Healthcare Provision for Chronic Fatigue Syndrome

  • Marie Thomas


This chapter focuses on healthcare provision for people with CFS in line with recommendations made by the CMO and the CFS/ME Working Group. The chapter begins with a survey of patient and GP illness beliefs and goes on to discuss the efficacy of pharmacological therapies. Finally, the chapter presents outcomes of three behavioural therapies used to manage symptoms of the illness. These include multi-convergent therapy developed by a physiotherapist and the counselling services and rehabilitation courses run by Action for ME. The efficacy of these therapies was evaluated using the subjective and objective developed in previous research.


Chronic fatigue syndrome Multi-convergent therapy Counselling Rehabilitation course Intervention 


  1. Åsbring, P., & Närvänen, A. (2003). Ideal versus reality: Physicians’ perspectives on patients with CFS and Fibromyalgia. Social Science and Medicine, 57, 711–720.Google Scholar
  2. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbough, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.CrossRefGoogle Scholar
  3. Campion, P. (2004). National Survey of General Practitioners’ beliefs about CFS/ME. A report to the Linbury Trust.Google Scholar
  4. Carlson, L., Speca, M., Patel, K., & Goodey, E. (2004). Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulphate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology, 29, 448–474.CrossRefGoogle Scholar
  5. CFS/ME Joint Working Group. (1996). A report of a Joint Working Group between the Royal College of Physicians, the Royal College of General Practitioners and the Royal College of Psychiatrists. London: CFS/ME Joint Working Group.Google Scholar
  6. CFS/ME Working Group. (2002). Report to the Chief Medical Officer of an independent working group. London: Department of Health.Google Scholar
  7. Cohen, S., Kamarack, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behaviour, 24, 385–396.CrossRefGoogle Scholar
  8. Cooper, L. (2000). Report on survey of local ME group members. A report in conjunction with Action for ME and ME Association.Google Scholar
  9. Davidson, R., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatatic Medicine, 65, 564–570.CrossRefGoogle Scholar
  10. Deale, A., Chalder, T., Marks, I., & Wessely, S. (1997). Cognitive behaviour therapy for chronic fatigue syndrome: A randomized controlled trial. American Journal of Psychiatry, 154, 408–414.CrossRefGoogle Scholar
  11. Deale, A., & Wessely, S. (2001). Patients’ perceptions of medical care in CFS. Social Science and Medicine, 52, 1859–1864.CrossRefGoogle Scholar
  12. Fukuda, K., Straus, S., Hickie, I., Sharpe, M. C., Dobbins, J. G., Komaroff, A., et al. (1994). The Chronic Fatigue Syndrome: A comprehensive approach to its definition and study. Annals of International Medicine, 121, 953–959.CrossRefGoogle Scholar
  13. Fulcher, K. Y., & White, P. D. (1997). Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. British Medical Journal, 314, 1647–1652.CrossRefGoogle Scholar
  14. Goodnick, P. J., Sandoval, R., Brickman, A., & Klimas, N. G. (1992). Bupropion treatment of fluoxetine-resistant chronic fatigue syndrome. Biological Psychiatry, 32, 834–838.CrossRefGoogle Scholar
  15. Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57, 35–43.CrossRefGoogle Scholar
  16. Harrison, S., Smith, A., & Sykes, R. (2002). Residential rehabilitation courses in the self-directed management of Chronic Fatigue Syndrome: A preliminary evaluation. Journal of Chronic Fatigue Syndrome, 10, 59–65.CrossRefGoogle Scholar
  17. Hickie, I. (1999). Nefazodone for patients with chronic fatigue syndrome. Australia and New Zealand Journal of Psychiatry, 33, 278–280.CrossRefGoogle Scholar
  18. Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioural Medicine, 8, 163–190.CrossRefGoogle Scholar
  19. Karnofsky, D. A., Abelmann, W. H., Craver, L. F., & Burchenal, J. H. (1948). The use of the nitrogen mustards in the palliative treatment of carcinoma. Cancer, 1, 634–656.CrossRefGoogle Scholar
  20. Kisely, S. (2002). Treatments for CFS and the internet: A systematic survey of what your patients are reading. Australia and New Zealand Journal of Psychiatry, 36, 240–245.CrossRefGoogle Scholar
  21. Mason, O., & Hargreaves, I. (2001). A qualitative study of mindfulness-based cognitive therapy for depression. British Journal of Medical Psychology, 74, 197–212.Google Scholar
  22. Morris, R., Wearden, A., Mullis, R., Strickland, P., Pearson, D. J., Appleby, L., et al. (1998). A double-blind placebo controlled trial of fluoxetine and graded exercise for CFS. British Journal of Psychiatry, 172, 485–490.CrossRefGoogle Scholar
  23. Natelson, B. H., Cheu, J., Pareja, J., Ellis, S. P., Policastro, T., & Findley, T. W. (1996). Randomised, double-blind, controlled placebo-phase in trial of low-dose phenelzine in the chronic fatigue syndrome. Psychopharmacology, 124, 226–230.CrossRefGoogle Scholar
  24. National Institute for Health and Care Excellence (NICE). Retrieved March 2018, from
  25. National Task Force on Chronic Fatigue Syndrome/Post Viral Fatigue Syndrome/Myalgic Encephalitis. (1994). Bristol: Westcare.Google Scholar
  26. National Task Force on CFS/ME. (1998). NHS services for people with CFS/ME. Bristol: Westcare.Google Scholar
  27. Noakes, T., St Clair Gibson, A., & Lambert, E. (2005). From catastrophe to complexity: A novel model of integrative central neural regulation of effort and fatigue during exercise in humans: Summary and conclusions. British Journal of Sports Medicine, 39, 120–124.CrossRefGoogle Scholar
  28. O’Malley, P. G., Jackson, J. L., Santoro, J., Tomkins, G., Balden, E., & Kroenke, K. (1999). Antidepressant therapy for unexplained symptoms and symptom syndromes. Journal of Family Practice, 48, 980–990.PubMedGoogle Scholar
  29. Ost, L. (1987). Applied relaxation: Description of a coping technique and review of controlled studies. Behaviour Research Therapy, 25, 397–409.CrossRefGoogle Scholar
  30. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measure, 1, 385–401.CrossRefGoogle Scholar
  31. Ray, C., Weir, W. R. C., Stewart, D., Millar, P., & Hyde, G. (1993). Ways of coping with CFS: Development of an illness management questionnaire. Social Science and Medicine, 37, 385–391.CrossRefGoogle Scholar
  32. Rimes, K. A., & Chalder, T. (2005). Treatments for chronic fatigue syndrome. Occupational Medicine, 55, 32–39.CrossRefGoogle Scholar
  33. Royal Colleges of Physicians, Psychiatrists and General Practitioners. (1996). Chronic Fatigue Syndrome: Report of a joint working group. London.Google Scholar
  34. Sadlier, M. J., Evans, J. R., Phillips, C., & Broad, A. (2000). A preliminary study into the effectiveness of multi-convergent therapy in the treatment of heterogeneous patients with CFS. Journal of Chronic Fatigue Syndrome, 7, 93–100.CrossRefGoogle Scholar
  35. Sadlier, M., & Stephens, D. (1995). An approach to the audit of tinnitus management. Journal of Laryngology and Otology, 109, 826–829.CrossRefGoogle Scholar
  36. Shah, A., Joshi, S., Mehrotra, P., Potdar, N., & Dhar, H. (2001). Effect of Saral meditation on intelligence, performance and cardiopulmonary functions. The Indian Journal of Medical Science, 55, 604–608.Google Scholar
  37. Sharpe, M., Archard, L., Banatvala, J., Borysiewicz, L., Clare, A., David, A., et al. (1991). CFS: Guidelines for research. Journal Royal Society of Medicine, 84, 118–121.CrossRefGoogle Scholar
  38. Sharpe, M., Hawton, K., & Simkin, S. (1996). Cognitive behaviour therapy for Chronic Fatigue Syndrome: A randomised controlled trial. British Medical Journal, 312, 22–26.CrossRefGoogle Scholar
  39. Shaw, G., Srivastava, E. D., Sadlier, M., Swann, P., James, J. Y., & Rhodes, J. (1991). Stress management for Irritable Bowel Syndrome: A controlled trial. Digestion, 50, 36–42.CrossRefGoogle Scholar
  40. Smith, A., Pollock, J., Thomas, M., Llewelyn, M., & Borysiewicz, L. (1996). The relationship between subjective ratings of sleep and mental functioning in healthy subjects and patients with chronic fatigue syndrome. Human Psychopharmocology, 11, 161–167.CrossRefGoogle Scholar
  41. Smith, A., Thomas, M., & Sadlier, M. (2009). Multi-convergent therapy: A possible intervention to aid return to work. Occupational Health at Work, 6, 30–32.Google Scholar
  42. Solberg, E., Berglund, K., Engen, O., Ekeberg, O., & Loeb, M. (1996). The effect of meditation on shooting performance. British Journal of Sports Medicine, 30, 342–346.Google Scholar
  43. Spielberger, C., Gorsuch, R., & Lushene, R. E. (1971). STAI manual for the State-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
  44. Steven, S. (2000). General Practitioners’ beliefs, attitudes and reported actions towards CFS. Australian Family Physician, 29, 80–85.PubMedGoogle Scholar
  45. Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18, 643–662.CrossRefGoogle Scholar
  46. Thomas, M. (2009). Exploring the beliefs and underlying functional deficits associated with CFS and the identification of predictors of recovery and successful illness management. PhD thesis, University of Wales.Google Scholar
  47. Thomas, M., Sadlier, M., & Smith, A. (2006). The effect of Multi Convergent Therapy on the psychopathology, mood and performance of Chronic Fatigue Syndrome patients: A preliminary study. Counselling and Psychotherapy Research, 6, 91–99.CrossRefGoogle Scholar
  48. Thomas, M., Sadlier, M., & Smith, A. (2008). A multiconvergent approach to the rehabilitation of patients with chronic fatigue syndrome: A comparative study. Physiotherapy, 94, 35–42.Google Scholar
  49. Thomas, M., & Smith, A. (2005). Primary healthcare provision and Chronic Fatigue Syndrome: A survey of patients’ and general practitioners’ beliefs. BMC Family Practice, 6, 49. Scholar
  50. Thomas, M., & Smith, A. (2006). An investigation of the long-term effects of antidepressant medication in the recovery of patients with CFS. Human Psychopharmacology, 21, 503–509.CrossRefGoogle Scholar
  51. Thomas, M., & Smith, A. (2007). The evaluation of counselling and rehabilitation courses for Chronic Fatigue Syndrome patients. Counselling and Psychotherapy Research, 7, 164–171.CrossRefGoogle Scholar
  52. Thomas, M., & Smith, A. (2008). An investigation into the cognitive deficits associated with Chronic Fatigue Syndrome. Open Neurology Journal, 2, 78–88.Google Scholar
  53. Vercoulen, J., Swanink, C. M., Zitman, F. G., Vreden, S. G., Hoofs, M. P., Fennis, J. F., et al. (1996). Randomised, double-blind, placebo-controlled study of fluoxetine in chronic fatigue syndrome. Lancet, 347, 1292–1298.CrossRefGoogle Scholar
  54. Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). Medical Care, 30, 473–483.CrossRefGoogle Scholar
  55. Wearden, A. J., Morriss, R. K., Mullis, R., Strickland, P., Pearson, D. J., Appleby, L., et al. (1998). Randomised, double-blind, placebo-controlled treatment trial of fluoxetine and graded exercise for chronic fatigue syndrome. British Journal of Psychiatry, 172, 485–490.CrossRefGoogle Scholar
  56. Wessely, S. (1996). CFS: Summary of a report of a joint committee of the Royal Colleges of Physicians, Psychiatrists and General Practitioners. Journal of the Royal Colleges of Physicians of London, 30, 497–504.Google Scholar
  57. Zevon, M. A., & Tellegen, A. (1982). The structure of mood change: An idographic/nomothetic analysis. Journal of Personality and Social Psychology, 43, 111–112.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Marie Thomas
    • 1
  1. 1.Bath Spa UniversityBathUK

Personalised recommendations