In the summer of 2001, I attended Harvard Medical School’s Clinical Training in Mind/Body Medicine in Boston, Massachusetts. The Mind/Body Medicine Program runs under the direction of Herbert Benson MD, who has devoted much of his career to researching the beneficial physiological consequences of eliciting relaxation. This program is designed to instruct medical professionals on how to introduce Mind/Body techniques to patients in the clinical setting.
In working together with Dr. Alison Bested MD FRCPC in her practice devoted to CFS/FM, I thought it would be of real value to learn these skills so that I could pass them on to CFS/FM patients. While at the Harvard course I had the good fortune to meet Dr. Ellen Slawsby, Program Director of the Chronic Fatigue Syndrome Program, Division of Behavioral Medicine at Harvard’s teaching hospital, Beth Israel Deaconess Medical Center. I was pleased to learn that there is a specialty program specifically for those with CFS, FM and other chronic pain conditions. After it became clear to Dr. Slawsby and her colleagues of my interest and passion in helping the healing process in CFS, I received an invitation to participate in professional training specific to the CFS program. I am so grateful that they were open-minded and respectful of naturopathic medical education in allowing my attendance.
The Harvard CFS program is an education and behavioural therapy group involving 11 weekly sessions. The purpose of the program is to provide the skills necessary in dealing with a chronic illness, symptom reduction, and to identify factors or situations that may be contributing to setbacks or lack of progress. All participants have a copy of Managing Pain Before it Manages You by Margaret Caudill MD PhD, a superb book that serves as a course guide, resource and workbook.
At the first session participants are encouraged to bring a spouse, partner or family member to give support and to provide insight into the effects of CFS/FM on other families. Peer sharing and support make up a significant portion of week one. Also during the first session the physical and psychological consequences of constant stress are discussed as well as the short and long-term benefits of eliciting a relaxation response. The relaxation response can be elicited through various methods, including meditation, focused breathing, guided imagery/visualization, yoga stretching and progressive muscle relaxation.
Throughout the weekly two and a half hour sessions, the various relaxation techniques are discussed and taught. Breath awareness and mindfulness, or the ability to focus on only one thing, are important aspects of getting the most from a relaxation response. Research by Dr. Benson and colleagues shows that repetition of a simple, mental focus via a word, short phrase or breath watching are important, as are keeping a passive mental attitude towards the thoughts and feelings experienced during the session. A comfortable position, a quiet environment and lots of practise are also critical in achieving the physiological benefits.
Each session is devoted to a particular topic such as pacing and activity scheduling, sleep hygiene, nutrition, exercise, cognitive restructuring (reframing), humour, journaling, communication skills and problem-solving. At all sessions the relaxation response is practiced. Homework involves reading a chapter or two of Dr. Caudill’s Managing Pain book. The patients in the program state that the word “pain” can readily be substituted for “fatigue” in the book. After completion of the program, patients are encouraged to attend “graduate groups” facilitated by peer volunteers on a monthly basis.
The benefits of properly organized and facilitated education and support groups in the treatment of CFS are being highlighted by medical research (Solderberg, Evengard. Psychother Psychsom 2001). The benefits of Mind/Body techniques have been validated as an effective FM treatment approach in a number of studies (Berman. J Rheumatol 2000; Sephton et al. Psychosom Med 2001; Worrel, et al. Mayo Clin Proc 2001). Unpublished data from the Harvard CFS program indicates that 87.5% of patients felt they were able to manage their symptoms more effectively and showed significant reductions in physical and mental fatigue.
Dr. Bested and I have been facilitating education and support groups at our office in Toronto, Ontario and now we have added to the course content based on my experiences with the Harvard program. We have groups of 10-12 CFS/FM patients and have sessions every two weeks for eight weeks. The response has been tremendous and participants have reported significant benefits from attendance. In 2002 we will have two concurrent eight-session programs. As with the Harvard program, our goals include education, particularly increasing coping skills, stress reduction and pacing. Drawing on Dr. Bested’s 10 years of clinical experience in treating CFS, the group process is greatly enhanced. In addition to session specific topics such as exercise, nutrition, Mind/Body techniques, sleep and lifestyle interventions, we also focus on the latest research from an integrative perspective (ie one inclusive of both conventional and complementary therapy). The meetings provide not only medical support but peer support as well. The patients quickly discover they are not alone with their illness; they often make friends within the group and can end the often-encountered social isolation. While it can be physically difficult for some to attend the sessions, almost all state that they were glad they made the effort. Our sessions are held every other week based on patient feedback; we find that our week-to-week attendance is higher when an alternating schedule is used.
In conclusion, the training at Harvard was of real value in enhancing our Toronto-based education and support group content. The group serves as a beneficial complement to other medical interventions and may help to improve the quality of life of those dealing with chronic illnesses such as CFS and FM. Participants have the dual benefit of medical and peer support.
This page was last reviewed/modified on 2006/08/20.