Skip to main content

Advertisement

Log in

Non-pharmacologic Interventions for CFS: A Randomized Trial

  • Published:
Journal of Clinical Psychology in Medical Settings Aims and scope Submit manuscript

Abstract

Non-pharmacological behavioral treatments for CFS have been suggested as promising. These trials have tested protocols composed of behavioral, cognitive and cognitive–behavioral interventions but there have been few efforts to differentially evaluate their outcomes. The primary purpose of the current study was to evaluate the effectiveness of nurse delivered non-pharmacologic interventions. In the present study, 114 participants diagnosed with CFS were randomly assigned to four 6-month interventions. The interventions were: cognitive–behavior therapy, cognitive therapy, anaerobic activity, and a relaxation control group. The study found that these interventions led to increases in several areas of functioning, with more consistent changes occurring among those participants in the cognitive condition. For the 25 variables in this study, significant change occurred for 28%, 20%, 16%, and 12% of the variables for the cognitive, cognitive behavior therapy, anaerobic activity, and relaxation conditions, respectively. However, the majority of participants continued to be diagnosed with CFS following the treatment trial. Implications of these findings are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Akagi, H., Klimes, I., & Bass, C. (2001). Cognitive behavioral therapy for chronic fatigue syndrome in a general hospital—feasible and effective. General Hospital Psychiatry, 23, 254–260.

    Article  PubMed  CAS  Google Scholar 

  • Antoni, M. H., Lutgendorf, S., Cole, S., Dhabhar, F., Sephton, S., McDonald, P., Stefanek, M., & Sood, A. (2006). The influence of biobehavioral factors on tumor biology, pathways and mechanisms. Nature Reviews Cancer, 6, 240–248.

    Article  PubMed  CAS  Google Scholar 

  • Antoni, M. H., & Weiss, D. E. (2003). Stress and immunity. In L. A. Jason, P. A. Fennell, & R. R. Taylor (Eds.), Handbook of chronic fatigue syndrome (pp. 527–545). Hoboken: John Wiley & Sons.

    Google Scholar 

  • Bazelmans, E., Prins, J. B., Lulofs, R., van der Meer, J. W. M., & Bleijenberg, G. (2005). Cognitive behaviour group therapy for chronic fatigue syndrome. A nonrandomized waiting list controlled study. Psychotherapy and Psychosomatics, 74, 218–224.

    Article  PubMed  CAS  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio: Psychological Corporation.

    Google Scholar 

  • Black, C. D., O’Connor, P. J., & McCully, K. K. (2005). Increased daily physical activity and fatigue symptoms in chronic fatigue syndrome. Dynamic Medicine, 4, 3. doi: 10;1186/1476-5918-4-3.

  • Black, C. D., & McCully, K. K. (2005). Time course of exercise induced alterations in daily activity in chronic fatigue syndrome. Dynamic Medicine, 4, 10. doi: 10.1186/1476-5918-4-10.

  • Buchwald, D., Pearlman, T., Umali, J., Schmaling, K., & Katon, W. (1996). Functional status in patients with chronic fatigue syndrome, other fatiguing illnesses, and healthy individuals. American Journal of Medicine, 101, 364–370.

    Article  PubMed  CAS  Google Scholar 

  • Burckhardt, C. S., & Anderson, K. L. (2003). The Quality of Life Scale (QOLS): Reliability, validity, and utilization. Health and Quality of Life Outcomes, 1, 60.

    Article  PubMed  Google Scholar 

  • Butland, R. J. A., Pang, J., Gross, E. R., Woodcock, A. A., & Geddes, D. M. (1982). Two, six, and 12-minute walking tests in respiratory disease. British Medical Journal, 284, 1607–1608.

    PubMed  CAS  Google Scholar 

  • Chambers, D., Bagnall, A. M., Hempel, S., & Forbes, C. (2006). Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myaglic encephalomyelitis: An updated systemic review. Journal of the Royal Society of Medicine, 99, 506–520.

    Article  PubMed  Google Scholar 

  • Chalder, T., Berelowitz, G., Pawlikowska, J., Watts, L., & Wessely, D. (1993). Development of a fatigue scale. Journal of Psychosomatic Research, 37, 147–153.

    Article  PubMed  CAS  Google Scholar 

  • Chengalur, S. N., Smith, G. A., Nelson, R. C., & Sadoff, A. M. (1990). Assessing sincerity of effort in maximal grip strength tests. American Journal of Physical Medicine and Rehabilitation, 69, 148–153.

    PubMed  CAS  Google Scholar 

  • Cho, H. J., Hotopf, M., & Wessely, S. (2005). The placebo response in the treatment of chronic fatigue syndrome. A systematic review and meta-analysis. Psychosomatic Medicine, 67, 301–313.

    Article  PubMed  Google Scholar 

  • Clapp, L. L., Richardson, M. T., Smith, J. F., Wang, M., Clapp, A. J., & Pieroni, R. E. (1999). Acute effects of thirty minutes of light-intensity, intermittent exercise on patients with chronic fatigue syndrome. Physical Therapy, 79, 749–756.

    PubMed  CAS  Google Scholar 

  • Cleeland, C. S., & Ryan, K. M. (1994). Pain assessment: The global use of the Brief Pain Inventory. Annals Academy of Medicine Singapore, 23, 129–138.

    CAS  Google Scholar 

  • Cohen, S., Kamark, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 37, 147–153.

    Google Scholar 

  • Cooper, L. (2001). Report on survey of members of local ME groups. Perspectives.

  • Deale, A., Chalder, T., Marks, I., & Wessely, S. (1997). Cognitive behaviour therapy for chronic fatigue syndrome: A randomized controlled trial. American Journal of Psychiatry, 154, 408–414.

    PubMed  CAS  Google Scholar 

  • Deale, A., Husain, K., Chalder, T., & Wessely, S. (2001). Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: A 5-year follow-up study. American Journal of Psychiatry, 158, 2038–2042.

    Article  PubMed  CAS  Google Scholar 

  • Donta, S. T., Clauw, D. J., Engel, C. C., Guarino, P., Peduzzi, P., Williams, D. A., et al. (2003). Cognitive behavioral therapy and aerobic exercise for Gulf war veterans’ illnesses: A randomized controlled trial. Journal of the American Medical Association, 289, 1396–1404.

    Article  PubMed  Google Scholar 

  • Edmonds, M., McGuire, H., & Price, J. (2004). Exercise therapy for chronic fatigue syndrome. The Cochrane Library, 3, 1–22.

    Google Scholar 

  • Fennell, P. A. (1995). A four stage progressive model of CFS. Journal of Chronic Fatigue Syndrome, 1, 69–79.

    Article  Google Scholar 

  • Ferguson, R. J., Robinson, A. B., & Splaine, M. (2002). Use of the Reliable Change Index to evaluate clinical significance in SF-36 outcomes. Quality of Life Research, 11, 509–516.

    Article  PubMed  Google Scholar 

  • Friedberg, F. (1996). Chronic fatigue syndrome: A new clinical application. Professional Psychology: Research and Practice, 27, 487–494.

    Article  Google Scholar 

  • Friedberg, F., & Jason, L. A. (1998). Understanding chronic fatigue syndrome: An empirical guide to assessment and treatment. Washington: American Psychological Association.

    Google Scholar 

  • Friedberg, F., & Krupp, L. B. (1994). A comparison of cognitive behavioral treatment for chronic fatigue syndrome and primary depression. Clinical Infectious Diseases, 18, 105–110.

    Google Scholar 

  • Fukuda, K., Straus, S. E., Hickie, I., Sharpe, M. C., Dobbins, J. G., & Komaroff, A. (1994). The chronic fatigue syndrome: A comprehensive approach to its definition and study. Annals of Internal Medicine, 121, 953–959.

    PubMed  CAS  Google Scholar 

  • Fulcher, K. Y., & White, P. D. (1997). Randomized controlled trial of graded exercise in patients with the chronic fatigue syndrome. British Medical Journal, 314, 1647–1652.

    PubMed  CAS  Google Scholar 

  • Gabbe, B. J., Bennell, K. L., Wajswelner, H., & Finch, C. F. (2004). Reliability of common lower extremity musculoskeletal screening tests. Physical Therapy in Sport, 5, 90–97.

    Google Scholar 

  • Goudsmit, E. (2001). Measuring the quality of trials of treatments for chronic fatigue syndrome. Journal of the American Medical Association, 286, 3078–3079.

    Article  PubMed  CAS  Google Scholar 

  • Gould, R., Abramson, I., Galasko, D., & Salmon, D. (2001). Rate of cognitive change in Alzheimer’s disease: Methodological approaches using random effects models. Journal of the International Neuropsychological Society, 7, 813–824.

    PubMed  CAS  Google Scholar 

  • Hawk, C., Jason, L. A., & Torres-Harding, S. (2007). Reliability of a chronic fatigue syndrome questionnaire. Journal of Chronic Fatigue Syndrome, 13, 41–66.

    Article  Google Scholar 

  • Hewitt, P. L., & Norton, G. R. (1993). The Beck Anxiety Inventory: A psychometric analysis. Psychological Assessment, 5, 408–412.

    Article  Google Scholar 

  • Huibers, M. J. H., Beurskens, A. J. H. M., van Schayck, C. P., Bazelmans, E., Metsemakers, J. F. M., Knottnerus, J. A., et al. (2004). Efficacy of cognitive-behavioral therapy by general practitioners for unexplained fatigue among employees. The British Journal of Psychiatry, 184, 240–246.

    Article  PubMed  Google Scholar 

  • Innes, E. (1999). Handgrip strength testing: A review of the literature. Australian Occupational Therapy Journal, 46, 120–140.

    Article  Google Scholar 

  • Jason, L. A., Melrose, H., Lerman, A., Burroughs, V., Lewis, K., King, C. P., et al. (1999). Managing chronic fatigue syndrome: A case study. AAOHN Journal, 47, 17–21.

    PubMed  CAS  Google Scholar 

  • Jason, L. A., Ropacki, J. A., Santoro, N. B., Richman, J. A., Heatherly, W., Taylor, R., et al. (1997). A screening scale for chronic fatigue syndrome: Reliability and validity. Journal of Chronic Fatigue Syndrome, 3, 39–59.

    Article  Google Scholar 

  • Jensen, M. P., & Karoly, P. (1992). Self-report scales and procedures for assessing pain in adults. In D. C. Turk & R. Melzack (Eds.), Handbook of pain assessment (pp. 135–151). New York: Guilford Press.

    Google Scholar 

  • Johnson, S. K., DeLuca, J., & Natelson, B. (1996). Depression in fatiguing illness: Comparing patients with chronic fatigue syndrome, multiple sclerosis and depression. Journal of Affective Disorders, 39, 21–30.

    Article  PubMed  CAS  Google Scholar 

  • Keller, S., Bann, C. M., Dodd, S. L., Schein, J., Mendoza, T. R., & Cleeland, C. S. (2004). Validity of the Brief Pain Inventory for use in documenting the outcomes of patients with noncancer pain. The Clinical Journal of Pain, 20, 309–318.

    Article  PubMed  Google Scholar 

  • Komaroff, A. L., Fagioli, L. R., Geiger, A. M., Doolittle, T. H., Lee, J., Kornish, R. J., et al. (1996). An examination of the working case definition of chronic fatigue syndrome. American Journal of Medicine, 100, 56–64.

    Article  PubMed  CAS  Google Scholar 

  • Krupp, L. B., LaRocca, N. G., Muir-Nash, J., & Steinberg, A. D. (1989). The Fatigue Severity Scale: Application to patents with multiple sclerosis and systemic Lupus erythematosus. Archives of Neurology, 46, 1121–1123.

    PubMed  CAS  Google Scholar 

  • Laird, N., & Ware, J. (1982). Random-effects models for longitudinal data. Biometrics, 38, 963–974.

    Article  PubMed  CAS  Google Scholar 

  • McGregor, B., Antoni, M., Boyers, A., Alferi, S., Blomberg, B., Carver, C. (2004). Cognitive–behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer. Journal of Psychosomatic Research, 56, 1–8.

    Article  PubMed  Google Scholar 

  • McHorney, C. A., Ware, J. E., Lu, A. W., & Sherbourne, C. D. (1994). The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32, 40–66.

    Article  PubMed  CAS  Google Scholar 

  • McKenzie, M., Dechene, L., Friedberg, F., & Fontanetta, R. (1995). Cognitive-behavioral coping skills in long-term chronic fatigue syndrome. Journal of Chronic Fatigue Syndrome, 1, 59–67.

    Article  Google Scholar 

  • Miller, G. E., & Cohen, S. (2001). Psychological interventions and the immune system: A meta-analytic review and critique. Health Psychology, 20, 47–63.

    Article  PubMed  CAS  Google Scholar 

  • Ost, L. (1987). Applied relaxation: Description of a coping technique and review of controlled studies. Behavior Research and Therapy, 25, 397–409.

    Article  CAS  Google Scholar 

  • Peckerman, A., LaManca, J. J., Dahl, K. A., Chemitiganti, R., Qureishi, B., & Natelson, B. H. (2003). Abnormal impedance cardiography predicts symptom severity in chronic fatigue syndrome. The American Journal of the Medical Sciences, 326, 55–60.

    Article  PubMed  Google Scholar 

  • Pepper, C. M., Krupp, L. B., Friedberg, F., Doscher, C., & Coyle, P. K. (1993). A comparison of neuropsychiatric characteristics in chronic fatigue syndrome, multiple sclerosis, and major depression. The Journal of Neuropsychiatry and Clinical Neurosciences, 5, 200–205.

    PubMed  CAS  Google Scholar 

  • Powell, P., Bentall, R. P., Nye, F. J., & Edwards, R. H. T. (2001). Randomized controlled trial of patient education to encourage exercise in chronic fatigue syndrome. British Medical Journal, 322, 1–5.

    Article  Google Scholar 

  • Powell, P., Bentall, R. P., Nye, F. J., & Edwards, R. H. T. (2004). Patient education to encourage graded exercise in chronic fatigue syndrome – 2-year follow-up randomized controlled trial. The British Journal of Psychiatry, 184, 142–146.

    Article  PubMed  Google Scholar 

  • Preliminary Report. (2001). The severely affected. AfME, Feb., 28, 2001.

  • Prins, J. B., Bleijenberg, G., Bazelmans, E., Elving, L. D., De Boo, T. M., Severens, J. L., et al. (2001). Cognitive behaviour therapy for chronic fatigue syndrome: A multicenter randomized controlled trial. Lancet, 357, 841–847.

    Article  PubMed  CAS  Google Scholar 

  • Ridsdale, L., Godfrey, E., Chalder, T., Seed, P., King, M., Wallace, P., et al. (2001). Chronic fatigue in general practice: Is counseling as good as cognitive behaviour therapy? A randomized trial. British Journal of General Practice, 51, 19–24.

    PubMed  CAS  Google Scholar 

  • Ridsdale, L., Darbishire, L., & Seed, P. (2004). Is graded exercise better than cognitive behavior therapy for fatigue? A UK randomized trial in primary care. Psychological Medicine, 34, 37–49.

    Article  PubMed  CAS  Google Scholar 

  • Robinson, G. K. (1991). The BLUP is a good thing: The estimation of random effects. Statistical Science, 6, 15–51.

    Google Scholar 

  • Severens, J. L., Prins, J. B., Van Wilt, G. J. Van Meer, J. W. M., & Bleijenberg, G. (2004). Cost-effectiveness of cognitive behavior therapy for patients with chronic fatigue syndrome. Quarterly Journal of Medicine, 97, 153–161.

    CAS  Google Scholar 

  • Sharpe, M., Hawton, K., Simkin, S., Surawy, C., Hackmann, A., Klimes, I., et al. (1996). Cognitive behavior therapy for the chronic fatigue syndrome: A randomized controlled trial. British Medical Journal, 312, 22–26.

    PubMed  CAS  Google Scholar 

  • Soderberg, S., & Evengard, B. (2001). Short-term group therapy for patients with chronic fatigue syndrome. Psychotherapy Psychosomatics, 70, 108–111.

    Article  CAS  Google Scholar 

  • Song, S., & Jason, L. A. (2005). A population-based study of chronic fatigue syndrome (CFS) experienced in differing patient groups: An effort to replicate Vercoulen et al.’s model of CFS. Journal of Mental Health, 14, 277–289.

    Article  CAS  Google Scholar 

  • Spitzer, R. L., Williams, J. B. W., Gibbon, M., & First, M. B. (1995). Structured Clinical Interview for the DSM-IV—non-patient edition (SCID—NP, version 2.0). Washington: American Psychiatric Press.

    Google Scholar 

  • Steer, R. A., Clark, D. A., Beck, A. T., & Ranieri, W. F. (1995). Common and specific dimensions of self-reported anxiety and depression: A replication. Journal of Abnormal Psychology, 104, 542–545.

    Article  PubMed  CAS  Google Scholar 

  • Surawy, C., Hackmann, A., Hawton, K., & Sharpe, M. (1995). Chronic fatigue syndrome: A cognitive approach. Behavior Research Therapy, 33, 535–544.

    Article  CAS  Google Scholar 

  • Taylor, R. R., & Jason, L. A. (1998). Comparing the DIS with the SCID: Chronic fatigue syndrome and psychiatric comorbidity. Psychology and Health: The International Review of Health Psychology, 13, 1087–1104.

    Google Scholar 

  • Taylor, R. R., Jason, L. A., Shiraishi, Y., Schoeny, M. E., & Keller, J. (2006). Conservation of resources theory, perceived stress, and chronic fatigue syndrome: Outcomes of a consumer-driven rehabilitation program. Rehabilitation Psychology, 51, 157–165.

    Article  Google Scholar 

  • Taylor, R. R., Jason, L. A., & Torres, A. (2000). Fatigue rating scales: An empirical comparison. Psychological Medicine, 30, 849–856.

    Article  PubMed  CAS  Google Scholar 

  • Van der Werf, S. P., de Vree, B., Alberts, M., van der Meer, J. W. M., & Bleijenberg, G. (2002). Natural course and predicting self-reported improvement in patients with chronic fatigue syndrome with a relatively short illness duration. Journal of Psychosomatic Research, 53, 749–753.

    Article  PubMed  Google Scholar 

  • Van Hoof, E. (2004). Cognitive behavioral therapy as cure-all for CFS. Journal of Chronic Fatigue Syndrome, 11, 43–47.

    Article  Google Scholar 

  • Vercoulen, J. H., Swanink, C. M., Galama, J. M., Fennis, J. F., Jongen, P. J., Hommes, O. R., et al. (1998). The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: Development of a model. Journal of Psychosomatic Research, 45, 507–517.

    Article  PubMed  CAS  Google Scholar 

  • Wallman, K. E., Morton, A. R., Goodman, C., Grove, R., & Guilfoyle, A. M. (2004). Randomised controlled trial of graded exercise in chronic fatigue syndrome. The Medical Journal of Australia, 180, 444–448.

    PubMed  Google Scholar 

  • Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey. Medical Care, 30, 473–483.

    Article  PubMed  Google Scholar 

  • Wearden, A. J., Morriss, R. K., Mullis, R., Strickland, P. L., Pearson, D. J., & Appleby, L. (1998). Randomised, double-blind, placebo-controlled treatment trial of fluoxetine and graded exercise for chronic fatigue syndrome. The British Journal of Psychiatry, 172, 485–490.

    Article  PubMed  CAS  Google Scholar 

  • White, P. D., Sharpe, M. C., Chalder, T., DeCesare, J. C., & Walwyn, R. (2007). Protocol for the PACE trial: A randomised controlled trial of adaptive pacing, cognitive behaviour therapy, and graded exercise, as supplements to standardised specialist medical care versus standardised specialist medical care alone for patients with the chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy. BMC Neurology, 7, 6. doi: 10.1186/1471-2377-7-6.

  • Whitehead, L., & Campion, P. (2002). Can general practitioners manage chronic fatigue syndrome? A controlled trial. Journal of Chronic Fatigue Syndrome, 10, 55–64.

    Article  Google Scholar 

  • Whiteside, A., Hansen, S., & Chaudhuri, A. (2004). Exercise lowers pain threshold in chronic fatigue syndrome. Pain, 109, 497–499.

    Article  PubMed  Google Scholar 

  • Whiting, P., Bagnall, A. M., Sowden, A. J., Cornell, J. E., Mulrow, C. D., & Ramirez, G. (2001). Interventions for the treatment and management of chronic fatigue syndrome. Journal of the American Medical Association, 286, 1360–1368.

    Article  PubMed  CAS  Google Scholar 

  • Wood, B., & Wessely, S. (1999). Personality and social attitudes in chronic fatigue syndrome. Journal of Psychosomatic Research, 47, 385–397.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

The authors appreciate the funding provided by NIAID (Grant No. AI 49720). We also particularly appreciate the help of Staci Stevens and Vincent Deary for their consultation help.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Leonard A. Jason.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jason, L.A., Torres-Harding, S., Friedberg, F. et al. Non-pharmacologic Interventions for CFS: A Randomized Trial. J Clin Psychol Med Settings 14, 275–296 (2007). https://doi.org/10.1007/s10880-007-9090-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10880-007-9090-7

Keywords

Navigation