Behavior therapy helps chronic fatigue patients
November 10, 1999
Web posted at: 12:18 PM EST (1718 GMT)
By William Collinge, Ph.D., M.P.H.
Martha was exhausted and she didn't know why. Just walking up a flight of stairs was a monumental task for the 47-year-old San Francisco librarian. When doctors finally diagnosed her with chronic fatigue syndrome, she was further disheartened to learn there was no known medical cure. She tried sleep medicines, antidepressants and a cabinet full of herbs and supplements, but still could only work quarter time at most.
Then in the fall of 1994, Martha (whose name is changed here to protect her privacy) enrolled in a nine-week experimental program to learn a new way of taking care of herself. Instead of searching for a medical miracle, she began a daily practice of meditation and qigong -- Chinese rejuvenation exercises. Although she still has mild relapses, today Martha considers herself well.
| CHRONIC FATIGUE|
Can changing one's beliefs and behavior turn the tide in chronic fatigue syndrome? Several recent studies suggest that what's become known as "cognitive behavior therapy" may help those with chronic fatigue syndrome as much as any of the drugs tested so far for the disease.
Not just for yuppies
Once derided as the "yuppie flu," chronic fatigue syndrome is now known to affect people from all walks of life. The cause is still a mystery, though doctors suspect a complex interaction of viruses and genetic vulnerabilities, at least in some people. Those who have it endure overwhelming fatigue, widespread pain, immune system irregularities and many other symptoms. Perhaps most devastating are the inability to concentrate and short-term memory loss. There is no known cure, and sufferers often find themselves burdened with a grocery bag full of remedies -- conventional and alternative -- in search of relief.
Lacking a definitive treatment, some researchers are exploring whether certain beliefs or behaviors might influence the course of chronic fatigue syndrome. The impact of beliefs on health was illustrated in a study published in the October 1997 issue of the Journal of Psychosomatic Research. Researchers at Brunel University in England followed 137 patients with the illness for a year. They concluded that those who believed they could control their health and actively took steps to assert control over it were the most likely to improve.
Hope and healing
Programs in cognitive behavior therapy (CBT) work to change patients' beliefs about their illness and their ability to control their lives. The programs also teach self-help strategies like gentle exercise, improving sleep habits, pacing everyday activity, reduction of stimulant intake, getting support from others, and daily practices like meditation and relaxation exercises.
To judge by the studies so far, it seems to work. One study involved 60 patients at Kings College Hospital in London. Researchers wanted to see whether patients' beliefs correlated with the course of their illness, and whether a CBT program could affect such beliefs. First the patients were surveyed to determine their beliefs about chronic fatigue syndrome, exercise, activity and rest. They were then randomly assigned to receive either 13 sessions of CBT or 13 sessions of relaxation training.
By the study's end, neither group had changed in their beliefs about the illness itself. But those in the CBT group had changed their beliefs about their ability to participate in exercise and other activity, and these changes were accompanied by an improvement in their symptoms. The study was published in the July 1998 issue of the Journal of Psychosomatic Research.
Cognitive behavior therapy reduces disability
A study in the January 7, 1996, issue of the British Medical Journal looked at whether CBT could improve people's ability to function with chronic fatigue syndrome. Researchers at Warneford Hospital in Oxford randomly assigned 60 patients to receive either 16 individual sessions of CBT or to stick with conventional treatment alone. Twenty-two out of 30 patients receiving CBT had clinically significant improvement in daily functioning, while only 8 in 30 of the others improved. These results were maintained at a 12-month follow-up, leading the researchers to conclude that CBT's benefits are long-lasting.
The treatment is no quick fix, though. "The biggest thing I had to learn was to pay attention to the signals my body was giving me," says Martha. "I also had to learn to pace myself, lower my expectations, and perhaps most of all, to have faith that I could get better. Even after getting those lessons, my healing process has still been long and slow. Chronic fatigue syndrome has left me with a greater appreciation for the fragility of life than ever."
Copyright 1999 webmed, Inc. All rights reserved.
RELATEDS AT :
What is chronic fatigue syndrome?
American Association for Chronic Fatigue Syndrome
Why meditate? Because it's good medicine
The new language of medicine
The new language of medicine: part II
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