Cognitive behaviour group therapy for chronic fatigue syndrome: a non-randomised waiting list controlled study.

BACKGROUND: It has been demonstrated that individual cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome (CFS). The aim of the present study was to investigate the effectiveness of cognitive behaviour group therapy (CBGT) in an unselected group of CFS patients. Additionally, pretreatment characteristics of CFS patients who improve after CBGT were explored. METHODS: In a non-randomised waiting list controlled design, 31 patients were allocated to CBGT and 36 to the waiting list condition. CBGT consisted of 12 two-hour sessions during 6 months. Main outcome measures were fatigue (Checklist Individual Strength) and functional impairment (Sickness Impact Profile). RESULTS: A moderate effect on fatigue in favour of CBGT was found. For functional impairment, the effect was opposite to what was expected. Patients who improved after CBGT had less complaints at baseline compared to patients who did not improve. CONCLUSIONS: An explanation for the moderate effect might be that during CBGT, rest and relaxation were too much emphasised. Furthermore, an unselected group of CFS patients and therapists inexperienced in CB(G)T for CFS participated. Suggestions to improve CBGT for future research are given.

Teaching and assessing communication skills in Maastricht: the first twenty years.

In order to share the issues involved in setting up a communication skills training programme in a medical school, the development of such a programme at the Skillslab of Maastricht Medical School, the Netherlands, is described and the problems encountered are addressed. A multidisciplinary working group developed teaching goals for communication skills, focused on observable behaviour to be displayed by students. These teaching goals were incorporated in a generic model for doctor-patient communication. A longitudinal training programme was created, throughout the four years of the preclinical curriculum. Students meet in small groups of 10, once every 2 weeks. In between group sessions they practise consultation skills in simulated patient contacts. Communication skills are assessed in the annual multiple station examination. In the development of this programme the following consecutive actions were taken: teaching material was produced, and an assessment tool was developed, as were instruments for programme evaluation. The programme evaluation allowed student feedback to teachers, the teachers' departments, and the administration of the medical school. Finally, teacher training was professionalized.

Differential reactions of type A and type B males to negative feedback about performance.

Psychological and physiological reactions to a failure experience were studied in type A males and type B males both during task and no-task periods. Before failure was induced, no difference in sympathetic reactivity was found, neither during task nor during no-task periods. After an experience of failure type A subjects showed higher sympathetic activation and effort to perform well, compared to type B subjects. The higher activation in type A subjects was even more prominent during no-task periods. The results are related to differences in coping strategy between type A and type B individuals, and the situational dependency of increased activation in type A subjects is discussed.

Effect of physical stress and time-pressure on performance.

Several aspects of the inverted U-model regarding the relation between activation and performance were tested in an experiment in which activation was manipulated both by increasing metabolic demands and by varying psychological demands. Psychological stress influenced performance but the direct manipulation of activation by increasing physical stress had no effect on performance. From these results we conclude that it is very unlikely that activation is causally related to performance. A better explanation seems that a stressor influences both activation and performance and that the effect of a stressor is highly specific and depends on the kind of stressor and the kind of task.