variables. Some variables include whether or not a person has a
disease; differentiating between causal factors and exacerbating
factors ( a therapy may reduce exacerbation but not address the actual
cause for example - CBT doesn't cure any disease); what is being
measured (for example relieving undifferentiated fatigue vs. post
exertional exhaustion unrelieved by rest and upon minimal exertion
such as household chores may not be the same thing) and how treatment
effectiveness is measured; and how recovery is defined.
The study does not appear to have separated patients with depression
from patients without depression.
The note that only 30% of people with CFS recover after CBT doesn't
alert physicians to the problems relating to extrapolation between
subgroups.
Clin Psychol Psychother. 2011 Oct 9. doi: 10.1002/cpp.793. [Epub ahead of p=
rint]
Mindfulness-Based Cognitive Therapy for People with Chronic Fatigue
Syndrome Still Experiencing Excessive Fatigue after Cognitive
Behaviour Therapy: A Pilot Randomized Study.
Rimes KA, Wingrove J.
University of Bath, Department of Psychology, Claverton Down, Bath, UK..
Cognitive behaviour therapy (CBT) is an effective treatment for
chronic fatigue syndrome (CFS; sometimes known as myalgic
encephalomyelitis). However, only a minority of patients fully recover
after CBT; thus, methods for improving treatment outcomes are
required.
This pilot study concerned a mindfulness-based cognitive therapy
(MBCT) intervention adapted for people with CFS who were still
experiencing excessive fatigue after CBT.
The study aimed to investigate the acceptability of this new
intervention and the feasibility of conducting a larger-scale
randomized trial in the future. Preliminary efficacy analyses were
also undertaken. Participants were randomly allocated to MBCT or
waiting list.
Sixteen MBCT participants and 19 waiting-list participants completed
the study, with the intervention being delivered in two separate
groups.
Acceptability, engagement and participant-rated helpfulness of the
intervention were high. Analysis of covariance controlling for
pre-treatment scores indicated that, at post-treatment, MBCT
participants reported lower levels of fatigue (the primary clinical
outcome) than the waiting-list group.
Similarly, there were significant group differences in fatigue at
2-month follow-up, and when the MBCT group was followed up to 6=E2=80=89mon=
ths
post-treatment, these improvements were maintained. The MBCT group
also had superior outcomes on measures of impairment, depressed mood,
catastrophic thinking about fatigue, all-or-nothing behavioural
responses, unhelpful beliefs about emotions, mindfulness and
self-compassion.
In conclusion, MBCT is a promising and acceptable additional
intervention for people still experiencing excessive fatigue after CBT
for CFS, which should be investigated in a larger randomized
controlled trial.
Copyright =C2=A9 2011 John Wiley & Sons, Ltd.
KEY PRACTITIONER MESSAGE: Only about 30% of people with chronic
fatigue syndrome (CFS) recover after cognitive behaviour therapy
(CBT); thus, methods for improving treatment outcomes are needed. This
is the first pilot randomized study to demonstrate that a
mindfulness-based intervention was associated with reduced fatigue and
other benefits for people with CFS who were still experiencing
excessive fatigue after a course of CBT. Levels of acceptability,
engagement in the intervention and rated helpfulness were high. A
larger-scale randomized controlled trial is required.
Copyright =C2=A9 2011 John Wiley & Sons, Ltd.
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