A 4-Day Mindfulness-Based Cognitive Behavioral Intervention Program for CFS/ME. An Open Study, With 1-Year Follow-Up

Abstract

Background: Chronic Fatigue Syndrome/Myalgic Encephalopathy (CFS/ME) is an incapacitating illness in which single treatment interventions seem to have variable effects. Based on an earlier study we have conducted a new study with a concentrated intervention program. The aims of this study were to: (1) explore the clinical course for patients with CFS/ME who participated in a treatment program delivered during four consecutive days, and (2) evaluate their satisfaction with this program. Methods: 305 patients diagnosed with CFS/ME (Oxford criteria), recruited from a clinical population referred to a specialist outpatient clinic, participated in an open uncontrolled study of the clinical course through 1 year. The study group participated in a 4-day group intervention program, comprised by education, cognitive group therapy sessions, mindfulness sessions, physical activity and writing sessions, within a context of cognitive behavioral therapy, mindfulness, acceptance and commitment model. Assessments were done by self-reports prior to the first consultation, 1 week before and 1 week after the intervention program, and at 3 months and 1 year after the intervention. SPSS 23 and R 3.3 were used for statistical analyses. The associations between case definitions and the outcome measures (Chalder Fatigue Scale (FS), Short Form 36 (SF-36) physical functioning scale) were assessed by a linear mixed effects model (LME). Results: Results showed statistically significant clinical changes for 80% of the patients after the intervention, changes being sustained through 1 year after the program. For both Fatigue Scale (FS) and the SF-36 there were statistically significant effects of time from baseline to all time points with a statistically significant drop in scores, applying the linear mixed effects model. A subgroup fulfilling the inclusion criteria from the PACE study (Chalder Fatigue Scale >6/11, SF-36 Physical functioning <65/100) showed clinically significant improvement through 1 year, changes in outcome measures were statistically significant (p < 0.001). None of the patients included in the program dropped out, and a great majority of patients expressed high satisfaction with the content, focus and amount of treatment. Conclusion: Clinical changes observed from pre-treatment to 1 year follow-up could represent effects of the 4-day concentrated intervention program, and should be further explored in a controlled study.

Keywords: 4-day concentrated treatment program; CFS/ME; acceptance and commitment therapy; chronic fatigue syndrome; cognitive behavioral therapy; myalgic encephalopathy; stress reduction.

Figure 1

Changes in outcome measures by timeline and case definitions CFS.

Figure 2

Acceptance and satisfaction with treatment program (CSQ-8). How would you rate the quality of service you have received?: 3.5 (SD = 0.6). Did you get the kind of service you wanted?: 3.4 (SD = 0.5). To what extent has our program met your needs?: 3.2 (SD = 0.7). If a friend were in need of similar help, would you recommend our program to him or her? 3.8 (SD = 0.4). How satisfied are you with the amount of help you have received?:3.5 (SD = 0.5). Have the services you received helped you to deal more effectively with your problems?: 3.5 (SD = 0.6). In an overall, general sense, how satisfied are you with the service you have received?:3.6 (SD = 0.5). If you were to seek help again, would you come back to our program? 3.7 (SD = 0.5).