starryeyes
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Unfortunately on p. 8 the CAA goes on more about CBT with questionable statements:
They do finally address the severely ill:
Cognitive Behavioral Therapy
CBT has been shown to be effective in managing CFS in small, short-term trials.[82] CBT may help CFS patients develop constructive coping strategies, better manage symptoms, improve their level of function, and enhance their ability to perform activities of daily life.[83,65] They can also learn to pace activity and make lifestyle adjustments to reduce the incidence of postexertional malaise and promote feelings of control and self-efficacy.[84]
* Manage patients' expectations of CBT. Studies of CBT in CFS show improvement in function and symptom management but very limited effect on pain and fatigue.
* Manage patients' responses to CBT. Some patients are resistant to this particular therapy because of early approaches in CFS that focused on errant illness beliefs, reinforcing for patients the idea that CBT therapists "believe CFS is all in your head." When patients realize that CBT is used as an adjunct therapy for cardiovascular disease, diabetes, cancer, orthopedic injuries, and other medical conditions, and that CBT may help CFS symptoms, they are more likely to be receptive to this therapy.
* Recommend CBT programs that focus on developing individualized activity programs that incorporate pacing and graded activity, and on coping behaviors, rather than programs that focus primarily on psychological factors.
* Be aware that increased symptomatology is the main reason cited for discontinuing CBT. This may be avoided if a paced, personalized plan is followed and activities are tailored to the individual's capabilities.
* Recognize that because CBT is often not covered by insurance, some CFS patients will not have access to formal therapy. In this situation, clinicians who understand CFS can provide information about the illness in general, lead individual patients to understand how their behavior is impacting the illness, and set up activity and exercise programs that are therapeutic.
They do finally address the severely ill:
Severely Ill Patients
A subset of people with CFS are so severely ill that they are largely housebound or bedbound. They require special attention, including a modified approach to exercise. Hand stretches and picking up and grasping objects may be all that can be managed at first. Gradually increasing activity to the point that patients can handle essential activities of daily living -- getting up, personal hygiene, and dressing -- is the next step.
Focusing on improving flexibility and minimizing the impact of deconditioning so patients can increase function enough to manage basic activities is the goal with severely ill patients.