14.40 – 15.05
Treatment options for Chronic Fatigue Syndrome
Professor Peter White
The treatment of Chronic Fatigue Syndrome (CFS) is based on the principles of physical and psychological
rehabilitation, aimed at restoring function by reversing barriers to recovery. These include maladaptive activity
patterns, such as “boom and bust”, fear avoidance, insomnia, and comorbid mood disorders.
There is systematic and meta-analytical evidence that both cognitive behaviour therapy (CBT) and graded exercise
therapy (GET) are moderately effective, cost-effective and safe, if delivered to individual patients by appropriately
qualified therapists who are adequately trained and supervised. Successful therapy is mutually negotiated rather
than imposed, and adapted by response. The NICE guidelines of 2007 support this approach, alongside medical
care and prescribed medicines for comorbid disorders such as depressive illness.
Some patient organisations have opposed CBT and GET, being concerned that efficacy has been exaggerated, and
safety concerns minimized. These concerns may influence patient choice and engagement. Abandonment of a
dualistic - mind or body - approach to management may help to address these issues.
Future research needs to include examination of mediators and moderators of therapy in order to improve
efficacy, and also address the heterogeneity of the disorder.
Professor Peter White is professor of psychological medicine at Barts and the London medical school, Queen
Mary University of London. He is a liaison psychiatrist at Bart’s and co-leads a chronic fatigue syndrome (CFS)
clinic, which also treats patients with secondary fatigue and chronic widespread pain (fibromyalgia). His research
interests have included illnesses affecting both mind and body and understanding the links between them. He has
particularly studied CFS, helping to establish its existence, particularly after infections, as well as safe and
effective treatments.