Cognitive behaviour therapy is effective in treating the symptoms of chronic fatigue syndrome, according to a recent systematic review carried out by Cochrane Researchers.
Chronic fatigue syndrome (CFS) is a potentially long-lasting illness that can cause considerable distress and disability. 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. Cognitive behaviour 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.Source: Wiley-Blackwell
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Cognitive behavioral therapy and exercise might help some people who have experienced garden-variety fatigue for an extended period of time -- for instance, people suffering from clinical depression. This is a good discovery for that set of people. The problem is, CBT and GET (graded exercise therapy) do NOT help people who actually have chronic fatigue syndrome.
One essential symptom of CFS is post-exertional malaise. Sufferers experience crushing fatigue (not just tiredness) and pain in response to any exertion, like walking to the bathroom. This symptom becomes worse, not better, with exercise. If someone doesn't experience post-exertional malaise, that person does not have CFS. However, the studies reviewed by Cochrane researchers included subjects without this symptom.
What happened: Some subjects felt worse as a result of the treatment and dropped out of the study -- most likely the ones with post-exertional malaise. The subjects who felt better (or at least no worse) tended not to drop out. The subjects who dropped out were excluded from the studies' results.
So, if your patient really has CFS as opposed to clinical depression, you could be doing great harm by treating with CBT and GET.
For a good resource on telling the difference between depression-related fatigue and chronic fatigue syndrome, go here.
For an even better description of myalgic encephalomyelitis (the older and more accurate term for what many now call CFS), go here.
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