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CBT – cognitive behavioural therapy
CBT aims “to establish a new
equilibrium”, vanhoudenhove06.txt, vanhoudenhove.etal06.txt.
A theoretical and empirical
review, deary.etal07.txt, deary.etal.07.txt, deary.etal07.pdf.
In CFS patients, the provocation of
fatigue is associated with exaggerated emotional responses that patients may have
difficulty suppressing. These findings are discussed in relation to the
cognitive-behavioural model of CFS, caseras.etal08.txt,
caseras.etal08.pdf.
Personality
styles in patients with FM, major depression and healthy controls, nordahl.stiles07.txt. Personality profiles in
CFS patients, le.bon.etal07.txt, le.bon.etal07.pdf.
According to strong advocates
for CBT, a cultural component underlies CFS, cho.etal08.txt,
cho.etal.08.txt, cho.etal08.pdf.
A
remarkable finding ‘Increase in prefrontal cortical volume following
cognitive behavioural therapy in patients with CFS’, delange.etal08.txt, delange.etal.08.txt, delange.etal08.pdf.
Another therapy has evolved: Mindfulness-based stress reduction (MBSR)
a systematic program for reduction of suffering associated with a wide range
of medical conditions, FM included, grossman.etal07.txt
Limitations to psychotherapy, moloney06.txt.
A
BMJ-review concluded that CBT (in combination with graded exercise) was the
only documented treatment for CFS, Reid et al., 2000.
A letter of response, Chaudhury, 2000. Also the NICE guidelines for ME/CFS
recommends CBT, leaving UK patient organizations in agony, meresearch.uk.comment06.txt.
CBT
in a hospital setting, Agaki et al., 2001
(txt), Agaki et al., 2001
(pdf), was criticized for patients having been
recruited on criteria not strictly fulfilling the CDC criteria, and for using
wrong WHO disease code, letter, Agaki, 2001.
A 5-year follow-up study concluded that CBT was better than relaxation
therapy, but was no cure for CFS, Deale et al., 2001.
Senior CFS researchers conclude that CBT is helpful but no cure for
CFS, Evengard & Klimas, 2002.
Implementing CBT for
CFS in a mental health center, scheeres.etal07.txt,
scheeres.etal.07.txt, scheeres.etal07.pdf. Implementing CBT for CFS in
mental health care: a costs and outcomes analysis, scheeres.etal08.txt, scheeres.etal.08.txt.
The
Canadian clinical CFS work definition includes a discussion of studies on
CBT, Carruthers et al., 2003.
Most
surprisingly to many a Dutch study, performed by experts in the field, concluded
that CBT made CFS patients worse, koolhaas.etal08.txt.
A Cochran review:
CBT is effective in reducing the symptoms of fatigue at post-treatment
compared with usual care, and may be more effective in reducing fatigue
symptoms compared with other psychological therapies. The evidence base at
follow-up is limited to a small group of studies with inconsistent findings.
There is a lack of evidence on the comparative effectiveness of CBT alone or
in combination with other treatments, and further studies are required to
inform the development of effective treatment programmes for people with
CFS, price.etal.08.txt, price.etal08.txt,
price.etal08.pdf.
Hypocortisolism in CFS is potentially reversible by
CBT, roberts.etal08.txt, roberts.etal.08.txt, roberts.etal08.pdf.
The
comprehensive UK trial PACE [CBT and graded
exercise] critized by patient groups, MCR.PACE.trial.scandal04.txt. The
protocol for this trial, white.etal07.txt, white.etal.07.txt.
CBT
is by no means a cure for CFS, vanhoof03.txt. The therapists found it more difficult to
treat patients with CFS than patients with psychological or other physical
problems, bazelmans.etal04.txt. A Dutch thesis on CBT and CFS, bazelmans04.pdf. A moderate effect on
fatigue but no effect on functional disability, bazelmans.etal05.txt, bazelmans.etal05.pdf.
The effect of CBT is no different in CFS with or without psychiatric
diagnosis, prins.etal05.pdf.
Group CBT did not significantly improve cognitive function, quality of life,
employment status or healthcare utility measures, odowd.etal.06.txt,
odowd.etal06.txt.
CBT may
result in patients feeling more able, but neuropsychological test results do
not improve, knoop.etal07.txt, knoop.etal07.pdf. These same authors conclude that ‘full
recovery’ from fatigue takes place in 21% of patients. This study has
no follow-up after CBT, knoop.et.al07.txt, knoop.et.al07.pdf. According to the
authors CBT is effective for pain also, knoop.etal.07.txt, knoop.etal.07.pdf.
Self-instruction, instead of CBT, works well, knoop.etal08.txt, knoop.etal08.pdf,
knoop.tables08.pdf .
When
asked about treatments English CFS/ME patients counted CBT as the least
effective, CBT, Jones, 2003. A recent Dutch study concluded that CBT
is not effective when practiced by general practitioners, huibers.etal04.txt, huibers.etal04.pdf. Another study could not document that CBT
is cost-effective, severens.etal04.txt, severens.etal04.pdf. A ‘letter to the editor’ on
this paper, letter.stouten04.pdf. Cost-effectiveness of CBT in the treatment
of chronic fatigue (CF) in primary care is equal to or higher than graded
exercise therapy, when the main outcome measure was improvements in fatigue, mccrone.etal04.txt.
CBT
delivered by GPs is not effective in the long term, leone.etal06.txt.
A meta-analysis concluded that CBT for
CFS tends to be moderately efficacious, malouff.etal07.txt, malouff.etal07.pdf.
The
respected Chicago CFS research group in a comprehensive 2001-review argued
for the beneficial effect of CBT for both CFS and FM, Friedberg & Jason,
2001 (short), Friedberg & Jason,
2001 (paper).
A study, where fitness training was combined with CBT, found this to improve
physical functioning in 25% of the patients, Williams et al., 2002, CBT works equally well for low back pain as for
FM, wells-fedennan.etal03.txt.
CBT and exercise has only short term
effect in FM, redondo.etal04.txt. Four CBT programmes compared in Sweden:
No major differences could be found
between the programmes, henriksson.etal04.txt.
In a UK-multicentre study CBT proved better
than guided support, but with rather high fall-out numbers, Prins et al., 2001. This article resulted in several
"letters to the editor", letters, Lancet, 2001.
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