Study: Psychotherapy, exercise can benefit people with chronic fatigue syndrome

From The NY Times:

A new study suggests that psychotherapy and a gradual increase in exercise can significantly benefit patients with chronic fatigue syndrome.

While this may sound like good news, the findings — published Thursday in The Lancet — are certain to displease many patients and to intensify a fierce, long-running debate about what causes the illness and how to treat it.

Many patients, citing two recent high-profile studies, believe the syndrome may be caused by viruses related to mouse leukemia viruses, and they are clamoring for access to antiretroviral drugs used to treat the virus that causes AIDS. That treatment is very expensive and would be expected to continue indefinitely, and health insurers are not generally willing to pay for untested drug regimens.

The new study, conducted at clinics in Britain and financed by that country’s government, is expected to lend ammunition to those who think the disease is primarily psychological or related to stress.

The authors note that the goal of cognitive behavioral therapy, the type of psychotherapy tested in the study, is to change the psychological factors “assumed to be responsible for perpetuation of the participant’s symptoms and disability.”

In the long-awaited study, patients who were randomly assigned to receive cognitive behavioral therapy or exercise therapy, in combination with specialized medical care, reported reduced fatigue levels and greater improvement in physical functioning than those receiving the medical care alone — or getting the medical care along with training in how to recognize the onset of fatigue and to adjust their activities accordingly.

The cognitive and behavioral interventions outlined in the new study are a series of sessions continuing for several months. The researchers are expected to address the cost-effectiveness of the treatments in another report. (Several of the study’s authors reported financial ties to the insurance industry.)

By contrast, the idea that a viral infection is responsible for chronic fatigue syndrome, also called myalgic encephalomyelitis, has been proposed at least since early outbreaks were investigated in the mid-1980s in the United States. Although studies have shown that many patients with the disease have elevated antibody levels for several viruses, no causal role has been proved for any of them. Health officials in the United States are coordinating studies to determine why the mouse leukemia viruses were found in patients in two studies but not in several others.

A major difficulty with conducting studies on the syndrome is that there are several different ways of defining and identifying the illness. These variations have led to a wide range of estimates of its prevalence.

Patient groups and some researchers have challenged the criteria used by the British investigators as likely to include many people with depression, which often causes severe fatigue. They also note that the study excluded patients who could not get to treatment centers, most likely ruling out some of the sickest patients. And at least one survey has found that exercise therapy can significantly worsen many patients’ symptoms.