Academic journal article Journal of Cognitive Psychotherapy

Cognitive-Behavioral Interventions with Chronic Fatigue Syndrome: A Single Case Study

Academic journal article Journal of Cognitive Psychotherapy

Cognitive-Behavioral Interventions with Chronic Fatigue Syndrome: A Single Case Study

Article excerpt

Chronic Fatigue Syndrome (CFS) is a disorder characterized by disabling fatigue often causing a reduction in daily activities and depressed mood. Individuals struggling with CFS have been noted to have maladaptive automatic thoughts that interfere with efforts to return to a satisfying lifestyle. Cognitive behavioral therapy (CBT) has been shown to be an effective treatment in changing maladaptive cognitions. A treatment package applying CBT techniques to the maladaptive thoughts associated with CFS was developed for these patients. This case-study examines the effectiveness of a CBT group intervention with a 39 year old Caucasian woman diagnosed with CFS for 3 years. Presented is a CBT conceptualization of CFS and a detailed case formulation delineating some disease specific cognitions. The patient discussed showed improvements in measures of psychological distress, perceived stress and depression. Although no change was noted in levels of reported fatigue, the patient reported fewer symptoms of depression, increased activity tolerance and improved quality of life after participation in group.

INTRODUCTION

Chronic Fatigue Syndrome (CFS) is a disorder characterized by disabling fatigue lasting greater than 6 months resulting in a reduction of daily activities to less than 50% below the premorbid level. Other symptoms of CFS include muscle and joint pain, low grade fever, sore throats, muscle weakness and sleep disturbance. Neuropsychological symptoms that are frequently associated with CFS include: difficulties with concentration, memory loss, and depression. In order to meet criteria for a diagnosis of CFS other medical conditions causing fatigue must first be ruled out (Holmes, Kaplan, Grantz, Komaroff, Schonberger, Straus, et al., 1988). The Center for Disease Control (CDC) has developed CFS diagnostic criteria to be used for research purposes (Fukuda, 1994).

Depression is a common complaint of patients with CFS with depressive symptoms evident in 30-70% of study samples (Behan, Behan, & Bell, 1985; Buchwald, Sullivan, & Komaulf, 1987; DuBois, Seeley, Brus, Sakamoto, Ballow, Harada, et al., 1984; Jones, Ray, Minnich, Hicks, Kilber, & Lucas, 1985; Lane, Manu, & Matthews, 1991; Salit, 1985; Straus, Tosato, Armstrong, Lawley, Preble, Henle, et al., 1985). In a recent study, 73% of the subjects with CFS reported experiencing a Major Depressive Episode at some point during the course of their illness (Lloyd, Hickie, Brockman, & , 1993). Further, in most documented cases depression was cited as preceding or occurring at onset of the fatigue (Manu, Lane, & Matthew, 1992). Although it is important to remember that CFS is a complex syndrome that differs from depression, depression and CFS do have many similar symptoms. Examples of shared symptoms are: restricted activity tolerance, a tendency to withdraw from positive activities, difficulty concentrating, sleep disturbance and anhedonia. These similarities extend to maladaptive cognitions as well. As with depressed patients, CFS patients hold negative views of the self, others and the world which interfere with the effective management of symptoms and activity level.

Investigators have hypothesized that there are specific patterns of cognitions experienced by patients coping with CFS (Surawy, Hackmann, Hawton, & Sharpe, 1995). CFS patients report a frequent cycle of inactivity resulting in deconditioning followed by unmodulated attempts to resume activity that results in an exacerbation of CFS symptoms. The excessive fatigue and physical symptoms that follow attempts to return to a premorbid level of activity result in cognitions with themes of hopelessness and discouragement. These cognitions in turn perpetuate a cycle in which the patient withdraws from meaningful activity. The subsequent lower level of functioning triggers a set of automatic thoughts with themes of worthlessness and self-criticism resulting in feelings of depression and anxiety. …

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