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تاريخ التسجيل : 11/10/2012
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Cognitive Behavior Therapy for Chronic Fatigue Syndrome: A Randomized Controlled Trial

في الجمعة فبراير 22, 2013 10:56 pm
Alicia Deale, M.Sc., Trudie Chalder, M.Sc.,
Isaac Marks, M.D., and Simon Wessely, M.D.

Objective: Cognitive behavior therapy for chronic fatigue syndrome was compared with
relaxation in a randomized controlled trial. Method: Sixty patients with chronic fatigue syndrome
were randomly assigned to 13 sessions of either cognitive behavior therapy (graded
activity and cognitive restructuring) or relaxation. Outcome was evaluated by using measures
of functional impairment, fatigue, mood, and global improvement. Results: Treatment was
completed by 53 patients. Functional impairment and fatigue improved more in the group that
received cognitive behavior therapy. At final follow-up, 70% of the completers in the cognitive
behavior therapy group achieved good outcomes (substantial improvement in physical functioning)
compared with 19% of those in the relaxation group who completed treatment. Conclusions:
Cognitive behavior therapy was more effective than a relaxation control in the management
of patients with chronic fatigue syndrome. Improvements were sustained over 6
months of follow-up
chronic fatigue syndrome, continuous or recurring
fatigue and marked disability often persist for many
years. No definitive treatment or etiology has been established,
and the available evidence suggests that
chronic fatigue syndrome is heterogeneous and multicausal
(1–3).
Uncertainty over cause need not prevent effective
treatment. Cognitive behavior therapy is used for medically
unexplained somatic problems (4) and for disorders
analogous to chronic fatigue syndrome, such as fibromyalgia
(5) and chronic pain (6, 7). Cognitive
behavioral models suggest that a combination of physiological,
behavioral, cognitive, affective, and social factors
contribute to chronic fatigue syndrome (8–10).
Cognitive behavior therapy is used to modify behaviors
and beliefs that may maintain disability and symptoms.
Few randomized controlled trials of cognitive behavior
therapy for chronic fatigue syndrome have been
conducted. An uncontrolled pilot study produced encouraging
results (11), which were largely maintained
4 years later (12). A nonrandomized study showed
some improvement in depression but none in disability

or fatigue (13). In a double-blind, randomized,
controlled trial (14), a brief cognitive behavioral intervention
was no more effective than routine clinic attendance.
A slight improvement was attributed to nonspecific
factors.
The purpose of this study was to test whether cognitive
behavior therapy (comprising graded activity and
cognitive restructuring) was significantly superior to relaxation,
selected to control for nonspecific treatment
factors, including support, therapist time and attention,
expectations, and homework practice.


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