CBT And Exercises For Chronic Fatigue Syndrome, Study By UK Researchers

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CBT and Exercises might be helpful for the treatment of Chronic Fatigue Syndrome

According to an article published in NPR, debates Chronic Fatigue Syndrome began about three decades ago, but its cause is remains known. Over all these years, researchers have identified various brain, immune system and energy metabolism irregularities involved with the syndrome. And even though the precise cause remains unidentified, much progress has been made about its treatment. One such treatment area is Cognitive Behavior Therapy (CBT). A study published in The Lancet this year found that talk therapy and exercises offered relief to some patients.

The Lancet Study And Results

The study was conducted on over 600 patients who were suffering from chronic fatigue syndrome. These patients were assigned to different treatments and received medical care for symptoms like pain, insomnia and anxiety.

These patients were divided into three groups

One group got counseled about how to pace activities.
Another took part in an exercise program.
Third received the cognitive behavioral talk therapy.
The therapy and the exercise group improved the most, reporting less fatigue, insomnia and anxiety.

Highlights of the CBT and Exercise combination therapy – based on the study it was found that

Patients do best when cognitive behavior therapy is also combined with gradually increased exercise.
Patients need to begin to push themselves in the face of their fatigue.
Patients should start with mild, gentle exercise like clearing the table, doing the dishes, or taking the dog for a short walk.
Patients should slowly build up to longer and more frequent walks.

Dr. Lucinda Bateman, a doctor at the Fatigue Consultation Clinic in Salt Lake City who specializes in chronic fatigue syndrome is skeptical about the Lancet study. She pointed out that the patients only improved moderately with the use of CBT and exercises. Their improvement is not much different than those who are counseled about pacing themselves.

Dr. Bateman’s Advice for Chronic Fatigue Syndrome

Patients should pace themselves, and try to do only as many activities as they can manage.
Some patients get caught in a “push and crash” cycle, which should be avoided.
When the patients start overdoing the physical exercises, their level of activity often comes to a crashing end and patients can relapse dramatically and even become bedridden for several days or longer.
Also an issue with the CBT’s implication is that chronic fatigue syndrome is psychosomatic.

The exact cause of chronic fatigue is still not known, says Bateman. She, like many other health care professionals who treat patients, is waiting eagerly for the day when science will pinpoint the cause of this syndrome and its symptoms.

Listed below are a few clinical trials investigating new treatments for Chronic Fatigue Syndrome.

KAL

While there indeed are and have been treatments studied it is premature to announce that much progress has been made. Most treatments only relieve one or two symptoms.

This may well be because CFS has become an umbrella term encompassing both patients and people with affective disorders only.

The study published in the Lancet had several draw backs.

The patients included has only mild to moderate CFS if that is what they had – it did not include bed bound or wheelchair bound patients.

As well, the authors used a rare definition than is not used internationally – a definition that requires neither specificity or severity as noted in a March 4 New York Times article by David Tuller MPH. This severely limits the applicability of the results beyond that cohort. There is no way of knowing whether they had the key symptom of post exertional malaise lasting 24-hours or longer unrelieved by rest and upon minimal exertion such as walking the dog or doing the dishes.

And finally, as noted by Dr. Charles Raison in his February 23 CNN blog post, the results were not impressive – only 30% improved. That means 70% of that particular cohort did not improve. If it were a drug trial would you be impressed?

The effects of cognitive behavioral therapy are the same as in any other organic disease – they can increasing coping skills assuming the coping skills are not already in place, however, there is no evidence that it reverses or cure any disease.

Droxidopa is only in Phase II trials and it will be 3-5 years before it is on the market. Great for patients receiving the drug in the study, but not for the other 99%+ patients who don’t yet have access.

The same is true of Ampligen. Although shown to be effective in 15% of patients it has yet to be approved by the FDA for CFS.

Pilot studies have show the effectiveness of anti-virals in some subgroups of patients, but unlike antibiotics which are effective against most bacteria, anti-virals are only effective against specific viruses.

Progress? Some. Much progress? Not so much.
Justin Reilly

This was a fraudulent study done by Wessely and White, known charlatans. Pls see excellent critiques of the PACE study byProf. Malcolm Hooper- meactionuk.org.uk -and Angela Kennedy.