Abstract on Cognitive Behavioral Therapy and CFS

Discussion in 'Fibromyalgia Main Forum' started by swedeboy, Apr 18, 2007.

  1. swedeboy

    swedeboy Member

    I recently came across this abstract the other day and I thought it could the start for some interesting debates.

    Journal of Psychotherapy and Psychosomatics. 2007;76(3):171-6.

    Title:
    "Is a full recovery possible after cognitive behavioural therapy for chronic fatigue syndrome?"
    by Knoop H, Bleijenberg G, Gielissen MF, van der Meer JW,
    White PD.

    Affiliations: Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

    Background: Cognitive behavioural therapy (CBT) for chronic fatigue syndrome (CFS) leads to a decrease in symptoms and disabilities. There is controversy about the nature of the change following treatment; some suggest that patients improve by learning to adapt to a chronic condition, others think that recovery is possible. The objective of this study was to find out whether recovery from CFS is possible after CBT.

    Methods: The outcome of a cohort of 96 patients treated for CFS with CBT was studied. The definition of recovery was based on the absence of the criteria for CFS set up by the Center for Disease Control (CDC), but also took into account the perception of the patients' fatigue and their own health. Data from healthy population norms were used in calculating conservative thresholds for recovery.

    Results: After treatment, 69% of the patients no longer met the CDC criteria for CFS. The percentage of recovered patients depended on the criteria used for recovery. Using the most comprehensive definition of recovery, 23% of the patients fully recovered. Fewer patients with a co-morbid medical condition recovered.

    Conclusion: Significant improvement following CBT is probable and a full recovery is possible. Sharing this information with patients can raise the expectations of the treatment, which may enhance outcomes without raising false hopes. Copyright (c) 2007 S. Karger AG, Basel.

    PMID: 17426416 [PubMed - in process]

    You can access the abstract here:
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed
    then type in chronic fatigue syndrome and press go.

    I think one (especially the general public) has to be careful when interpreting this abstract, because I feel that it could give the wrong impression of CFS and CFS treatments. I'm sure this abstract will appear in next weeks Pro Health's e-newsletter aswell.
  2. Lichu3

    Lichu3 New Member

    I think it's hard to make conclusions without the full article so this is just based on the abstract posted.

    My biggest concern with articles like this is non-objective outcome measures. Either patients or researchers are giving their opinions on recovery but there is nothing objectively measured in the sense of lab tests, x-rays, etc. (Of course, it is difficult to find objective measures with this condition.)

    I know many people on this site are aware CFS includes more symptoms than just the CDC criteria. So did the researchers look at other symptoms?

    Some studies like this also took finding another diagnosis (e.g. sleep apnea) meant the patient no longer had CFS, without really indicating whether the person actually felt better. This goes back to the part of the CDC criteria where you can't have anything else causing fatigue in order to have CFS.

    This is probably why in the Stanford trials, they are including exercise/ psychological testing to show measurable, more objective outcomes rather than just relying on patient reports (as dramatically positive as they are).
  3. swedeboy

    swedeboy Member

    All very good points.
  4. Slayadragon

    Slayadragon New Member

    Yes, that issue about how you can't have any other disease that causes any CFS symptoms and still be diagnosed with CFS really annoys me. I think one disease they specifically point out as exclusionary is manic-depression.....as if you can't have both m-d and any other disease! I know what it was like to have m-d without CFS, and it certainly was not the same thing at _all_.

    Your comments about the article above are really good ones. Thanks for sharing them.

    best, Lisa
  5. LouiseK

    LouiseK New Member

    You all sound so calm. I find this article very alarming. Now I'm going to have my doctor telling me I just need a few sessions with a shrink and I'll be healed? And what if I'm not? If the cure doesn't work does that mean I don't have the disease? Or that I do?

    CFS is a hellish disease which, over time, permeates every single body system. In my case I actually believe I felt it in every cell when I first came down with it. Not a talk therapy kind of illness, I am sure of that.

    Do you not think that these people did not have CFS to begin with? That somehow the pool of participants was flawed?

    Really dreary. I hope it doesn't get spread around. Ironically no one cares much for medical research so it probably won't be an issue.

    23% of patients fully recovered??? That's funny the CDC says that 5 - 10% of people with this EVER fully recover, let alone after three months of talk therapy.
  6. Lichu3

    Lichu3 New Member

    Yes, the selection of samples is always a problem according to many CFS researchers.

    The CDC criteria are very broad.
    I only have limited journal access so I can't read how they selected their subjects for this study. It would be great if future research of CFS either narrowed their subject pool to e.g. those with a acute post-infectious onset or at least did a breakdown of the different types of onset their subjects had.

    I'm at least glad it isn't in a medical journal - this looks like it is targeted at mostly psychologists.

    (Thanks for the compliments Lisa and Sean. Sean, are you going to our support group meeting Saturday? Always neat to meet people in person.)
  7. Diva55

    Diva55 New Member

    There was fairly recent investigation into ME (CFS/FM) in the UK spurred by the government to get people off of Incapacity Benefits - so there must be a LOT of us claiming!

    Their conclusion for treatment on the National Health Service was damn CBT and GET (Graded exercise therapy)!!

    This is ALL they have recommended with no further investigation. I've read lots on the company behind these ivestigations and their connections with the government.

    SO ALL the doctors in the UK have this on their records that the only treatment to be given for CFS / FM is CBT & GET.

    I have told my doctor what I think of it & he hasn't pushed it on me but other people will be dumped into it.

    Although my doctor is very open minded I've a feeling if I ask for any other meds to be trialled he would be hard pushed to get them through the medical authority if I'm not put into the CBT /GET ptogram first.

    As I said to him - if I could "talk" myself into being better, don't you think I would do that! And exercise when some days any light exercise puts me in bed for days after!

    I've a feeling that soon the Incapacity Benefits will be linked into this program - if you have not been put in the program, you will not get benefits!

    This sort of publicity definitely says "it's all in the head & you're lazy"....makes me SO mad.


  8. foxglove9922

    foxglove9922 New Member

    Could someone please describe exactly what Cognitve Behavioural Therapy is?

    Foxglove
  9. swedeboy

    swedeboy Member

    I don't have the contact info for the support group. I am unable to enter the chat rooms and get the group leaders email address to get the address because my for some reason my browser doesn't support it. I used to be able to enter the chat rooms, but now my computer gets bogged down.

    Is the Support Group Listed at CFIDS.org?

  10. Clay2

    Clay2 New Member

    I've been through CBT for post traumatic stress and it probably saved my life. I have tremendous respect for my psychologist and coach and saw him just this morning in fact.

    CBT somewhat helps me deal with the stresses of this disease, but this CFS 'cure' is total nonsense. It's an insult to CBT and to psychologists to suggest they think they can cure any old thing they want. It makes them all look like idiots.

    CBT is a fantastic tool when used appropriately.
  11. foxglove9922

    foxglove9922 New Member

    Thanks guys, I thought it was something along those lines.

    Foxglove
  12. momof471

    momof471 New Member

    I am currently doing CBT, I have fibro not CFS, the only thing it has really taught me is to smile and say I'm Fine, even though I feel like something the dog drug in. I find myself telling my Psych what she wants to hear, because that is what we are being taught with CBT. Inside I get really ticked off that I have to smile and say'I'm Fine' because I'm not fine. So this study tells me these people heard what they were being told and then when asked how they feel they smiled and said 'I'm Fine'!

    God Bless
  13. swedeboy

    swedeboy Member

    You Know I have often wondered what that does to us. I mean what does it do to us when we smile and say we are fine when in fact we are in a lot of pain and or may feel really sad. I wonder if it really helps? I think other people may not take our illness seriously if we are only acting.

    Maybe we should say, well I am only telling you I am fine, and I am smiling because my shrink says I should, but really I am not fine and I am in a world of pain. I've only had one appointment with my psycologist so far, and my next one is on monday for CBT.

    take care, Sean
  14. momof471

    momof471 New Member

    I think there are certain times we should say 'I'm Fine' and leave it at that. Sometimes that stresses me less. But when I go to a healthcare provider or family or friend, I should not have to parrot off 'I'm Fine' when I'm not and that does disturb me. When I went to Floorida in December with my family, I was really nervous about the pain before I went, therapist talked me through this, I went on trip, I was in sooo much pain, but I stuck with it for the sake of my family, went to therapist, asked how trip was, I said I enjoyed watching my family, but I had some serious pain issues, her answer was, " So, you had a good time then." That afternoon I came home and cried and told my husband I'm glad they had a good time, I don't regret going but for me it totally stank!!! He sat there and cried with me and told me not to ever hold something like that back again.

    In some cases cbt can help, but I think if not careful, it builds up a whole lot of anger and that creates even bigger issues. Sorry to ramble, but this post really struck home.

    God Bless
  15. swedeboy

    swedeboy Member

    Thanks so much for you comments!