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Old September 30th, 2006, 09:18 PM
James Pretzer James Pretzer is offline
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Default CBT for Chronic Fatigue Syndrome

The UK National Institute for Health and Clinical Excellence [“NICE”] draft guidelines for treatment of chronic fatigue syndrome recommend CBT and Graded Exercise. Here are some excerpts:


1.3.1.11 CBT should be individual or group therapy depending on the individual circumstances.

1.3.1.12 A programme of CBT should include:

• acknowledgement and validation of the patient’s symptoms and condition

• acknowledgement of the patient’s existing skills and abilities

• explanation of the CBT model for CFS/ME and therapy rationale, for example, the relationship between thoughts, feelings, behaviours and symptoms, and the distinction between causal and perpetuating factors

• discussion of the patient’s attitudes and expectations

• development of a supportive and collaborative therapeutic relationship

• development of a shared model of understanding and therapeutic goals

• tailoring to the patient’s needs and level of activity.


1.3.1.13 A programme of CBT may also include:

• developing awareness of thoughts or expectations, or beliefs and defining fatigue-related cognitions and behaviour

• self-monitoring to record patterns of activity and rest, and thoughts, feelings, and behaviours

• establishing a stable and maintainable level of functioning, followed by a gradual, and mutually agreed, increase/decrease in activity

• challenging cognitions which may adversely affect rehabilitation and/or symptom management, for example, fear of activity and perfectionist beliefs

• addressing complex adjustment to diagnosis and acceptance of illness limitations, for example, grief, anger and guilt-evoking beliefs and expectations such as ‘I should be able to do more’ or ‘I can’t do what I used to do’

• identifying perpetuating factors that increase, maintain or exacerbate CFS/ME symptoms to facilitate the patient’s self-efficacy and sense of control over symptoms

• decreasing somatic attributions and addressing symptom over-vigilance and/or checking behaviours by providing physiological explanations of symptoms and using refocusing/distraction techniques

• problem solving using activity management and homework tasks to test out alternative thoughts or beliefs. For example, activity as a therapeutic tool, pleasure and mastery tasks

• building on existing assertion and communication skills in order to set appropriate limits on activity

• management of sleep problems, such as establishing a consistent sleep routine by challenging unhelpful beliefs about sleep, behavioural approaches to sleep disturbance, stress management, and/or relaxation training

• treatment of any associated or comorbid anxiety, depression or post-traumatic stress disorder (refer to NICE guidelines)

• development of setback management or relapse prevention, such as encouraging and building on self-management skills, identifying potential triggers to relapse, problem solving, normalising fluctuations in symptoms…



Competencies…

1.3.3.4 CBT should be delivered only by a suitably trained CBT therapist with appropriate clinical supervision who can demonstrate that they adhere closely to empirically grounded therapy protocols preferably with experience in CFS/ME, or other chronic conditions or medically unexplained symptoms…”



The second recommended component is Graded exercise therapy (GET):

“…GET is an evidence-based self-management approach to CFS/ME involving appropriate physical assessment, mutually negotiated meaningful goal setting and education. It involves setting an achievable baseline of physical activity, followed by individually tailored and planned increases in duration of exercise. This is followed by an increase in intensity when able; taking into account a patient’s preferences and objectives, current activity patterns, sleep, setbacks, and emotional factors; with the objective of improving CFS/ME symptoms and functioning aiming towards recovery…”

The draft gudelines can be downloaded at - http://www.nice.org.uk/download.aspx?o=368978
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