Research on the indication of cognitive behavioral therapy and graded exercise in chronic fatigue syndrome

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We classified the patients who attended the Fatigue Clinic of the Department of Hematology and Oncology, Osaka University Hospital into four groups by a psychiatric interview based on SCID in the Department of Psychiatry, Osaka University Hospital. These four groups consisted of a group without psychiatric disorders (Group I), a group with subsequent psychiatric disorders (Group II), a group which could be simultaneously diagnosed as psychiatric disorders at the first onset of chronic fatigue syndrome (CFS), and a group which fulfilled the exclusion criteria (Exclusion Group). We mainly included patients in Group I in the present research. The patients received 10 sessions (45 minutes per 2week) of cognitive behavioral therapy (CBT). The assessment, PDQ-R, SSAS, CISS and Holmes & Rahe's Scale, Jikakusho-Shirabe, JIBT, SDS, MOS-SF36 were measured before and after the therapy. The contents of CBT comprised modification of cognitive distortions which could prolong fatigue (overadaptation, … More avoidance of physical activity, obsession on the somatic symptoms, etc.) by interviews and activity charts, appropriate planning and execution of work and rest, and gradual increase of activity. Although the therapy indicated preferable effects in the patients, the effects were different in each cases and it was suggested that uniformed evaluation could fail to detect the effectiveness of CBT for CFS. In applying CBT to Japanese patients with CFS, there were several important points. First, we emphasize necessity for cooperation of physician, psychiatrist and CBT psychologist. Second, as a first intervention, behavioral technique seemed more suitable than cognitive technique. Third, objective methods to evaluate therapeutic effects were required. At present, we published several articles on the psychiatric screening interview and overview of CBT for CFS in Japan. We are now preparing an article on the prognosis of CFS which indicates that patients in Group III showed poorer prognosis of medical treatment by physician. Less