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15 Aug

Prins, Bleijenberg et al from the University Medical Center, Nijmegen, The Netherlands, compared the effects of cognitive-behavioral therapy (relaxation, guided imagery, and other self-regulatory techniques) to professionally facilitated support groups and a control group of standard care in the treatment of CFS (chronic fatigue syndrome). Of 278 patients diagnosed with CFS, 93 were randomly assigned to CBT, 94 to support groups and 91 to the control condition. Evaluations were done at the start, after 8 months, and after 14 months, to assess the severity of fatigue and degree of functional impairment. At 14 months, CBT was found to be significantly more effective than the other 2 conditions for fatigue and for functional impairment. Support groups were no more effective than the control condition.

Citation: Prins JB, Bleijenberg G, Bazelmans E, Elving LD, de Boo TM, Severens JL, van de Wilt GJ, Spinhoven P, van der Meer JW. Cognitive Behaviour Therapy for Chronic Fatigue Syndrome: A Multicentre randomised controlled trial. Lancet 2001 Mar 17;357(9259):841-847
15 Aug

Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study.

Sixty patients with Chronic Fatigue Syndrome from 3 different London hospitals were randomly assigned to either cognitive behavior therapy or a relaxation therapy. Five years later, 53 of them completed questionnaires and interviews measuring their improvement in symptoms. A total of 68% of the patients who received behavior therapy, and 36% who received relaxation therapy rated themselves as much improved at the 5 year follow-up. In addition, significantly more CBT patients met the criteria for complete recovery, freedom from relapse, and steadily improved symptoms, as compared to the relaxation therapy group. The study concludes that cognitive behavior therapy can produce lasting benefits for CFS, but is not a cure.

Citation: Deale, Husain, Chalder & Wessely. Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study. American Journal of Psychiatry 2001 Dec; 158 (12): pp. 2038-42.

15 Aug

Cognitive behaviour therapy appears to be an effective and acceptable treatment for adult out-patients with chronic fatigue syndrome. A systematic review by Price and Couper for the Cochrane Library, Issue 2, 2001, looked at all randomized controlled trials of cognitive-behaviour therapy (CBT) for adults with chronic fatigue syndrome (CFS).

Although only 3 relevant trials of adequate quality were found, these studies managed to demonstrate that CBT significantly benefits physical functioning in adult out-patients with CFS, when compared to orthodox medical management. In addition, these patients found these tools highly acceptable.Cognitive behaviour therapy appears to be an effective and acceptable treatment for adult out-patients with chronic fatigue syndrome. A systematic review by Price and Couper for the Cochrane Library, Issue 2, 2001, looked at all randomized controlled trials of cognitive-behaviour therapy (CBT) for adults with chronic fatigue syndrome (CFS).

15 Aug

The September 19th issue of JAMA/b> features a systematic review of the literature on what interventions have been found to work for chronic fatigue syndrome. Nineteen databases were searched for any published or unpublished studies in any language, and the study included randomized and nonrandomized controlled trials. Of 350 studies, 44 met the inclusion criteria, including 36 randomized controlled trials. In these studies, subjects numbered from 12 to 326, with a total of 2801 participants combined. The most promising results were in cognitive behavioral therapy and graded exercise therapy. However, there were sufficient design inadequacies in many of these studies, to conclude that further investigation is warranted.

Citation: Whiting P, Bagnall AM, Sowden AJ, Cornell JE, Mulrow CD, Ramirez G. Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. JAMA. 2001 September 19; 286(11): 1378-9.

15 Aug

The effect of guided imagery and amitriptyline on daily fibromyalgia pain: a prospective, randomized, controlled trial.

A Norwegian research team compared the effects of attention distracting imagery, attention focusing imagery and amitriptyline (elavil and similar anti-depressants) on fibromyalgia pain in 55 women. They monitored them daily for pain in a randomized, controlled clinical trial. One group (n=17) received relaxation training and “pleasant” guided imagery designed to distract them from their pain. Another group (n=21) received relaxation training and attention imagery that focused on the "active workings of the internal pain control systems”. The control group received treatment as usual (n=17). Patients were also randomly assigned to 50-mg amitriptyline/day or placebo. The slopes of diary pain ratings over a 4-week period were used as the outcome measures. The team found significant differences of the pain-slopes between the three psychological conditions (P=0.0001). The pleasant imagery declined significantly (P<0.005) when compared with the control group (P>0.05). The attention imagery group''s slope did not. Neither was there a difference between the amitriptyline and placebo slopes (main effects, P=0.98). The study concludes that pleasant imagery is an effective intervention in reducing fibromyalgic pain during the 28-day study period. Amitriptyline had no significant advantage over placebo during the study period.

Citation: Fors EA, Sexton H, Gotestam KG. The effect of guided imagery and amitriptyline on daily fibromyalgia pain: a prospective, randomized, controlled trial. Journal of Psychiatry Research 2002 May-Jun;36(3):179-87

15 Aug

.In randomized, controlled clinical trials at Georgetown University’s Department of Psychiatry, a research team led by D.A. Williams assigned 145 patients with fibromyalgia to either (1) standard medical care that included pharmacological management of symptoms and suggestions for aerobic fitness, or (2) the same standard medical treatment plus 6 sessions of Cognitive-Behavioral treatment aimed at improving physical functioning.

Twenty-five percent of the patients receiving CBT were able to achieve clinically meaningful levels of longterm improvement in physical functioning, whereas only 12% of the patients receiving standard care achieved the same level of improvement. There were no lasting differences on pain ratings between groups.
15 Aug

The effects of relaxation response meditation on the symptoms of irritable bowel syndrome: results of a contolled treatment study.

SUNY at Albany''s Keefer and Blanchard matched 16 adults with Irritable Bowel Syndrome into pairs and randomly assigned them to either a 6 week meditation condition, or a 6 week wait list with a monitoring condition.

15 Aug

In an exploratory study by Vidakovic-Vukic in Amsterdam, 27 patients with irritable bowel syndrome were treated with hypnotherapy, along with standard care. Of those 27, two stopped the therapy prematurely, and one remained symptomatic. The other 24 patients experienced clear improvement. Pain and flatulence was either reduced or disappeared completely, and bowel habits normalized. This compared very favorably to results obtained with standard care alone. The study concludes that hypnotherapy is a valuable addition to the conventional treatment of IBS.

Citation: Vidakovic-Vukic M, Hypnotherapy in the treatment of irritable bowel syndrome: methods and results in Amsterdam. Scandanavian Journal of Gastroenterolgy. 1999;230:49-51.
15 Aug

In a study by Harvey, Hinton, Gunary and Barry from the Gastroenterology Unit at Frenchay Hospital, Bristol, England, 33 patients with irritable bowel syndrome were treated with four 40-minute sessions of hypnotherapy over 7 weeks.

Twenty patients improved, 11 of whom lost nearly all symptoms. Short term improvement was maintained for 3 months without further formal treatment. Hypnotherapy in groups of up to 8 patients was as effective as individual therapy.

Citation: Harvey RF, Hinton RA, Gunary RM, Barry RE, Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet 1989, Feb 25; 1 (8635): 424-5.

15 Aug

Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness.

Two hundred fifty British patients with Irritable Bowel syndrome were treated with 12 sessions of hypnotherapy over a three month period (with homework in between sessions). They completed questionnaires before and after the treatment, scoring themselves on symptoms, quality of life, anxiety and depression. The large number of subjects allowed for some strong data. Marked improvement was seen in all symptom measures, quality of life, and anxiety and depression (all p’s < 0.001), which was in keeping with previous studies. All subgroups of patients appeared to do equally well, with the notable exception of males with diarrhea, who improved less than other patients (p < 0.001). No factors, such as anxiety and depression or other prehypnotherapy variables, could explain this relative lack of improvement. The study concludes that hypnotherapy is substantiated as an extremely effective treatment for irritable bowel syndrome. It may be less useful in males with diarrhea symptoms, however, for reasons that are not made clear by the scope of the study.

Citation: Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. American Journal of Gastroenterology, 2002 Apr;97(4):pp. 954-61

15 Aug

Ten of the thirteen original participants from the Relaxation Response pilot study with Irritable Bowel Syndrome (IBS) patients participated in a one year follow-up study, to determine whether the effects of Herbert Benson’s Relaxation Response Meditation (RRM) on IBS symptom reduction were maintained over the year.

From pre-treatment to one-year follow-up, significant reductions were noted for the symptoms of abdominal pain (p = 0.017), diarrhea (p = 0.045), flatulence (p = 0.030), and bloating (p = 0.018). When changes were examined from the original three month follow-up point, where the initial study ended, to the one year follow-up, significant additional reductions were noted in pain (p = 0.03) and bloating (p = 0.04), which tended to be the most distressing symptoms of IBS. The study tentatively concludes that: (1) continued use of meditation is particularly effective in reducing the symptoms of pain and bloating; and (2) RRM is a beneficial treatment for IBS in the both short- and the long-term.

Citation: Keefer L, Blanchard EB. A one year follow-up of relaxation response meditation as a treatment for irritable bowel syndrome. Behavioral Research & Therapy. 2002 May;40(5):541-6.

15 Aug

Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms.

A team of researchers from UNC Chapel Hill, interested in learning how hypnosis manages to improve irritable bowel syndrome (IBS), designed two studies that measured and separated out possible physiological mechanisms from psychological ones. Patients with severe IBS received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients in one study, and treatment changes in autonomic functions such as heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients in the second study. Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. The study concludes that hypnosis improves IBS symptoms through reductions in psychological distress and somatization, and that percieved improvements were unrelated to changes in the physiological parameters measured.

Citation: Palsson OS, Turner MJ, Johnson DA, Burnelt CK, Whitehead WE. Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Dig Dis Sci 2002 Nov;47(11):2605-14