Treatment research has recently focused on two behavioral therapies, one for the mind, another for the body. In graded-exercise therapy, patients, under supervision, are encouraged to gradually increase their activity level—beginning with a two-minute walk, for example, and then lengthening their workouts by a couple of minutes each day. The idea is to increase stamina without risking the overexertion that can be so devastating. Three studies on graded-exercise therapy, all published since 1996, found that many patients participating in exercise programs felt better, and some even regained their former levels of physical activity.
At Johns Hopkins, Rowe noticed that many of his chronic fatigue syndrome patients had unexpected stiffness and a limited range of movement. So on 100 or so of them, he says, he has tried manual therapy in which a physical therapist gently moves a patient’s limbs and body to restore normal movement before encouraging her to resume physical activity. “As the patients’ mobility has increased,” he says, “their symptoms have diminished, and many of them now can even exercise without suffering relapses.”
The other approach is cognitive behavioral therapy—counseling that focuses on the psychological and social problems that patients often develop while trying to cope with the affliction, including depression, frustration, social withdrawal and feelings of helplessness. Cognitive behavioral therapy aims at helping patients gain control over their symptoms.
Wessely, the London-based psychiatrist and author, says graded-exercise therapy and cognitive behavioral therapy have helped some chronic fatigue patients for many months and even years beyond the initial treatment period. “They’re the best treatment approaches that we have now,” he says.
But some patient advocates have criticized the behavioral approach, saying it trivializes the affliction as psychological in origin. Kenney, of the CFS patients’ group, cautions that patients can’t just exercise the disorder away and may harm themselves if they carelessly try to do so. Wessely points out that the behavioral treatments have also helped people with clearly physical illnesses such as cancer and arthritis and insists that whether the cause of chronic fatigue syndrome is physical or psychological doesn’t matter.