Outcomes and predictors of response from an optimised, multidisciplinary intervention for chronic fatigue states

Abstract

The manualised protocol of integrated CBT and GET was successfully implemented, confirming the generally positive findings of clinical trials. Assessment and treatment protocols are available for dissemination to allow standardised management. The beneficial effects described here provide the basis for ongoing studies to optimise the intervention further and better identify those most likely to respond.

Randomised controlled trial of online continuing education for health professionals to improve the management of chronic fatigue syndrome: a study protocol

“…The online education programme is an interactive, self-paced online activity that has been developed from a CFS treatment manual previously created, and tested for efficacy, by the research group. 7 The content contains an introduction and seven modules that include information on CFS symptoms, assessment and diagnosis and detailed descriptions of interventions used to manage CFS symptoms, as well as material on conditions that may occur secondary to fatigue (eg, reduced mood, anxiety, etc). The remaining modules cover: psychoeducation, activity pacing and GET, interventions for sleep disturbance, interventions for cognitive disturbance (eg, cognitive remediation), and interventions for mood, anxiety and emotion coping.…”

“…Many patients and allied health professionals incorrectly assume GET involves the development of a traditional exercise programme (this is an easy mistake to make given the potentially misleading term: GET ) that requires marked physical exertion, which should be continued regardless of increasing symptoms. However, after appropriate day-to-day pacing of regular activities has been established—that is, establishing a daily or weekly schedule of activities that does not exceed the individual’s energy thresholds 7— GET merely commences with conservative incremental increases in the duration of daily physical activities, including incidental tasks such as domestic chores. This is followed by gradual progression to more structured exercise, such as walking, which is introduced and cautiously increased in a graded fashion, generally at levels far below physical activity guidelines for the general population.…”

“…This is followed by gradual progression to more structured exercise, such as walking, which is introduced and cautiously increased in a graded fashion, generally at levels far below physical activity guidelines for the general population. 7 Thus, to provide safe and effective GET for people with CFS some clinicians may need to recalibrate their notions of exercise. The implementation of GET as part of an intervention for people with CFS subsequent to the establishment of appropriate pacing of activities is important because activity pacing alone does not consistently provide benefit.…”

“…The implementation of GET as part of an intervention for people with CFS subsequent to the establishment of appropriate pacing of activities is important because activity pacing alone does not consistently provide benefit. 7 18 …”

Chronic fatigue syndrome: progress and possibilities

“…Cognitive behaviour therapy (CBT) is a commonly trialled intervention. In the context of CFS, CBT is best considered as a multifaceted strategy to identify and modify illness behaviours and beliefs to reduce symptom severity and improve functional capacity . Beliefs that should be challenged include that more sleep will alleviate the fatigue, that avoiding activity is preferable, and that ignoring symptoms and simply pushing beyond activity thresholds will overcome the illness.…”