This document contains two studies related to psychological treatments for chronic conditions: 1) A study of chronic fatigue syndrome patients found that poorer outcomes were predicted by membership in a self-help group, receiving sickness benefits, and symptoms of dysphoria. Severity and duration of symptoms did not predict response. 2) A randomized controlled trial of 125 fibromyalgia patients compared operant behavioral therapy, cognitive behavioral therapy, and attention placebo. Both behavioral therapies significantly reduced pain intensity while cognitive therapy improved cognitive and affective variables and operant therapy improved physical functioning and behaviors. The attention placebo resulted in no improvement or deterioration.

1. Bentall,R.P.,etal. (2002). "Predictorsof response totreatmentforchronicfatigue syndrome."BrJ
Psychiatry181: 248-252.
BACKGROUND:Controlledtrialshave shownthatpsychological interventionsdesignedto
encourage gradedexercisecanfacilitate recoveryfromchronicfatigue syndrome.AIMS:Toidentify
predictorsof response topsychologicaltreatmentforchronicfatigue syndrome.METHOD:Of 114
patientsassignedtoequallyeffective treatmentconditionsinarandomised,controlledtrial,95
completedfollow-upassessments.Relationshipsbetweenvariablesmeasuredpriortorandomisation
and changesinphysical functioningandsubjective handicapat1 yearwere evaluatedbymultiple
regression.RESULTS: Poor outcome was predictedby membershipofa self-helpgroup,beinginreceipt
of sicknessbenefitatthe start of treatment,anddysphoriaasmeasuredbythe Hospital Anxietyand
Depressionscale.Severityof symptomsanddurationof illnesswere notpredictorsof response.
CONCLUSIONS:Pooroutcome inthe psychological treatmentof chronicfatigue syndrome ispredicted
by variablesthatindicate resistance toaccepting the therapeuticrationale,poormotivationto
treatmentadherence orsecondarygainsfromillness.
Thieme,K.,etal.(2006). "Psychological paintreatmentinfibromyalgiasyndrome:efficacyof operant
behavioural andcognitivebehavioural treatments."ArthritisResTher8(4):R121.
The presentstudyfocusedonthe evaluationof the effectsof operantbehavioural (OBT) and
cognitive behavioural(CBT) treatmentsforfibromyalgiasyndrome (FMS).One hundredandtwenty-five
patientswhofulfilledthe AmericanCollegeof RheumatologycriteriaforFMS were randomlyassignedto
OBT (n = 43), CBT (n= 42), or an attention-placebo(AP) treatment(n= 40) that consistedof discussions
of FMS-relatedproblems.Assessmentsof physical functioning,pain,affectivedistress,andcognitive and
behavioural variableswere performedpre-treatmentandpost-treatmentaswell as6 and 12 months
post-treatment.Patientsreceivingthe OBTor CBT reporteda significantreductioninpainintensitypost-
treatment(all Fs> 3.89, all Ps < 0.01). In addition,the CBTgroupreportedstatisticallysignificant
improvementsincognitive(all Fs>7.95, all P < 0.01) and affective variables(allFs> 2.99, all Ps < 0.02),
and the OBT group demonstratedstatisticallysignificantimprovementsinphysical functioningand
behavioural variables(all Fs> 5.99, all Ps< 0.001) comparedwithAP.The AP groupreportedno
significantimprovementbutactuallydeteriorationinthe outcome variables.The post-treatmenteffects
for the OBT and CBT groupswere maintainedatboththe 6- and 12-monthfollow-ups.These results
suggestthatboth OBT and CBT are effective intreatingpatientswithFMSwithsome differencesinthe
outcome measuresspecificallytargetedbythe individualtreatmentscomparedwithanunstructured
discussiongroup. The APgroup showedthat unstructured discussionof FMS-relatedproblemsmaybe
detrimental.