Psychology / (M.A.(Clinical Psycholoy)

Psychology / (M.A.(Clinical Psycholoy)

Chronic Fatigue Syndrome (CFS) is a chronic disabling condition characterised by persistent physical and mental fatigue, and a variety of somatic, psychological and neurological symptoms. The aetiology of CFS is unknown and the cause of the illness remains controversial. Cognitive-behavioural therapy (CBT) is a non-pharmacological treatment approach that has been shown to be effective in treating patients with CFS. It is based on a model that hypothesises that certain maladaptive thoughts and dysfunctional beliefs may contribute to self-defeating behaviour that perpetuates symptoms and disability, and thereby impedes recovery. The main aim of this study was to critically examine the cognitive-behavioural approach of CFS outlined by Sharpe, Chalder, Palmer & Wessely (1997) by conducting three in-depth case studies. An additional aim was to present a full cognitive developmental case conceptualisation of CFS based on the theories of Leahy (1996) and Young (1994). This case study evaluated the effectiveness of a CBT treatment programme in a 48-year-old Caucasian woman diagnosed with CFS for three years. The treatment consisted of sixteen sessions of CBT and was evaluated both quantitatively and qualitatively. On the basis of this study, a set of core maladaptive schema in the area of disconnection and rejection was identified. In addition, it was found that specific compensatory schemas had developed to offset the core maladaptive schemas and that this compensatory strategy played an important role in maintaining the condition. The results also showed a significant decline in fatigue coupled with a moderate decline in functional disability and depression. A one-month follow-up interview revealed evidence of a substantial consolidation of therapeutic gains in that the improvements observed at the end of the treatment were sustained. Finally, the feasibility of incorporating a cognitive-developmental and/or schema-focused model into the standard CBT treatment model is discussed and the case study method as a research toll is evaluated in light of the findings.

D.Litt. et Phil. / The goal of this study was to determine the impact of cognitive behavioural therapy on people who meet the international diagnostic criteria for CFS, by specifically looking at symptoms and health behaviour. Whereas CFS was originally only studied from a medical perspective, recent years have seen an increased interest from psychologists. Initially the debate centered around whether CFS was a medical or psychiatric illness, but with the development of health psychology as a recognised field of its own, the focus shifted to the investigation of how medical and psychological factors work together to create the symptomatology of CFS. The approach adopted by the research team was that CFS was a biopsychosocial illness and that biological factors such as genetic predisposition, psychological factors such as cognitions and emotions and social factors such as the pressures of families and society work together to establish the health of a person. The study thus set out to gather information regarding all of these aspects in order to add to the current body of knowledge. As previous research efforts had been critisised regarding the validity of the diagnosis of the CFS patients included in their samples, an important challenge that was faced by the researcher was to establish that all the research group participants did meet with the diagnostic criteria. It also had to be ensured that their symptoms could not be accounted for by any other medical illness that was listed as an exclusion criteria for CFS. In order to achieve this patients who had not already had the necessary medical tests done, were requested to do so. The therapeutic intervention was based on cognitive behavioural principles which had been proven to be effective in the treatment of other illnesses that had a biological as well as psychological , aspect to it, for example anxiety, fibromyalgia and chronic pain. The aspects that were addressed had been found by previous researchers to be of great importance in a therapeutic intervention for CFS. These aspects included illness beliefs, information regarding CFS, locus of control and coping mechanisms, avoidance, activity levels, negative and dysfunctional thoughts, social support, lifestyle changes, stress management, sleep, exercise and personality factors. The specific techniques that were included in the intervention were self monitoring, monitoring and modifying of dysfunctional thoughts, goal setting, relaxation and systematic desensitisation. The research group consisted of 37 patients who met the internationally accepted diagnostic criteria for CFS. The control group was a contrast group of comparable size, which included only people who were free from psychological disorders and medical illnesses. The research group participated in a cognitive behavioural intervention, which was designed around the needs of each individual. They therapy was conducted at a community clinic at Rand Afrikaans University between February 1995 and October 1995. Pretests were completed upon commencement of the therapy and the posttests upon termination of the therapy. The control group completed their pre- and posttests at the average interval of the research group pre- and posttests. In order to make a multi-dimensional assessment of the impact of the cognitive behavioural intervention on CFS, various instruments were ulitised. The first instrument was a biographical questionnaire, which recorded the name, sex, age, income group, highest formal qualification, type of work, etcetera. The second questionnaire was an adapted version of the Support and Service Utilisation Schedule, which was employed to control for the other medical and therapeutic interventions that patients participated in, for example the medication taken, alternative medical practitioners visited and sources of support. The participants were asked to maintain their use of these services that they had been using for a long period and to not embark on any new therapies and treatments while they were partaking in the cognitive behavioural intervention.