Treatments for patients with chronic fatigue syndrome that focus on easing their fear of symptoms and gradually increasing their physical activity are safe and effective, according to a new study.
The results show that two therapies, known as cognitive behavioral therapy and graded exercise therapy, can reduce fatigue and improve function of patients.
The findings contradict suggestions from some patient organizations for chronic fatigue syndrome that these therapies can hurt patients, the researchers said.
Further, a therapy viewed by these organizations as safe called adaptive pacing therapy, which requires patients to limit their activity was not as effective as cognitive behavioral therapy or graded exercise therapy, and did not provide an additional safety benefit, the researchers said.
The contradictions put some health care providers in a tough spot, said Leonard Jason, a professor of psychology at DePaul University in Chicago.
"They are, in some ways invalidating the experiences of thousands of patients, so that's something that needs to be considered," Jason said. Jason has conducted studies that found adaptive pacing therapy to be beneficial.
In any case, the improvements seen during cognitive behavioral therapy and graded exercise therapy were moderate, so the search for new therapies must continue, the researchers said.
The study will be published online tomorrow (Feb. 18) in the journal the Lancet.
Treatment for chronic fatigue
Chronic fatigue syndrome is characterized by extreme fatigue for at least six months that is not alleviated by rest, and cannot be explained by other conditions, according to the Centers for Disease Control and Prevention. The cause is not known.
The condition affects about 0.2 percent to 2.6 percent of the population worldwide, the researchers said.
Peter White, of The London School of Medicine in the United Kingdom, and colleagues compared the effectiveness of cognitive behavioral therapy, graded exercise therapy, adaptive pacing therapy and specialist medical care.
Cognitive behavioral therapy and graded exercise therapy are both based on the theory that chronic fatigue syndrome is reversible. Cognitive behavioral therapy posits that fear of being active and avoiding activity can perpetuate fatigue, the researchers said, and the therapy involves talking to a therapist about these fears. Graded exercise therapy gradually increases a patients' level of activity.
Adaptive pacing therapy is based on the ideas that chronic fatigue syndrome is not reversible, and patients have a finite amount of energy. The therapy tries to adapt patients to their condition. They keep a diary to identify activities that set off fatigue, and try to avoid activities that need much energy .
In specialist medical care, patients are given information and general advice.
In the study, 640 patients were randomly assigned to receive specialist medical care alone, or specialist medical care with one of the following: cognitive behavioral therapy, graded exercise therapy or adaptive pacing therapy.
After one year, patients who received cognitive behavioral therapy or graded exercise therapy had lower scores on tests for fatigue, and higher scores on tests of physical function, than patients who received only specialist medical care. Scores of those in the adaptive pacing therapy group did not differ from those in the specialist medical care group.
One limitation of the study is that the criteria used to include patients were very broad and not commonly used within the field, Jason said. The study did not use criteria that take into account severity of symptoms, he said.
In addition, physical improvement of the patients was not well-defined, Jason said.
Jason said he is worried that physicians will react to the study by pushing their patients to perform actives that will be harmful, even though the study itself does not suggest it.
Ultimately, health professionals from many disciplines should come together to address the medical and psychological issues of patients, he said.
Pass it on: Cognitive behavioral therapy and graded exercise therapy may be effective treatments for chronic fatigue syndrome.
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