Having had this unfortunate condition diagnosed twice myself, when I had two undiagnosed illnesses causing my problem, (Sarcoidosis and Hypothyroidism), I was interested to see a book written by two cognitive behaviour psychotherapists.
Both Burgess and Calder work at King’s College Hospital in their research and treatment unit; presumably this is staffed by doctors who will thoroughly investigate the patients as the recognised causes of Chronic Fatigue Syndrome (CFS) are not listed.
However symptoms are listed in detail as well as details about a defect in Cortisol production, change in muscle function and disturbance of the sleep-wake rhythm.
In the management section antidepressants are mentioned, stating that there is little evidence that they work, and little mention that a low dose of Amitriptilene or other Tricyclics can make a great difference to a patient`s sleep pattern and mood.
Other modalities such as pacing and graded exercise are mentioned as improving fatigue.
In the practical strategies section activity and sleep diaries are recommended with detailed two-hourly sections required to fill in, day and night as well as a series of targets to be met. There are sections on overcoming unhelpful thoughts and worry and anxiety by self help manoeuvres. Contesting negative core beliefs are discussed but no mention that an anti-depressant should always be reconsidered.
Three case histories are described, which are excellent.
This book would suit a patient who has been thoroughly investigated and has not been helped by Tricyclic antidepressants, graded exercise, pacing, reducing one`s work load and other common sense modalities.
Presumably the patients seen by the authors fulfil these criteria, but I am concerned that many of the CFS patients do not.
All in all a detailed approach to cognitive behaviour therapy for this condition.
Dr Rosemary Alexander, MB ChB MRCP
