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Development of an optimised, multi-disciplinary intervention for chronic fatigue states.

Development of an optimised, multi-disciplinary intervention for chronic fatigue states.

Medically-unexplained fatigue states are prevalent and often disabling in the general population. These include chronic fatigue syndrome (CFS) and post-cancer fatigue (PCF). These syndromes are characterised by debilitating fatigue, neurocognitive difficulties, muscle pain as well as sleep -wake cycle and mood disturbance. A growing evidence base suggests that a multi-disciplinary intervention incorporating cognitive -behavioural therapy (CBT), activity pacing, and graded exercise therapy (GET) provides the most promising current treatment for reducing symptoms and improving functional status.

155 patients with CFS or PCF provided informed written consent and were recruited into the fatigue clinic outcome study. Patients completed the 12 -week intervention which involved sessions with clinical psychologists and exercise physiologists. Modules of treatment included CBT for CFS/PCF, activity pacing, GET, sleep-wake cycle and neurocognitive intervention (cognitive exercise). Additionally, subjects received treatment for depression, anxiety, and adjustment as required. Data was collected via routine outcome measures at baseline, 12 -weeks, and 24 -weeks.

Subjects included 106 women (68%) and 49 (32%) men, with a mean age of 36 years, a mean duration of illness of 5.2 years, and the majority unable to work. Both by intention-to-treat and complete dataset analyses, significant improvements were recorded at 12 and 24 weeks in self -reported fatigue (p<0.05) and role limitation due to impairments in physical functioning (p<0.05). Self -reported psychological distress was also reduced (p<0.05). Logistic regression showed that older age and higher levels of pain were negative predictors of treatment response.

This modularized, multi-disciplinary approach based on CBT and GET principles is effective in reducing symptoms and improving functional status amongst patients with fatigue syndromes. Ongoing research will focus on identifying predictors of outcome including examining the effect of motivation on treatment response.

Speakers: Sarah Horsfield
Conference: AACBT
Areas of Interest / Categories: AACBT 2014, General Health, General Practice

AACBT 2014

Making a Public Health Approach to Parenting Support Really Work.

As the benefits of positive parenting programs become more apparent, there is increasing calls for such programs to be more widely available in the community. Poor reach of existing programs, low father

Transitioning to the ‘Third Wave’ Behaviour Therapies and their Relevance to Self-Care and Resiliency.

The transition to the ‘third wave’ behaviour therapies will be explored mainly with respect to Acceptance and Commitment Therapy (ACT). A broad review and commentary on the current research

Using D-Cycloserine to Augment Exposure Therapy for Children with Specific Phobia.

D-Cycloserine (DCS) is a cognitive enhancing medication believed to “consolidate” fear extinction learning into memory during exposure therapy. This paper examines whether DCS could augment extinction of a specific fear in children. We conducted a double-blind placebo-controlled Randomized Controlled Trial to investigate whether 50mg of DCS can enhance fear extinction of a dog or spider phobia. Thus far, we have recruited 17 children (M age = 9.4 years) who ingested DCS or a placebo prior to receiving a massed session of in vivo exposure. Avoidance was measured using a standardized ten-step Behaviour Approach Tests (BAT), where successive steps increased proximity to the feared stimulus. BATs were conducted at pretreatment, immediately post-treatment and on follow-up one week later to measure return of fear.

Developing and Maintaining Resilient and Effective Therapists: The Role of Supervision.

Providing psychotherapy can be extremely rewarding but can also make a range of different demands on the therapist. These demands may vary as a function of the stage of development as a therapist, the type of caseload, the context in which the therapist works, the volume of work, and the interactions with other situations or events that may be happening elsewhere in the therapist’s professional and personal life. Supervision can have a range of functions, but one important function is supporting the therapist.  Effective supervision is thought to be a key contributor to ensuring not only safe and effective therapy but also to maintaining resourceful and resilient therapists. While other forms of psychotherapy have well established models and traditions of supervision, CBT is relatively lacking in these areas and there is relatively little literature to guide CBT supervision, especially in contrast to the vast literatures that exist for cognitive behaviour therapy.   

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The field of e-psychology is rapidly expanding, with new Internet and phone-based programs regularly becoming available for an increasing variety of mental health issues. There is a strong evidence base supporting Internet delivered psychological interventions, but less is known about particular program components or patterns of usage that are most impactful and thus associated with better outcomes.

Anorexia Nervosa: Intrapersonal, Interpersonal, both, or it depends?

The aim was to investigate the contributions of intrapersonal and interpersonal processes to eating disorders symptomatology in anorexia nervosa. Thematic analysis was used to investigate the interpersonal experiences of adolescent girls during inpatient treatment of anorexia nervosa. In a quantitative study, findings from the qualitative study informed hypotheses, development of items for a self-report questionnaire and selection of validated questionnaires to assess eating disorders symptomatology, perfectionism and aspects of interpersonal functioning in women with anorexia nervosa and non-clinical female comparisons.

Body Image and Eating Disorder Symptomatology among Female Athletes.

The present study compared levels of body dissatisfaction, and disordered eating symptomatology among elite, recreational, and non-competitive female Australian athletes (N = 320) aged 17 to 30 years competing in leanness focused sports (e.g., Ballet, light weight rowing, long distance running) and non-leanness focused sports (e.g., netball, football, rugby).