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Two therapies help fight chronic fatigue syndrome

Patients struggling with chronic fatigue syndrome may be helped the most when standard treatment is coupled with cognitive behaviour therapy or exercise therapy.

Two therapies help fight chronic fatigue syndrome

Patients struggling with chronic fatigue syndrome may be helped the most when standard treatment is coupled with cognitive behaviour therapy or exercise therapy.

It is not yet understood what gives rise to chronic fatigue syndrome (CFS), a complex condition characterised by profound tiredness, impaired concentration, diminished memory, sleep difficulties and muscle and joint pain. The cognitive behavioural therapy targets the building fear and avoidance of activity that can exacerbate CFS. In effect, it seeks to break a vicious cycle in which mental inhibitions actually perpetuate and aggravate the underlying chronic fatigue. Exercise therapy, also known as gradual exercise therapy (GET), tries to reduce fatigue and disability by gradually helping patients increase their activity levels to improve their overall physical fitness.

To explore which therapies or combinations of therapies might be best, 641 chronic fatigue patients from four different rehabilitation centers in Britain were divided up into one of four groups. Over the course of a year, all got standard specialist medical care, while three of the groups received one additional treatment: pacing therapy, cognitive therapy or exercise therapy.

It was found the greatest improvements in terms of both fatigue levels and physical function were experienced by those patients who were treated with standard therapy in combination with either cognitive therapy or exercise therapy. Patients who got a combination of standard treatment and pacing therapy fared no better than those who got standard treatment alone. The standard intervention, known as specialist medical care, is centered around giving patient's information about their condition, advice on how to manage symptoms and assistance with coping approaches.

Specifically, 60 percent of the standard/cognitive or standard/GET patients experienced fatigue and function improvements, while 30 percent reported normal levels of fatigue and function. Half as many of the standard therapy alone or standard/pacing patients reported normal fatigue and function levels. The researchers noted that all the treatments were equally safe, and serious reactions were rare. Also, cognitive behavioural therapy and graded exercise are moderately helpful, but not curative.

The researchers found little appreciable benefit with a third alternate therapeutic approach that focuses on helping patients strictly structure their activity and relaxation routines to match their severely reduced energy levels. This strategy, known as 'adaptive pacing therapy', assumes that chronic fatigue syndrome is not, in fact, reversible with behavioural changes.

The apparent promise of cognitive behaviour therapy and graded exercise therapy offers considerable hope to patients combating this condition. The findings support the controversial notion that incremental adjustments in physical behaviour and/or mental attitude can ultimately have a positive impact on the disorder.
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