First, he wonders whether the exercise is a placebo effect based on the anticipation of improvement. The second question is the acceptability of this treatment. Many CFS patients actively avoid exercise and many healthcare providers in fact recommend rest at all costs rather than a concern of relapse. However, the positive aspect of the CBT and the exercise is that it has the patients question their fears. In both cases, there is a psychotherapeutic affect that may be beneficial.
The use of antidepressants is another approach that has been suggested and studied. However, the results on this have also been mixed. As Demitrack (1996, p. 282) states, "At the present time, it is unrealistic to present medication as a sole treatment for this disease." It may be that medications could work in the short-term and provide enough symptomatic relief to allow other more lasting nonpharmaceutical therapeutic interventions to help. Future studies should look at combined pharmaceutical and nonpharmaceutical approaches used together.
Abbey (1996, p. 206), who has studied the results of much of the research done thus far in CFS treatment. She sees that in many cases that psychotherapy can be of positive help. For example, group therapy can offer hope, universality, sharing of information, altruism, socialization, catharsis and group cohesiveness. She also recognizes the benefit of cognitive behavioral therapy that can produce better illness adjustment and significant reduction in disability. She notes, "An illness such as chronic fatigue syndrome, for which psychopharmacological treatments may confer substantial benefits in terms of symptom relief, particularly highlights the importance of successfully integrating psychotherapy and pharmacotherapy."
Wessley (1998, p. 395) sees that healthcare providers will continue to be challenged in the future by this condition. Chronic fatigue, he says, is just one example of the large range of medically unexplained syndromes...
Many of these, including CFS, are poorly managed by present existing services. Much of this is due to the fact of the high degree of specialization within the medical field. CFS is not just a physical illness, nor just a psychological illness. It needs to be treated holistically. "Unfortunately such individuals are rare and this may be a major impediment to the development of effective services" for these individuals who are suffering from CFS.
As noted in Lubkin and Larsen (2006, p.20), when caring for a patient and family who is suffering from a long-term illness, it is an ongoing challenge for healthcare providers and the society at large. How healthcare professionals balance quality of care and quantity of care will continue to be an issue in the future with such chronic cases. "It is essential that the healthcare system in the United States develop a continuum of care for its population with chronic illness. The acute care system of the past and present, or, as some call it, a 'nonsystem,' must be redefined to better care for its clients."
References
Center for Disease Control (2006, May 9). Chronic Fatigue Syndrome. Retrieved January 30, 2007 http://www.cdc.gov/cfs/cfsbasicfacts.htm.
Demitrack, M. And Abbey, S. (1996) (Eds) Chronic Fatigue Syndrome. New York: Guilford Press.
Hyland, M.E. et. al. (2006) Letter to the Editor. The Lancet 367 (9522), 1573-1576
Komaroff, a., & Fagioli, L. (1996) Medial Assessment of Fatigue and Chronic Fatigue Syndrome. In M. Demitrack and S. Abbey (Eds) Chronic Fatigue Syndrome (pg. 154-181). New York: Guilford Press,.
Lubkin, I., and Larsen, P. (2006) Chronic Illness. Boston: Jones and Bartlett.
Powell, P. et. al. (2001). Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome. British Medical Journal 322
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