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Talk Therapy Helps Gulf War Illness

Improves Fatigue, Mental Health, and Physical Function Better Than Exercise Does

WebMD Health News

Oct. 29, 2002 -- A form of talk therapy proved more effective than exercise in reducing pain and improving symptoms caused by conditions experienced by many Gulf War veterans, a new study shows.

An estimated 100,000 of the nearly 700,000 Americans who served in operations Desert Storm and Desert Shield have registered post-war illnesses with the Department of Veterans Affairs or the Department of Defense. Most commonly reported are overwhelming fatigue, depression, impaired mental ability, and muscle and joint pain that occurred after fighting in Iraq. Symptoms are similar to those of fibromyalgia and chronic fatigue syndrome.

In a study of nearly 1,100 veterans, researchers found their symptoms improved with any treatment they examined over a three-month period -- regular low-impact aerobic exercise, weekly cognitive behavioral "talk" therapy, combining both treatments, or even standard care. But the greatest impact was in those receiving both talk therapy and exercise -- over 18% improvement in physical function.

"The cognitive therapy alone helped with their physical symptoms more so than exercise alone," says rheumatologist and lead researcher David Clauw, MD, of the University of Michigan Health System.

Those who had only the weekly talk therapy had an 18% improvement in symptoms, compared with 12% for those who only exercised. Study participants getting usual physician care that didn't include either treatment had an 11% improvement.

Significant improvements were also seen in mental health function. Fatigue, distress, and the ability to think and understand were seen with exercise alone and with exercise plus cognitive behavioral therapy.

"With cognitive behavioral therapy, people are taught to identify bad habits that they may unknowingly have slipped into and learn different ways of approaching their illness," says Clauw, who presented his findings at the annual meeting of the American College of Rheumatology.

"For example, they learn how to pace their activity levels. When you have an illness such as chronic fatigue syndrome or fibromyalgia, knowing that the symptoms may worsen, many people become totally sedentary when their symptoms are bad," he tells WebMD. "Then they try to catch up by overexerting themselves when symptoms decrease. They don't understand that they are creating 'valleys' by overdoing it on days they feel better."

Still, some question the long-term effects of such treatments.

"Saying that regular exercise and being able to discuss your symptoms with supportive, compassionate doctors will help is like saying that breathing is important," says Stephen Robinson, executive director of The National Gulf War Resource Center and a member of the Veteran Affairs research advisory committee on Gulf War illnesses.

"Certainly it will have an immediate and perhaps dramatic effect. But what happens years later when you're no longer under the care of these supportive and compassionate physicians?

"I went through one of these programs, and what they do is teach you to cope in a very sympathetic way. But they don't provide answers -- the reasons why you are sick or what exposures over there might have caused your illnesses," he tells WebMD. "It's like when you were sad and you went to your mother and she held you and you felt better. It didn't take away the reason you were sad; all it did was give you a place to turn." -->

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