Therapy (CBT) is widely recommended for patients with
ME/CFS, it is far from clear whether cognitive behavior therapy is helpful for most
patients. The rationale for using CBT in ME/CFS is that inaccurate beliefs (that etiology is physical) and ineffective coping (activity avoidance) maintain and perpetuate CFS morbidity (Deale et al, 1997;Sharpe et al, 1996). However, it has never been proven
that these illness beliefs contribute to morbidity in CFS. Where correlations do exist it is possible, even likely, that beliefs in physical etiology are correct and that activity avoidance is necessary for the more severely ill (Lloyd et al, 1993;Ray et al, 1995).
Of the 6 reported studies using CBT in “ME/CFS” two selected patients as defined
by the Oxford (Deale et al, 1997;Sharpe et al, 1996) one using the Australian criteria
(Lloyd et al, 1993) and one using the Fukuda criteria “with the exception of the criterion
requiring four of eight additional symptoms to be present” (Prins et al, 2001). These
methods of patient selection allow for considerable heterogeneity and inclusion of psychiatrically ill patients with fatigue. Therefore, the results may not be applicable to the average Fukuda or Canadian defined patient. Of the remaining two studies using valid selection criteria, one found no benefit of CBT (Friedberg & Krupp, 1994). The only study reporting benefit (improved functional capacity and decreased fatigue) was conducted in adolescents (Stulemeijer et al, 2005).
It is important to note that no CBT study has reported that patients have been improved enough to return to work nor have they reported changes in the physical symptoms
of CFS eg. muscle pain, fever, lymphadenopathy, headache or orthostatic intolerance. Furthermore, clinical experience suggests that trying to convince a patient with ME/CFS that s/he does not have a physical disorder and should not rest when tired leads to conflict in the doctor-patient relationship and poor outcome for the patients. Therefore it would be prudent to await further research before recommending this CBT approach.
Despite the fact that worsening of symptoms after exercise is a compulsory criteria
for diagnosis of ME/CFS, graded exercise programs have often prescribed for such
patients. Presumably these recommendations are made on the assumption that exercise
will be accompanied by improved aerobic capacity, increased anaerobic threshold and
improved exercise tolerance. However, in patients with ME/CFS, neither exercise tolerance nor fitness has been shown to improve with exercise programs. This may be connected with abnormal responses to exercise in people with ME/CFS. The resting heart
rate of patients is elevated, and maximum oxygen uptake is reduced compared with
healthy sedentary controls (Riley et al, 1990;Farquhar et al, 2002;Fulcher & White,
1997;De Becker et al, 2000). SPECT scan brain analysis indicates worsening of hypoperfusion
(Goldstein, 1993) and decreased cerebral blood flow (Peterson et al, 1994) after
exercise. Decreased cognition (Blackwood et al, 1998a;LaManca et al, 1998), decreased
pain threshold (Whiteside et al, 2004a;Whiteside et al, 2004b) and reduced maximal muscle contraction (Paul et al, 1999) are also reported.
According to the recent Cochrane Collaboration metanalysis (Edmonds et al, 2004) there are five studies on exercise and ME/CFS that are methodologically sound. However three of these studies used the Oxford criteria for patient selection which requiring only fatigue of 6 months duration for diagnosis. One of these excluded patients with sleep disrupted sleep (Fulcher & White, 1997) meaning that virtually all patients seen in clinical practice would be excluded. There are two studies using valid diagnostic criteria and both report improved fatigue by self report (Chalder Fatigue Scale) (Wallman et al, 2004;Moss-Morris et al, 2005). Neither of these report follow-ups past 12 weeks. Neither report on core physical symptoms of ME/CFS such as pain, unrefreshing sleep, infective, autonomic, neurological or endocrine symptoms. It is unclear whether these findings are applicable to severely ill patients as none of these patients are well enough to participate in studies. It will require more study on a broader group of patients, reporting all symptoms to discern if graded exercise affects the core symptoms of ME/CFS.
From- ‘Chronic Fatigue Syndrome - Assessment and Treatment of Patients with ME/CFS:
Clinical Guidelines for Psychiatrists’ by Eleanor Stein MD FRCP(C)
