TREATMENT
Many therapies have been tried in systemic exertion intolerance disease (SEID), also known as chronic fatigue syndrome (CFS), but only counseling therapies (eg, cognitive behavioral therapy) and graded exercise therapy appear to produce meaningful benefit [
1-5]. A systematic review of 35 randomized trials evaluating therapies for SEID/CFS concluded that counseling therapies and graded exercise therapy may have benefits for some patients with SEID/CFS [
5]. However, neither of these modalities is curative. There is no known specific medical therapy forSEID/CFS. Patients and their clinicians should be circumspect about trying potentially dangerous and often expensive regimens.
Cognitive behavioral therapy — Cognitive behavioral therapy (CBT) has been effective in patients with SEID/CFS and may be useful in those with idiopathic chronic fatigue [
6-9]. This approach typically involves a series of one-hour sessions designed to alter beliefs and behaviors that might delay recovery. In a trial, 641 patients with SEID/CFS were randomly assigned to receive CBT, graded exercise therapy, or adaptive pacing therapy, which involves helping the patient to plan and pace activities to reduce fatigue; all patients also received specialty medical care [
9]. Patients received 14 sessions of therapy during the first 23 weeks, and an additional session was offered at 36 weeks. When assessed at 52 weeks, CBT in combination with specialist medical care was associated with less fatigue and better physical function compared with specialist medical care alone. Graded exercise therapy led to similar benefits, but adaptive pacing therapy did not.
Similar findings were observed in a randomized trial that compared CBT with relaxation training in 60 patients [
7], and the benefit persisted at five years following the intervention as assessed by an interviewer who did not know to which original group the patient had been assigned [
8].
