An evaluation of multidisciplinary intervention for chronic fatigue syndrome with long-term follow-up, and a comparison with untreated controls


      Individuals meeting the Fukuda et al definition for chronic fatigue syndrome completed a multidisciplinary assessment that included medical, psychiatric, behavioral, and psychological evaluations. Patients were then offered a comprehensive multidisciplinary intervention that included (1) bringing the patient under optimal medical management; (2) treating any ongoing affective or anxiety disorder pharmacologically; and (3) implementing a comprehensive cognitive–behavioral treatment program. Fifty-one patients proceeded to treatment. The cognitive–behavioral component was carried out through the use of a therapist working with the patients in their own environments. The program was individually tailored to patients, but included (1) structured physical exercise and activation; (2) sleep management strategies; (3) careful activity management; (4) regulation of stimulant intake and reductions in use of symptomatic medications; (5) cognitive intervention designed to deal with patients’ beliefs concerning the nature of their disorder; (6) participation of patients’ family; and (7) efforts to establish specific vocational and avocational goals. Third parties were encouraged to collaborate cooperatively. Employers were urged to provide employment opportunities and facilitate a graduated but time-targeted return to work. Disability carriers were encouraged to provide interim financial support in the form of disability benefits, support therapeutic intervention, but also to establish a clear time-frame to access to benefits. Of 51 treated patients, 31 returned to gainful employment, 14 were functioning at a level equivalent to employment, and 6 remained significantly disabled. Twenty of the original 71 patients were contacted an average of 33 months later. Patients who had been treated showed good maintenance of gains. Untreated patients showed improvement in only a minority of cases.
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        • Fukuda K
        • Straus S.E
        • Hickie I
        • Sharpe M.C
        • Dobbins J.G
        • Komaroff A
        The chronic fatigue syndrome.
        Ann Intern Med. 1994; 121: 953-959
        • Demitrack M.A
        • Abbey S.E
        Chronic Fatigue Syndrome. The Guilford Press, New York1996
        • Cott A
        The disease-illness distinction.
        in: McHugh S Vallis M Illness Behaviour. Plenum Publishing, New York1987: 71-99
      1. Mechanic D. Chronic fatigue syndrome and the treatment process. Chronic Fatigue Syndrome. Ciba Foundation Symposium, 173, 1993:318–341.

        • Fordyce W.E
        Pain treatment centers at a crossroads.
        in: Cohen M.J.M Campbell J.N Chronic Pain The Behavioral Perspective. IASP Press, Seattle1996: 39-46
        • Keefe F.J
        • Holzberg A.D
        • Beaupré P.M
        Contributions of pain behavior assessment and pain assessment to the development of pain clinics.
        in: Cohen M.J.M Campbell J.N Pain Treatment Centers at a Crossroads A Practical and Conceptual Reappraisal. IASP Press, Seattle1996: 79-100
        • Neilson W.R
        • Walker L
        • McCain G.A
        Cognitive-behavioral treatment of fibromyalgia syndrome.
        J Rheumatol. 1992; 19: 58-103
      2. Parkinson W, Cott A, Adachi J, Bedard M, Phobiac M, et al. Effects of cognitive-behavioural and pharmacological interventions on fibromyalgia. In preparation.

        • Sharpe M
        • Hawton K
        • Simkin S
        • Surawy C
        • et al.
        Cognitive behaviour therapy for the chronic fatigue syndrome.
        BMJ. 1996; 312: 22-26
        • Butler S
        • Chalder T
        • Ron M
        • Wessely S
        Cognitive behaviour therapy in chronic fatigue syndrome.
        J Neurosurg Psych. 1991; 54: 153-158
        • Friedberg F
        • Krupp L.B
        A comparison of cognitive behavioral treatment for chronic fatigue syndrome and primary depression.
        Clin Infect Dis. 1994; 18: 105-109
        • Lloyd A.R
        • Hickie I
        • Brockman A
        • Hickie A
        • Wilson A
        • et al.
        Immunologic and psychologic therapy for patients with chronic fatigue syndrome.
        Am J Med. 1993; 94: 197-203
        • Salit I.E
        The chronic fatigue syndrome.
        in: Chalmers A Littlejohn G.O Salit I Wolfe F Fibromyalgia, Chronic Fatigue Syndrome, and Repetitive Strain Injury. Haworth Medical Press, New York1995: 17-25
        • Marlin R.G
        • Anchel H
        • Goldberg W
        • Gibson J
        Multidisciplinary intervention for chronic fatigue syndrome. American Association for Chronic Fatigue Syndrome, Fort Lauderdale, FL1994
        • Marlin R.G
        Chronic disability syndromes. Canadian Institute, Toronto, Ontario1996
        • Cott A
        • Anchel H
        • Goldberg W
        • Fabich M
        • et al.
        Non-institutional treatment of chronic pain by field management.
        Pain. 1990; 40: 183-194