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 Chronic Fatigue Syndrome: The Scientific Rationale for Behavioral Medicine in CFIDS 
 
Recent years have seen a growing body of research documenting the benefits of behavioral medicine in chronic illnesses. Many findings are relevant to CFIDS because they suggest that behavioral methods may help ameliorate some of its most difficult symptoms. While no such research with PWC's has yet been published, there is sufficient scientific rationale to argue that behavioral medicine should be included as part of a comprehensive treatment approach.

"Complementary," Not "Alternative"
One potential source of confusion about the role of behavioral medicine, which can lead to unnecessary bias against it, is the use of the term "alternative." Particularly in the case of CFIDS, it should not be construed as an "alternative treatment" because it does not treat disease. Rather, it is complementary or adjunctive to appropriate medical treatment. Its goal is to support and enhance the person's host resistance and help reduce the severity of symptoms.

Methods
The repertoire of behavioral medicine includes behavioral or psychological strategies which directly influence physiological states. The methods are applied in structured group programs, in individual therapy, and in daily practice at home.

The most fundamental and empirically supported of these strategies is induction of "the relaxation response."' This is a physiological state with beneficial effects for a wide array of symptoms including pain (arthralgias and myalgias), insomnia, gastrointestinal disturbances, anxiety and depression.1Other common techniques include the use of mental imagery, hypnosis, biofeedback, and various breath therapy methods.

Relevant Research Findings
Following is a sample of demonstrated effects which appear to have important implications for the symptoms and disease process of CFIDS.

A controlled study measured the effects of a behavioral medicine program on symptoms of AIDS. The treatment group received training in biofeedback, guided imagery, and hypnosis. Results included significant decreases in fever, fatigue, pain, headache, nausea, and insomnia; and increased vigor and hardiness.2

A study of 48 patients with HIV who took a group behavioral medicine program found significantly reduced tension, anxiety, fatigue, depression, and total mood disturbance.3

A controlled study of immunological and psychological outcomes of a group program was conducted with malignant melanoma patients. Results included significant increases in large granular lymphocytes (defined as CD57 withLeu-7) and NK cells (defined as CD16 with Leu-II and CD56 with NKHI), along with indications of increased NK cytotoxic activity. There were also significantly lower levels of psychological distress, and higher levels of positive coping methods in comparison to patients who did not have the group.4

In another controlled study, subjects who were trained to induce the relaxation response showed a significant improvement in NK cell activity, as well as lower antibody titers to a herpes simplex type I antigen. In addition, there were significant decreases in symptoms of emotional distress.5

For another study, researchers examined the impact of regular induction of the relaxation response in ameliorating the effects of stress in healthy subjects. The frequency of practice of the technique was significantly and positively associated with the percentage of T-helper cells circulating in the blood.6

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 About The Author
William Collinge MPH, PhDWilliam Collinge, PhD, MPH is a consultant, author, speaker and researcher in the field of integrative health care. He has served as a scientific review panelist for the National Institutes of Health in mind/body......more
 
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