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CFIDS for Psychologists
a book review
By Katrina Berne, PhD

This book puts CFIDS in terms mental health professionals will understand

Understanding Chronic Fatigue Syndrome: An Empirical Guide to Assessment and Treatment
By Fred Friedberg, PhD, and Leonard A. Jason, PhD
1998, American Psychological Association, Washington, D.C.
$39.95 (Available through booksellers or from the publisher at 800/374-2721)

In the absence of an appropriate resource for understanding chronic fatigue syndrome (CFS), many mental health professionals have fallen prey to the abundant misinformation and myths that surround this mysterious, multi-system illness. Most professional information has appeared in medical rather than psychological literature. This lack of information has created an unfortunate chasm between professionals and their patients. Persons with CFS (PWCs) may complain that they feel misunderstood by their treating psychologists or psychiatrists, the very people who are supposed to understand and offer help. Additionally, the stigmatizing and misleading name "chronic fatigue syndrome" has supported the societal notion that in the absence of a known organic cause, illness is assumed to be "all in the patient's head."

Understanding Chronic Fatigue Syndrome: An Empirical Guide to Assessment and Treatment fills this void by carefully examining the various aspects of this complex disorder. Authors Fred Friedberg, PhD, and Leonard A. Jason, PhD, present accurate information, backed by solid research findings, and offer resources and clinical treatment interventions for psychologists. To their credit, the authors do not seek to justify the illness or to convert "non-believers" but instead to educate. They accomplish this goal effectively by addressing many facets of this debilitating and often disabling disorder, including the limitations and losses experienced by patients and their significant others. Psychologists can play a key role in the assessment and treatment of CFS, helping demoralized PWCs to develop a new sense of personal value, purpose and direction.

This comprehensive, well-organized book is divided into three sections: Overview (History, Definition and Prevalence; Predisposing Factors, and Explanatory Models), Assessment (Measurement of CFS Symptoms, Fatigue Rating Scales, Psychometric Evaluation and Differential Diagnosis), and Treatment (Medical and Alternative Therapies, Cognitive-Behavioral Intervention, Clinical Interview, A Coping Skills Treatment Program, and Service Needs and Community Intervention). Six useful appendices nicely supplement these topics: Case Definitions, Medical Assessment, Symptom Report Form, Fatigue-Related Cognitions Scale, a Four-Stage Model of CFS and a Social Support Scale.

Among the many pertinent issues addressed are prevalence and demographics, the need for more precise diagnostic criteria, inadequate government response, the putative role of viruses as causal agents or epiphenomena, and the possibility that CFS is not a single entity but instead a group of related disorders. The authors discuss the usefulness and limitations of existing medical and neuropsychological tests. They also note that although documented abnormalities exist, findings have been variable among researchers.

Understanding Chronic Fatigue Syndrome offers helpful discussions of similarities and differences between CFS and such other fatiguing disorders as postinfectious Lyme disease, fibromyalgia, environmental illness, irritable bowel syndrome, neuromuscular fatiguing illness, multiple sclerosis, lupus, primary depression, malingering, somatization disorder and generalized anxiety disorder.

The authors put to rest the myth that CFS is a fad diagnosis or a purely psychological phenomenon. They present CFS as an illness affecting both psyche and soma that may best be characterized by its interacting immunological, neurological and psychological aspects. They discuss the relationship of stress to symptoms and to immunological and neurological functioning.

Unlike texts that are primarily problem-focused, Friedberg and Jason's book is solution-oriented. The authors describe primary treatment goals as the determination of appropriate activity level and an increased ability to cope with the illness, in the absence of a cure or universally successful medical intervention. Friedberg emphasizes the need for patient self-monitoring and pacing, and Jason describes his "envelope theory" seeking a balance between perceived energy and expended energy in such a way that tolerance of activity can be increased without producing relapse. Various therapeutic interventions are discussed: cognitive restructuring, memory assistance, coping skills training, stress management, behavior modification, relaxation training, pleasant mood induction and maintenance, activity pacing, life restructuring, graded activity, patient awareness of energy budgeting, social support and online resources. The authors clarify the role of cognitive behavioral therapy (CBT) in CFS, criticizing certain poorly designed studies that have exaggerated its benefits and created misconceptions about what CBT can reasonably be expected to accomplish.

The authors are successful in their mission to provide the knowledge and sensitivity necessary for offering appropriate psychological care to PWCs. It is doubtful that any skeptic could read this book and continue to perceive CFS as a fad diagnosis, a plea for attention or simply a case of primary depression.

Although a scholarly text, Understanding Chronic Fatigue Syndrome is user-friendly and appropriate for both clinicians and psychologically sophisticated PWCs. Psychologists and their patients will benefit greatly from this valuable resource. Patients would be well served by recommending Understanding Chronic Fatigue Syndrome to their mental health professionals.

Katrina Berne, PhD, is a PWC, author of Running on Empty and a psychologist in private practice in Mesa, Ariz.

This article appears in the January/February 1999 issue of "The CFIDS Chronicle", and is copyrighted © 1999 by The CFIDS Association of America, Inc., PO Box 220398, Charlotte, NC 28222-0398 Telephone: 800/44-CFIDS (800/442-3437). It is reprinted here with permission.

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