Personalised relaxation practice to improve sleep and functioning in patients with chronic fatigue syndrome and depression: study protocol for a randomised controlled trial

A Comprehensive Update of the Current Understanding of Chronic Fatigue Syndrome

This is a comprehensive literature review of chronic fatigue syndrome (CFS). We provide a description of the background, etiology, pathogenesis, diagnosis, and management regarding CFS. CFS is a multifaceted illness that has many symptoms and a wide array of clinical presentations. As of recent, CFS has been merged with myalgic encephalomyelitis (ME). Much of the difficulty in its management has stemmed from a lack of a concrete understanding of its etiology and pathogenesis. There is a potential association between dysfunction of the autoimmune, neuroendocrine, or autonomic nervous systems and the development of CFS. Possible triggering events, such as infections followed by an immune dysregulation resulting have also been proposed. In fact, ME/CFS was first described following Epstein Barr virus (EBV) infections, but it was later determined that it was not always preceded by EBV infection. Patient diagnosed with CFS have shown a noticeably earlier activation of anaerobic metabolism as a source of energy, which is suggestive of impaired oxygen consumption. The differential diagnoses range from tick-borne illnesses to psychiatric disorders to thyroid gland dysfunction. Given the many overlapping symptoms of CFS with other illnesses makes diagnosing it far from an easy task. The Centers for Disease Control and Prevention (CDC) considers it a diagnosing of exclusion, stating that self-reported fatigue for at minimum of six months and four of the following symptoms are necessary for a proper diagnosis: memory problems, sore throat, post-exertion malaise, tender cervical or axillary lymph nodes, myalgia, multi-joint pain, headaches, and troubled sleep. In turn, management of CFS is just as difficult. Treatment ranges from conservative, such as cognitive behavioral therapy (CBT) and antidepressants, to minimally invasive management. Minimally invasive management involving ranscutaneous electrical acupoint stimulation of target points has demonstrated significant improvement in fatigue and associated symptoms in a 2017 randomized controlled study. The understanding of CFS is evolving before us as we continue to learn more about it. As further reliable studies are conducted, providing a better grasp of what the syndrome encompasses, we will be able to improve our diagnosis and management of it.

A Personalised Emotion-Based Model for Relaxation in Virtual Reality

One of the most frequent health problems is stress. It has been linked to negative effects on employee well-being in many occupations, and it is considered responsible for many physical and psychological problems. Traditional in-person relaxation therapy has proven to be effective in reducing stress. However, it has some drawbacks such as high cost, required infrastructure and the need for qualified trainers. Relaxation therapy in Virtual Reality (VR) tries to solve these problems. However, one aspect has received little attention, that is personalised therapy. Indeed, while many studies show the need for patient-tailored relaxation exercises, little existing work focuses on personalised VR content. One reason for this is the complexity of recognising emotions, which is required for emotion-based adaptive VR. In this work, a method for adapting VR content to the emotional state of the user is presented. This model has been applied in a VR relaxation therapy application, which adapts to the user’s emotional state utilising a heuristic optimiser. Simulations have proven the performance and usability of the emotion model. Additionally, this paper explores the impact of the order in which adaptations are performed on the effectiveness of the relaxation experience.