An evaluation of multidisciplinary intervention for chronic fatigue syndrome with long-term follow-up, and a comparison with untreated controls.

Individuals meeting the Fukuda et al definition for chronic fatigue syndrome completed a multidisciplinary assessment that included medical, psychiatric, behavioral, and psychological evaluations. Patients were then offered a comprehensive multidisciplinary intervention that included (1) bringing the patient under optimal medical management; (2) treating any ongoing affective or anxiety disorder pharmacologically; and (3) implementing a comprehensive cognitive-behavioral treatment program. Fifty-one patients proceeded to treatment. The cognitive-behavioral component was carried out through the use of a therapist working with the patients in their own environments. The program was individually tailored to patients, but included (1) structured physical exercise and activation; (2) sleep management strategies; (3) careful activity management; (4) regulation of stimulant intake and reductions in use of symptomatic medications; (5) cognitive intervention designed to deal with patients' beliefs concerning the nature of their disorder; (6) participation of patients' family; and (7) efforts to establish specific vocational and avocational goals. Third parties were encouraged to collaborate cooperatively. Employers were urged to provide employment opportunities and facilitate a graduated but time-targeted return to work. Disability carriers were encouraged to provide interim financial support in the form of disability benefits, support therapeutic intervention, but also to establish a clear time-frame to access to benefits. Of 51 treated patients, 31 returned to gainful employment, 14 were functioning at a level equivalent to employment, and 6 remained significantly disabled. Twenty of the original 71 patients were contacted an average of 33 months later. Patients who had been treated showed good maintenance of gains. Untreated patients showed improvement in only a minority of cases.

Extended dissociative training of sudomotor response patterns.

Subjects viewed two feedback displays, one depicting skin conductance and the other either respiratory behavior (respiration group) or subtle body movements (movement group). The subject's task was to increase skin conductance and the concomitant activity on integration trials, and to increase conductance while holding the concomitant behavior constant on dissociation trials. All subjects succeeded at integration over 15 sessions of training. In addition, 4 of 5 subjects in the respiration group successfully increased skin conductance on dissociation trials without altering the pre-trial pattern of breathing. However, volar activities (e.g., finger-to-finger contact, finger flexion) were observed on these trials. Volar activities were also adopted on dissociation trials by subjects trained in the movement group. Successful subjects in this group identified volar manipulations that did not affect a sensitive movement transducer. Attempts by subjects to compensate for habituation of conductance responses to deep breaths and finger flexion reduced or reversed within-subject correlations involving these concomitants, on integration and dissociation trials. The results do not support the view that visceral-somatic linkages can be uncoupled through instrumental learning.

Awareness of the response after feedback training for changes in heart rate and sudomotor laterality.

What is the relation between the ability to control visceral responding on a biofeedback task and the ability to report behaviors actually contributing to this performance? Subjects received biofeedback training for unidentified visceral responses and then gave written reports about what they had done to control the feedback displays. Independent judges were given these reports and, on the basis of knowledge about activities known to contribute to visceral activity, were asked to determine the visceral responses for which the subjects had been trained. The reports of subjects who succeeded at bidirectional control of heart rate (Experiment 1) or sudomotor laterality (Experiment 2) showed awareness of behaviors related to feedback as assessed by this procedure, whereas the reports of subjects who failed at bidirectional control did not. Subsequent experiments indicated that these results did not depend on a learning strategy that might have been specific to the initial studies. These findings call into question the view that people are unaware of what they have done to produce the response after training on biofeedback tasks. Earlier studies reporting lack of awareness in biofeedback are discussed in light of factors that affect the measurement of biofeedback learning and response awareness.