Die Behandlung chronischer Erschöpfungssyndrome wurde und wird kontrovers diskutiert, was trotz aller Eindeutigkeit der empirischen Faktenlage auf die divergierenden Annahmen zu den Ursachen der chronischen Erschöpfung und auf die Zielsetzungen der abgeleiteten therapeutischen Vorgehensweisen zurückzuführen ist. Interessanterweise lassen sich die wirksamen Behandlungen nicht durch die von ihnen postulierten Mechanismen erklären. Unter Berücksichtigung früherer und historischer Behandlungsansätze chronischer Erschöpfungssyndrome soll das Rational aktueller Vorgehensweisen kritisch hinterfragt und die Notwendigkeit weiterer Forschung zu den Veränderungsmechanismen hervorgehoben werden.

Keywords:
Chronische Erschöpfung, Behandlung
1.
Aderka IM, Nickerson A, Bøe HJ, Hofmann S: Sudden gains during psychological treatments of anxiety and depression: a meta-analysis. J Consult Clin Psychol 2012;80:93-101.
2.
Alberts B: Retraction. Science 2011;334:1636.
3.
Bleijenberg G, Knoop H: Chronic fatigue syndrome: where to PACE from here? Lancet 2011;377:786-788.
4.
Bourke JH, Johnson AL, Sharpe M, Chalder T, White PD: Pain in chronic fatigue syndrome: response to rehabilitative treatments in the PACE trial. Psychol Med 2013;23:1-8.
5.
Cairns R, Hotopf M: A systematic review describing the prognosis of chronic fatigue syndrome. Occup Med (Lond) 2005;55:20-31.
6.
Candy B, Chalder T, Cleare AJ, Peakman A, Skowera A, Wessely S, Weinman J, Zuckerman M, Hotopf M: Predictors of fatigue following the onset of infectious mononucleosis. Psychol Med 2003;33:847-855.
7.
Cho HJ, Hotopf M, Wessely S: The placebo response in the treatment of chronic fatigue syndrome: a systematic review and meta-analysis. Psychosom Med 2005;67:301-313.
8.
Crawley E, Collin SM, White PD, Rimes K, Sterne JA, May MT; CFS/ME National Outcomes Database: Treatment outcome in adults with chronic fatigue syndrome: a prospective study in England based on the CFS/ME National Outcomes Database. QJM 2013;106:555-565.
9.
Daniels J, Wearden AJ: Socialization to the model: the active component in the therapeutic alliance? A preliminary study. Behav Cogn Psychother 2011; 39:221-227.
10.
Di Giorgio A, Hudson M, Jerjes W, Cleare AJ: 24-Hour pituitary and adrenal hormone profiles in chronic fatigue syndrome. Psychosom Med 2005; 67:433-440.
11.
Dörr J, Nater U: Erschöpfungssyndrome - Eine Diskussion verschiedener Begriffe, Definitionsansätze und klassifikatorischer Konzepte. Psychother Psychosom Med Psychol 2013;63:69-76.
12.
Edmonds M, McGuire H, Price J: Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev 2004;(3):CD003200.pub2.
13.
Gaab J: Psychotherapie chronischer Erschöpfungszustände. Psychotherapeut 2004;49:431-445.
14.
Gaab J: Suche nach der Ursache des chronischen Erschöpfungssyndroms. Psychotherapeut 2011;56: 211-215.
15.
Gaab J, Ehlert U: Chronische Erschöpfung und Chronisches Erschöpfungssyndrom. Fortschritte der Psychotherapie. Göttingen, Hogrefe Verlag, 2005.
16.
Gaab J, Hüster D, Peisen R, Engert V, Heitz V, Schad T, Schürmeyer TH, Ehlert U: Hypothalamic-pituitary-adrenal axis reactivity in chronic fatigue syndrome and health under psychological, physiological, and pharmacological stimulation. Psychosom Med 2002a;64:951-962.
17.
Gaab J, Hüster D, Peisen R, Engert V, Schad T, Schürmeyer TH, Ehlert U: Low-dose dexamethasone suppression test in chronic fatigue syndrome and health. Psychosom Med 2002b;64:311-318.
18.
Gaab J, Hüster D, Peisen R, Engert V, Heitz V, Schad T, Schürmeyer T, Ehlert U: Assessment of cortisol response with low-dose and high-dose ACTH in patients with chronic fatigue syndrome and healthy comparison subjects. Psychosomatics 2003a;44:113-119.
19.
Gaab J, Rohleder N, Heitz V, Schad T, Engert V, Schürmeyer TH, Ehlert U: Enhanced glucocorticoid sensitivity in patients with chronic fatigue syndrome. Acta Neuropsychiatr 2003b;15:184-191.
20.
Gaab J, Engert V, Heitz V, Schad T, Schürmeyer TH, Ehlert U: Associations between neuroendocrine responses to the insulin tolerance test and patient characteristics in chronic fatigue syndrome. J Psychosom Res 2004;56:419-424.
21.
Godfrey E, Chalder T, Ridsdale L, Seed P, Ogden J: Investigating the active ingredients of cognitive behaviour therapy and counselling for patients with chronic fatigue in primary care: developing a new process measure to assess treatment fidelity and predict outcome. Br J Clin Psychol 2007;46:253-272.
22.
Hamilton WT, Gallagher AM, Thomas JM, White PD: The prognosis of different fatigue diagnostic labels: a longitudinal survey. Fam Pract 2005;22:383-388.
23.
Heim C, Nater UM, Maloney E, Boneva R, Jones JF, Reeves WC: Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction. Arch Gen Psychiatry 2008;66:72-80.
24.
Historical Collections at the Claude Moore Health Sciences Library: Neurasthenia and the Culture of Nervous Exhaustion - The American West. 2007. http://exhibits.hsl.virginia.edu/nerves/west/.
25.
Hossenbaccus Z, White PD: Views on the nature of chronic fatigue syndrome: content analysis. JRSM Short Rep 2013;4:4.
26.
Jason LA, Torres-Harding S, Friedberg F, Corradi C, Njoku MG, Donalek J, Reynolds N, Brown M, Weitner BB, Rademaker A, Papernik M, et al.: Non-pharmacologic interventions for CFS: a randomized trial. J Clin Psychol Med Settings 2007a;14:275-296.
27.
Jason LA, Torres-Harding S, Maher K, Reynolds N, Brown M, Sorenson M, Donalek J, Corradi K, Fletcher MA, Lu T: Baseline cortisol levels predict treatment outcomes in chronic fatigue syndrome non-pharmacologic clinical trial. J Chronic Fatigue Syndrome 2007b;14:39-59.
28.
Jason LA, Brown M, Brown A, Evans M, Flores S, Grant-Holler E, Sunnquist M: Energy conservation/envelope theory interventions to help patients with myalgic encephalomyelitis/chronic fatigue syndrome. Fatigue 2013;1:27-42.
29.
Johnston S, Brenu EW, Staines DR, Marshall-Gradisnik S: The adoption of chronic fatigue syndrome/myalgic encephalomyelitis case definitions to assess prevalence: a systematic review. Ann Epidemiol 2013;23:371-376.
30.
Kindlon T: Reporting of harms associated with graded exercise therapy and cognitive behavioural therapy in myalgic encephalomyelitis/chronic fatigue syndrome. Bull IACFS/ME 2011;(2):59-111.
31.
Knudsen AK, Omenås AN, Harvey SB, Løvvik CM, Lervik LV, Mykletun A: Chronic fatigue syndrome in the media: a content analysis of newspaper articles. JRSM Short Rep 2011;2:42.
32.
Malouff JM, Thorsteinsson EB, Rooke SE, Bhullar N, Schutte NS: Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis. Clin Psychol Rev 2008;28:736-745.
33.
Martin A, Gaab J: Evidenzbasierte Psychotherapie bei chronischer organisch unklarer Erschöpfung. Psychotherapeut 2011;56:231-238.
34.
McCrone P, Sharpe M, Chalder T, Knapp M, Johnson AL, Goldsmith KA, White PD: Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: a cost-effectiveness analysis. PLoS One 2012;7:e40808.
35.
Moss-Morris R, Petrie K: Discriminating between chronic fatigue syndrome and depression: a cognitive analysis. Psychol Med 2001;31:469-479.
36.
Moss-Morris R, Sharon C, Tobin R, Baldi JC: A randomized controlled graded exercise trial for chronic fatigue syndrome: outcomes and mechanisms of change. J Health Psychol 2005;10:245-259.
37.
Nater UM, Maloney E, Boneva RS, Gurbaxani BM, Lin JM, Jones JF, Reeves WC, Heim C: Attenuated morning salivary cortisol concentrations in a population-based study of persons with chronic fatigue syndrome and well controls. J Clin Endocrinol Metab 2008;93:703-709.
38.
Nijhof SL, Bleijenberg G, Uiterwaal CSPM, Kimpen JLL, van de Putte EM: Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial. Lancet 2012;379:1412-1418.
39.
Nijhof SL, Rutten JM, Uiterwaal CS, Bleijenberg G, Kimpen JL, Putte EM: The role of hypocortisolism in chronic fatigue syndrome. Psychoneuroendocrinology 2014;42:199-206.
40.
Papadopoulos AS, Cleare AJ: Hypothalamic-pituitary-adrenal axis dysfunction in chronic fatigue syndrome. Nat Rev Endocrinol 2011;8:22-32.
41.
Price JR, Mitchell E, Tidy E, Hunot V: Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev 2008;(3):CD001027.
42.
Prins JB, Bos E, Huibers MJ, Servaes P, van der Werf SP, van der Meer JW, Bleijenberg G: Social support and the persistence of complaints in chronic fatigue syndrome. Psychother Psychosom 2004;73: 174-182.
43.
Raine R, Carter S, Sensky T, Black N: General practitioners' perceptions of chronic fatigue syndrome and beliefs about its management, compared with irritable bowel syndrome: qualitative study. BMJ 2004;328:1354-1357.
44.
Ridsdale L, Godfrey E, Chalder T, Seed P, King M, Wallace P, Wessely S; Fatigue Trialists' Group: Chronic fatigue in general practice: is counselling as good as cognitive behaviour therapy? A UK randomised trial. Br J Gen Pract 2001;51:19-24.
45.
Ridsdale L, Hurley M, King M, McCrone P, Donaldson N: The effect of counselling, graded exercise and usual care for people with chronic fatigue in primary care: a randomized trial. Psychol Med 2012;42:2217-2224.
46.
Ring A, Dowrick C, Humphris G, Salmon P: Do patients with unexplained physical symptoms pressurise general practitioners for somatic treatment? A qualitative study. BMJ 2004;328:1057.
47.
Roberts AD, Papadopoulos AS, Wessely S, Chalder T, Cleare AJ: Salivary cortisol output before and after cognitive behavioural therapy for chronic fatigue syndrome. J Affect Disord 2009;115:280-286.
48.
Roberts AD, Papadopoulos AS, Wessely S, Chalder T, Cleare AJ: Does hypocortisolism predict a poor response to cognitive behavioural therapy in chronic fatigue syndrome? Psychol Med 2010;40:515-522.
49.
Rubin GJ, Hotopf M, Papadopoulos A, Cleare A: Salivary cortisol as a predictor of postoperative fatigue. Psychosom Med 2005;67:441-447.
50.
Salmon P, Peters S, Stanley I: Patients' perceptions of medical explanations for somatisation disorders: qualitative analysis. BMJ 1999;318:372-376.
51.
Song S, Jason LA: A population-based study of chronic fatigue syndrome (CFS) experienced in differing patient groups: an effort to replicate Vercoulen et al.'s model of CFS. J Ment Health 2005;14:277-289.
52.
Stiles A: Go rest, young man. Monit Psychol 2012;43:32. www.apa.org/monitor/2012/01/go-rest.aspx.
53.
Tak LM, Cleare AJ, Ormel J, Manoharan A, Kok IC, Wessely S, Rosmalen JG: Meta-analysis and metaregression of hypothalamic-pituitary-adrenal axis activity in functional somatic disorders. Biol Psychol 2011;87:183-194.
54.
The Lancet: Patients' power and PACE. Lancet 2011; 377:1808.
55.
The Medical Staff of the Royal Free Hospital: An outbreak of encephalomyelitis in the Royal Free Hospital Group, London, in 1955. BMJ 1957;19:895-904.
56.
Van Cauwenbergh D, De Kooning M, Ickmans K, Nijs J: How to exercise people with chronic fatigue syndrome: evidence-based practice guidelines. Eur J Clin Invest 2012;42:1136-1144.
57.
Wessely S: History of the postviral fatigue syndrome. Br Med Bull 1991;47:919-941.
58.
Wessely S, White PD: There is only one functional somatic syndrome. Br J Psychiatry 2004;185:95-96.
59.
White PD: The role of physical inactivity in the chronic fatigue syndrome. J Psychosom Res 2000;49:283-284.
60.
White PD: How common is chronic fatigue syndrome; how long is a piece of string? Popul Health Metr 2007;5:6.
61.
White PD, Chalder T: Chronic fatigue syndrome: treatment without a cause. Lancet 2012;379:1372-1373.
62.
White PD, Goldsmith K, Johnson AL, Chalder T, Sharpe M: The PACE trial in chronic fatigue syndrome - Authors' Reply. Lancet 2011a;377:1834-1835.
63.
White PD, Goldsmith KA, Johnson AL, Potts L, Wal-wyn R, DeCesare JC, Baber HL, Burgess M, Clark LV, Cox DL, Bavinton J, Angus BJ, Murphy G, Murphy M, O'Dowd H, Wilks D, McCrone P, Chalder T, Sharpe M; PACE Trial Management Group: Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 2011b;377:823-836.
64.
White PD, Goldsmith K, Johnson AL, Chalder T, Sharpe M: Recovery from chronic fatigue syndrome after treatments given in the PACE trial. Psychol Med 2013;43:2227-2235.
65.
Whiting P, Bagnall AM, Sowden AJ, Cornell JE, Mulrow CD, Ramirez G: Interventions for the treatment and management of chronic fatigue syndrome. J Am Med Assoc 2001;286:1360-1368.
66.
Wiborg JF, Knoop H, Stulemeijer M, Prins JB, Bleijenberg G: How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity. Psychol Med 2010;40:1281-1287.
67.
Wiborg JF, Knoop H, Prins JB, Bleijenberg G: Does a decrease in avoidance behavior and focusing on fatigue mediate the effect of cognitive behaviour therapy for chronic fatigue syndrome? J Psychosom Res 2011;70:306-310.
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2014
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