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Cognitive behavior therapy, exercise, and CFS/FM.

Cognitive behavior therapy (CBT) helps people with chronic fatigue syndrome (CFS; a.k.a. myalgia encephalomyelitis) and fibromyalgia learn how to pace their activities and develop an accurate perspective of their energy levels. People with these conditions often live in fear that symptoms will flare. That fear can incapacitate them. CBT therapists teach patients self-help strategies that let them gain some control over their symptoms. CBT strategies include keeping an energy diary that tracks symptoms, energy level changes, and activities; doing relaxation exercises and meditation; finding ways to promote better sleep; prioritizing and delegating tasks; learning flexibility; pacing daily activities; and performing gentle physical exercise.

CBT is very controversial among the CFS/FM community because some practitioners have pointed to its effectiveness in clinical studies as evidence that the illness stems from "wrong thinking." Such practitioners use graded exercise therapy (GET) in their CBT programs. GET assumes that CFS/FM symptoms have no physiological cause, that "deconditioning, depression, and believing one is ill are at the root of CFS," according to Moira Smith. Graded exercise therapy encourages patients to stick to ever-increasing exercise goals, like an athlete in training. In reality, CFS/FM symptoms vary from day to day. Trying to stick to an inflexible schedule may compound the problem. Interestingly, the clinical studies that recommend CBT/GET as an effective treatment rarely include the most disabled and tend to have high drop-out rates.

Pacing, on the other hand, acknowledges a biological dysfunction and recognizes that a relapse will occur if patients overextend their energy. "Pacing," Moira Smith explains, "is all about 'listening to your body' (instead of your conscience or other people) and accepting that this means your activity levels will vary a lot." Cognitive behavior therapy that uses pacing strategies helps patients learn how to work with their energy levels instead of pushing themselves to the point of symptom flare-ups and disability.

Carruthers, et al. Myalgic encephalomyelitis/chronic fatigue syndrome: clinical working case definition, diagnostic and treatment protocols. Journal of Chronic Fatigue Syndrome. 2003; 11(1): 46-49. Available at: Accessed November 22, 2007.

Parks R. Cognitive-behavioral therapy for chronic fatigue syndrome. WebMD. May 15, 2007. Available at: Accessed November 8, 2007.

Smith M. Pacing and graded exercise compared. Available at Accessed November 8, 2007.

Stulemeijer M, de Jong LWAM, Fiselier TJW, et al. Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomized controlled trial. BMJ. January 1, 2005;330(14). Available at: Accessed November 8, 2007.
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Title Annotation:Shorts
Author:Klotter, Jule
Publication:Townsend Letter
Geographic Code:1USA
Date:Feb 1, 2008
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