Butler S, Chalder T, Ron M, Wessely S
Department of Psychiatry, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
J Neurol Neurosurg Psychiatry. 1991 Feb;54(2):153-8. doi: 10.1136/jnnp.54.2.153.
Fifty patients fulfilling operational criteria for the chronic fatigue syndrome (CFS), and who had been ill for a mean of five years, were offered cognitive behaviour therapy in an open trial. Those fulfilling operational criteria for depressive illness were also offered tricyclic antidepressants. The rationale was that a distinction be drawn between factors that precipitate the illness and those that perpetuate it. Among the latter are cognitive factors such as the belief that physical symptoms always imply tissue damage, and behavioural factors such as persistent avoidance of activities associated with an increase in symptoms. Therapy led to substantial improvements in overall disability, fatigue, somatic and psychiatric symptoms. The principal problems encountered were a high refusal rate and difficulties in treating affective disorders. Outcome depended more on the strength of the initial attribution of symptoms to exclusively physical causes, and was not influenced by length of illness. These results suggest that current views on both treatment and prognosis in CFS are unnecessarily pessimistic. It is also suggested that advice currently offered to chronic patients, to avoid physical and mental activity, is counterproductive.
五十名符合慢性疲劳综合征（CFS）操作标准且平均患病五年的患者，在一项开放性试验中接受了认知行为疗法。那些符合抑郁症操作标准的患者还服用了三环类抗抑郁药。其基本原理是区分引发疾病的因素和使疾病持续存在的因素。后者包括认知因素，如认为身体症状总是意味着组织损伤，以及行为因素，如持续避免与症状加重相关的活动。治疗使整体残疾、疲劳、躯体和精神症状有了显著改善。遇到的主要问题是高拒绝率和治疗情感障碍的困难。结果更多地取决于最初将症状完全归因于身体原因的强度，且不受病程长短的影响。这些结果表明，目前对CFS治疗和预后的看法过于悲观。还表明目前给慢性病患者的建议，即避免身体和精神活动，会适得其反。
