A Two-Year Follow-Up Case of Chronic Fatigue Syndrome: Substantial Improvement in Personality Following a Yoga-Based Lifestyle Intervention

Abstract

Background and Objective:

Chronic Fatigue Syndrome (CFS) is characterized by excessive fatigue after minimal physical or mental exertion, muscle and joint pain, poor concentration, dizziness, and sleep disturbances. We report here the effect of a yoga-based lifestyle intervention in a 30-year old male patient with a documented diagnosis of CFS with compromised quality of life (QoL) and altered personality.

Methods:

The patient initially attended a short-term yoga-based lifestyle intervention program that consisted of yoga-postures, breathing exercises (pranayama), meditation, group discussions, and individualized advice on stress management, diet and physical activity besides group support. Thereafter, patient attended 5 more such programs.

Results:

There was a notable and consistent improvement in his clinical profile, positive aspects of personality and subjective well-being, and reduction in anxiety following this yoga-based lifestyle intervention.

Conclusion:

Overall, the results suggest that lifestyle intervention may improve clinical condition and personality in patients with CFS.

Introduction

Chronic fatigue syndrome (CFS), a debilitating disorder, is characterized by excessive fatigue after minimal physical or mental exertion, muscle and joint pain, poor concentration, dizziness, and sleep disturbances. Symptoms overlap considerably with those of depression and anxiety.¹ Treatment options include cognitive-behavioral therapy, graded exercise therapy, pharmacologic treatment, and alternative medicine therapies.

Case Report

A 30-year-old well-educated male patient was diagnosed with CFS by a physician in consultation with a psychiatrist. During follow-up, routine and specific investigations to rule out any infective, metabolic, or immunologic abnormalities were performed; all results were within normal limits. A brief history of the patient revealed that he was having an intermittent high-grade fever associated with headache, myalgia, and joint pain for the past year. The pain was migratory in nature and kept shifting between major and minor joints throughout the body. The pain was not related to physical exhaustion and was not relieved by rest or sleep. This markedly reduced the patient's sleep time and, in turn, usually resulted in daytime drowsiness and fatigue. The patient also reported episodes of conjunctivitis during this period. He also experienced heat intolerance, facial swelling, and eye redness during acute episodes. He described himself as very disturbed by his symptoms, as unable to concentrate on his work, as having impaired short-term memory, and as having suicidal ideation.

The patient was symptomatically treated with analgesics, antipyretics, and anxiolytics during acute episodes. He also received tricyclic antidepressants (amitriptyline). None of these treatments provided clinically meaningful relief. The patient was referred to the Integral Health Clinic (IHC) for yoga-based lifestyle intervention in April 2010.

Intervention

The pretested^2,3 IHC intervention consists of a short-term lifestyle intervention program that includes yoga postures; breathing exercises; meditation; group discussions; and individualized advice on stress management, diet, and physical activity in addition to group support. At IHC, this patient was enrolled initially in one of these yoga-based lifestyle intervention programs, supervised by yoga experts and medical consultants, after providing written informed consent. Each session lasted about 2 hours per day for 10 days over 2 weeks. Routine clinical and laboratory variables were measured before and after the intervention. Personality assessments were performed using the NEO-Five Factor Inventory (NEO-FFI, 60 items) on the Big Five personality domains (neuroticism, extraversion, agreeableness, openness, and conscientiousness).⁴ In addition, the State and Trait Anxiety Inventory (STAI-Y 1 and 2) and Subjective well-being Inventory (SUBI) questionnaire were used to assess anxiety and well-being.⁵

Following a remarkable improvement in his condition after attending the first program, this patient attended 5 more such lifestyle intervention programs at IHC within a span of about 2 years (April 2010 to December 2011).

Results

The data showed substantial improvement in the patient's condition with the intervention. He reported a decrease in pain and facial swelling and improvement in sleep profile. Overall, fasting blood glucose and lipid profile improved (Table 1). In general, body weight and body mass index decreased from baseline to day 10 of each program. Furthermore, personality measures markedly improved, as shown by the Big Five personality domains (Fig. 1A).

FIG. 1.

Cumulative results on study instruments. (A) Big Five Factors before and after lifestyle intervention. (B) Subjective well-being Inventor (SUBI) scores for positive aspects before and after lifestyle intervention. (C) SUBI scores for negative aspects before and after lifestyle intervention. (D) State trait and anxiety scores before and after lifestyle intervention.

Table 1.

Clinical Characteristics at Baseline (Day 0) and End of Each Program (Day 10)

		Lifestyle intervention programs
Characteristic	Day	1	2	3	4	5	6
Weight (kg)	Day 0	69.4	67	67	64.9	65.3	66.95
	Day 10	68	66	66	65.7	66.2	66.15
Body mass index (kg/m²)	Day 0	24.01	23.18	23.18	22.45	22.5	23.16
	Day 10	23.52	22.84	22.94	22.73	22.9	22.88
Systolic blood pressure (mmHg)	Day 0	110	114	110	110	114	118
	Day 10	120	112	110	118	125	114
Diastolic blood pressure (mmHg)	Day 0	80	72	70	75	58	72
	Day 10	90	78	80	76	65	69
Pulse rate (beats/min)	Day 0	86	75	78	74	76	76
	Day 10	72	78	72	71	75	72
Fasting blood glucose (mg/dL)	Day 0	106	113	119	104	110	110
	Day 10	104	113	118	99	112	104
Total cholesterol (mg/dL)	Day 0	197	198	219	211	194	205
	Day 10	200	193	188	186	185	197
Low-density lipoprotein cholesterol (mg/dL)	Day 0	127	132	143	146	129	138
	Day 10	128	129	119	122	125	131
High-density lipoprotein cholesterol (mg/dL)	Day 0	40	38	43	45	31	48
	Day 10	41	39	46	44	30	44
Triglycerides (mg/dL)	Day 0	152	140	152	85	170	97
	Day 10	142	119	113	82	168	111

These data were summarized for all the assessments, and cumulative scores were calculated for all 6 programs attended for baseline (day 0) and end of the program (day 10). A negative aspect of personality (neuroticism) decreased and positive aspects of personality (extraversion, agreeableness, openness, and conscientiousness) increased, as measured by NEO-FFI. Subjective well-being improved, as shown by the SUBI questionnaire. This instrument includes 11 factors (F1–F11), of which F1–F6 are positive (F1, positive affect in general well-being; F2, congruence between expectations and achievements; F3, confidence in coping; F4, transcendence; F5, family group support; F6, social support) and F7–F11 are negative (F7, primary group concern; F8, inadequate mental mastery; F9, perceived ill health; F10, deficiency in social contacts; F11, negative affect in general well-being). Scores for positive factors increased (Fig. 1B) and scores for negative factors decreased (Fig. 1C). Anxiety improved gradually over the 2 years, as shown by the STAI-Y 1 and 2 questionnaire, which reflects both long-term anxiety status and current anxiety status (Fig. 1D).

Since his referral to IHC, this patient has attended 6 lifestyle intervention program. On each occasion he reported a continually improved quality of life and decreased manifestation of symptoms, including fatigue and pain, and a better sleep pattern. Furthermore, the acute episodes and relapses have markedly decreased. Of note, the patient reported a decrease in the dose of antidepressant to about one fourth, and now he requires almost no analgesics or antipyretics.

Discussion

The results showed a notable improvement in clinical as well as psychiatric profiles during the 2 years the patient attended lifestyle intervention programs at IHC. Joint and muscle pain decreased substantially. The patient's weight and fasting blood glucose levels were also reduced, and his lipid profile improved. Further, personality notably improved as measured by the Big Five factors of personality. Neuroticism decreased and positive factors of personality (extraversion, agreeableness, openness, and conscientiousness) increased. The Big Five model conceptualizes five factors of personality: neuroticism (low emotional stability; high stress and nervousness), conscientiousness (being hard-working, dedicated, and orderly), agreeableness (kindness and consideration), openness to experience (intellect/imagination and creativity), and extraversion (enthusiasm, energy, and sociability).^6,7 In addition to an improvement in personality scores, there was an improvement in subjective well-being as seen by better SUBI scores. Similar improvement was evident at the end of each lifestyle intervention program.

This benefit is notable because patients with CFS have compromised quality of life and personality alterations. The illness leads to a vicious cycle encompassing physiologic changes, illness beliefs, reduced and inconsistent activity, sleep disturbance, and medical uncertainty that keeps perpetuating symptoms. Patients with CFS have higher emotional instability and lower extraversion.⁸ Cognitive-behavioral therapy and graded exercise therapy can significantly reduce fatigue and disability in CFS. Both moderately improve fatigue levels, work and social adjustment, anxiety, and postexertional malaise.⁹ Previous studies using CBT have shown some benefit with respect to improvement in negative aspects of personality (neuroticism).¹⁰

The patient with CFS described here showed an overall improvement in personality, subjective well-being, and clinical profile. Such benefit is plausible as yoga works on the principles of psychoneuroimmunology¹¹ and is now being recognized as a potential intervention module of alternative and complementary medicine.¹² We have previously shown that this lifestyle intervention improves stress, inflammation, anxiety, subjective well-being, and personality,¹³ which was in line with results of other studies.^14
–16 The beneficial effect of this yoga-based lifestyle intervention program may be attributed to reduction in stress and inflammation because CFS,¹⁷ as well as high neuroticism and low conscientiousness, are associated with inflammation and interleukin-6.¹⁸

Footnotes

Author Disclosure Statement

The authors report no competing financial interests.

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