Cognitive Behavioral Therapy and Aerobic Exercise for Gulf War Veterans' Illnesses: A Randomized Controlled Trial
CONTEXT Gulf War veterans' illnesses (GWVI), multisymptom illnesses characterized by persistent pain, fatigue, and cognitive symptoms, have been reported by many Gulf War veterans. There are currently no effective therapies available to treat GWVI. OBJECTIVE To compare the effectiveness of cogn...
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Published in | JAMA : the journal of the American Medical Association Vol. 289; no. 11; pp. 1396 - 1404 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Chicago, IL
American Medical Association
19.03.2003
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Subjects | |
Online Access | Get full text |
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Summary: | CONTEXT Gulf War veterans' illnesses (GWVI), multisymptom illnesses characterized
by persistent pain, fatigue, and cognitive symptoms, have been reported by
many Gulf War veterans. There are currently no effective therapies available
to treat GWVI. OBJECTIVE To compare the effectiveness of cognitive behavioral therapy (CBT),
exercise, and the combination of both for improving physical functioning and
reducing the symptoms of GWVI. DESIGN, SETTING, AND PATIENTS Randomized controlled 2 × 2 factorial trial conducted from April
1999 to September 2001 among 1092 Gulf War veterans who reported at least
2 of 3 symptom types (fatigue, pain, and cognitive) for more than 6 months
and at the time of screening. Treatment assignment was unmasked except for
a masked assessor of study outcomes at each clinical site (18 Department of
Veterans Affairs [VA] and 2 Department of Defense [DOD] medical centers). INTERVENTIONS Veterans were randomly assigned to receive usual care (n = 271), consisting
of any and all care received from inside or outside the VA or DOD health care
systems; CBT plus usual care (n = 286); exercise plus usual care (n = 269);
or CBT plus exercise plus usual care (n = 266). Exercise sessions were 60
minutes and CBT sessions were 60 to 90 minutes; both met weekly for 12 weeks. MAIN OUTCOME MEASURES The primary end point was a 7-point or greater increase (improvement)
on the Physical Component Summary scale of the Veterans Short Form 36-Item
Health Survey at 12 months. Secondary outcomes were standardized measures
of pain, fatigue, cognitive symptoms, distress, and mental health functioning.
Participants were evaluated at baseline and at 3, 6, and 12 months. RESULTS The percentage of veterans with improvement in physical function at
1 year was 11.5% for usual care, 11.7% for exercise alone, 18.4% for CBT plus
exercise, and 18.5% for CBT alone. The adjusted odds ratios (OR) for improvement
in exercise, CBT, and exercise plus CBT vs usual care were 1.07 (95% confidence
interval [CI], 0.63-1.82), 1.72 (95% CI, 0.91-3.23), and 1.84 (95% CI, 0.95-3.55),
respectively. The OR for the overall (marginal) effect of receiving CBT (n
= 552) vs no CBT (n = 535) was 1.71 (95% CI, 1.15-2.53) and for exercise (n
= 531) vs no exercise (n = 556) was 1.07 (95% CI, 0.76-1.50). For secondary
outcomes, exercise alone or in combination with CBT significantly improved
fatigue, distress, cognitive symptoms, and mental health functioning, while
CBT alone significantly improved cognitive symptoms and mental health functioning.
Neither treatment had a significant impact on pain. CONCLUSION Our results suggest that CBT and/or exercise can provide modest relief
for some of the symptoms of chronic multisymptom illnesses such as GWVI. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 |
ISSN: | 0098-7484 1538-3598 |
DOI: | 10.1001/jama.289.11.1396 |