Chronic Fatigue & CRP

ABSTRACT:  Leading CFS researcher, Jay A. Goldstein, MD posits an etiology for CFS in limbic encephalopathy in a dysregulated neuroimmune network.  Thus his allopathic treatment protocols include interventions in the “bidirectional communication” between the immune and neuroendocrine systems.  This means that CFS can be considered among those syndromes which respond to Psychoneuroimmunology (PNI), through intervention in the “cross-talk” between the central nervous system and the immune system.  Viral disease can also cause neuropsychological deficits which are amplified under physical or emotional stress.  The limbic system plays a crucial role in regulatory physiology. The Consciousness Restructuring Process (CRP) can influence this psychophysical network, through cognitive, behavioral and attitudinal changes that alter the state of limbic elements.  Nonrestorative, alpha-EEG sleep abnormalities are common in CFS patients.  Nevertheless, most report frequent, vivid dreams and nightmares which can be used to initiate the therapeutic process.

KEYWORDS: Chronic Fatigue Syndromes, Consciousness Restructuring Process, dreams, healing psychotherapy, REM, placebo effect, limbic system, immune system, psychoneuroimmunology, depression, somatization, fibromyalgia, panic disorder, sleep disturbances, nightmares, natural killer cells, REM journeys, PTSD, chaos theory, Candace Prt, neuropeptides, biochemicals, consciousness, EEG sleep abnormalities, Epstein-Barr virus, amygdala.

WHAT IS CHRONIC FATIGUE SYNDROME (CFS)?

Chronic Fatigue Syndrome (CFS) has been called one of the most treatment-resistant disorders encountered in primary care.  Though there are several views of its underlying causes, this paper will approach it as a disorder of regulatory physiology, and describe a process-oriented therapy which intervenes to re-establish self-organizing order in the whole pyschophysical organism.

CFS is the result of an interplay of genetic, environmental, and infectious factors.  Only the limbic dysfunction theory can account for the diverse symptomology, whether its source is a viral syndrome, post-viral syndrome, immune dysfunction, neurologic disease, or metabolic/nutritional/toxic/hypersensitivity disorder.  As of today, the biopsychosocial model yields the best treatment options, combining allopathic medication and psychotherapy.

Most patients who complain of fatigue have normal workups.  However, the symptom profile of CFS is fairly distinctive, with prolonged fatigue after exercise, cognitive impairment, characteristic tender-points, and recurrent flu-like illnesses with sore throat.  Onset generally occurs between ages 30-35.  The finding of limbic/prefrontal abnormalities in all CFS patients augments the distinction between CFS and depression, and between “physical” and “mental,” and lends support to a certain type of somatization as relevant to CFS physiology.  The tendency to somatization is amplified when childhood abuse is a factor.  The amygdala, or alarm signal in the brain, gets conditioned into hyperactivity.  Traumatic stress modifies synaptic connections to alter normal regulation of neuroimmune function, and may be a factor in predisposition.

In CFS, the brain is involved with inappropriate, or chronic, immune activation which leads to the production of auto-toxic chemicals in the body, which in turn feedback to the brain producing mood disorders and cognitive dysfuctions.  The bidirectional communication of this psychosomatic network forms a feedback loop between the immune system and CNS (Central Nervous System).  Thus, CFS appears to be a psychoneuroimmunolgic disease since neurologic symptoms are prominent and the severity of the illness, including flu-like symptoms, is so influenced by stress.

It becomes difficult when the disease is raging to know “what is me and what is the disease process?”  Emotional issues are involved such as lowered self-esteem and sensitivity to rejection.

SYMPTOMS AND DIAGNOSIS OF CFS

The symptoms of CFS are numerous and easily mistaken for other disorders, such as fibromyalgia (FM) or multiple sclerosis (MS).  Both CFS/FM syndromes can appear together and share characteristic tender-points and hypersensitivity, and limbic disorders.  Many neuropsychiatric, allergic, neuroendocrine, psychosomatic, and functional disorders can be found in the CFS population.  Thus, it is a syndrome with various manifestations, characterized by multi-system dysregulation.

Diagnosis includes distinguishing the range of symptoms from its mimics, such as FM, and the chronic fatigue of Hepatitis C and mononucleosis.  As well as a physical exam and tests, there are brain function tests (neuropsychological testing), like that of the SPECT scanner, PET and MRI.  Topographic brain mapping with evoked responses is almost always abnormal in CFS patients .  The temporal lobes, left more than right, are most frequently abnormal on visual and auditory evoked response measurement by BEAM (brain electrical activity mapping).  Functional capacity evaluation (FCE) is also useful.

Cognitive testing has shown that CFS patients are prone to overestimating their cognitive abilities. A 90-item symptom checklist for CFS uses a 5-point self-rating scale.  It has nine dimensional scales: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism.  [See Appendix A for CFS Symptom Checklist].  Screening also includes depression, anxiety and somatization inventories.  CFS can occur simultaneously with personality and mental health disorders, such as Bipolar, MPD, Borderline Personality, and Anxiety Disorder.

CFS symptoms range from hypersensitivity and mood swings to sleep disturbances, frequent nightmares, muscle and joint aches and weakness, to recurrent flu-like symptoms, decreased libido, allergies and other immune disorders.  Other aspects  include irritability, PMS, anxiety, panic disorder, restless leg syndrome (RLS), sleep apnea, headache, bruxism, fibromyalgia, tinnitus, vertigo, hyperventilation, carpal tunnel syndrome (CTS), arrhythmia or tachycardia,  and irritable bowel syndrome (IBS).

Symptoms can be mild or severe, and vary widely between patients in type and degree of impact.  A defect in natural killer (NK) cell activity is frequently seen in the CFS population.  Reactivation of CFS is often accompanied by reactivation of other stress-related viruses, such as Herpes.  It has been conjectured that perhaps the gene products of multiple infectious agents may need to synergize to produce the characteristic syndrome.

Hugh Besedovsky, a preeminent researcher on immune function, views the immune system as being a “receptor sensorial organ” and has demonstrated that the hypothalamus and the limbic system respond to activation of the immune system as they would to other types of “somatic” receptors.  In line with the immune system’s being a receptor sensorial organ that responds to alterations in an internal self image, these researchers postulate a “code based on combinations of soluble messengers which could inform the central nervous system about the type of immune response in operation.” The response of the organism will therefore be determined by the immune and neuroendocrine systems acting in a network.

The immune system cannot be dealt with in an isolated manner.  That is why Psychoneuroimmunology takes a psychophysical approach.  The Consciousness Restructuring Process uses this philosophy of treatment as the basis for a mind/body intervention which creates more harmony in that interaction.  It is especially useful in the so-called “treatment-resistant depression,” which responds poorly to drug treatment.

THE LIMBIC SYSTEM

We can only understand CFS by grasping that the generation of symptoms involves a part of the brain called the limbic system, master regulator of the brain and body.  Limbic dysfunction may produce the symptoms of chronic fatigue syndrome.  Thus, some symptoms of CFS are similar to temporolimbic epilepsy and migraine auras.  The limbic system is the visceral brain which acts as a buffer between the internal and external world.  It is involved in memory storage and retrival.

CFS is not depression, per se, but features serotonin deficiency.  It can be more productively viewed as a limbic encephalopathy (limbic/prefrontal abnormalities).  It is aggravated by stress, exercise, infection, and possibly nasal allergy.  It is thought that the associated fatigue is inappropriately generated by the central nervous system, unrelated to physical exertion.  Those with CFS can wake up fatigued from stress, odors, trauma, circadian oscillations, or from no apparent cause.  The medial temporal lobe is the fatigue center.  This is exacerbated by slow-wave sleep deprivation and leads to cognitive dysfunction.

The limbic system comprises several brain structures associated with memory and emotion, particularly the temporal lobe of the brain.  The hypothalamus, the limbic system, and the amygdala have all been proposed as the centers of emotional expression.

The emotions are what link body and mind into bodymind.  Neuropeptides or cytokines and neurotransmitters are small informational substances which both initiate and respond to environmental and emotional cues.  Neuropeptides and their receptors, the biochemicals of emotion, orchestrate many key bodily processes, linking behavior and biology to effect a smooth functioning of the organism.  The immune system and endocrine system are intrinsic parts of this bodymind circuit.

The limbic system plays a role in the emotional hijackings we experience, sexual passion, worry, and PTSD (Post Traumatic Stress Disorder).  It is implicated when passions overwhelm reason, when we have instinctual impulses to act.  It regulates the psychophysiology of anger, fear, fight-flight, happiness, love, surprise, disgust, and sadness.  Our biological propensities are shaped further by our life experiences and our culture.  Childhood trauma preconditions the limbic system for PTSD.

We all know the higher centers don’t always govern emotional life, especially in crucial matters of the heart, and in emotional emergencies.  Control defaults to the limbic system.  Because so many of the brain’s higher centers sprouted from or extended the scope of the limbic area, the emotional brain plays a crucial role in neural architecture.  It shares intertwined circuits with all parts of the neocortex, enabling it to influence the functioning of the rest of the brain--including its centers for thought.

The amygdala plays a crucial role in this circuit as a neural tripwire or emergency alarm signal.  It activates the emotional centers.  This visceral-mind is a source of “gut-feelings.” This emotional sentinel can be programmed with out-of-date neural alarms which keep the body/mind hypervigilant and overreactive.  They may be residuals from very old or more recent traumas, compounding with one another.

Emotions affect our health and toxic emotions influence it adversely, through anger, suicidal ideas, panic and anxiety which is out of proportion and out of place.  A single trauma can program a severe dysfunction, but the Consciousness Restructuring Process facilitates emotional relearning which promotes psychophysical recovery or remission.  Therapy targets precisely the effects of PTSD on the amygdala and connected neurotransmitter circuits.

The hallmarks of the emotional mind are a quick but sloppy response, first feelings and then thoughts, a symbolic childlike reality, the past imposed on the present, selective memory, and a state-specific reality dictated by the feeling or mood of the moment.  Both drugs and mood states have been shown to induce state-specific encoding operations and retrieval strategies, and provide specific cues for accessing previous experience.  Information acquired in a given state remains available in memory, but inaccessible when remembering takes place under different retrieval (state) conditions.

HEALING TRAUMATIC STRESS

Horrors frozen in memory can be “liquified” and transformed for the benefit of the whole person.  PTSD is a limbic disorder which may be compounding some cases of CFS and FM, and manifest as Dependent Personality Disorder.  CFS patients with this feature may use their disease for secondary gains, and thus try to avoid recovery as a means of maintaining a pseudo-control or the status quo.

In PTSD, emotional re-learning fails to occur, and fear pathways are reinforced and generalized by anything even vaguely reminiscent of the original trauma.  For CFS patients, making new memories is extremely fragile and disrupted by proactive interference; they do not benefit from memory cues.  The making of new memories is easily disturbed by increasing the amount of information presented.

How does this translate into body chemistry?  Our labels filter and influence how we experience emotions.  How we chose to label an emotion or thought, influences our internal, subjective experience.  These choices influence our stress level.  A former  decision about an experience, a former belief about the world, prevents us from allowing in new information.

In Chaos Theory, when information gets organized in the same way each time, it is called infinite nesting, the natural phenomena by whereby structures tend to replicate themselves.  Belief structures acts as control parameters for the outcome of behavior creating artificial boundaries.  Patterns repeat underlying beliefs, patterns within patterns, which is known in Chaos Theory as self-similarity.

The self-organizing of our internal universe in order to maintain its equilibrium causes major psycho-emotional limitations.  We reject all disruptions to this underlying state and self-organizing, and accept only those which maintain our view of ourself and the world.  If condensed energy or a nucleus of energy shifts its attention around and becomes aware of itself as undifferentiated energy, then the attraction to create the molecules of anger, disease, fear, or pain is shifted.

Through our label, we experience and condense an emotion into a particle.  This decision about undifferentiated energy, labeled fear, pain, or stress, initates and kindles the production of neuropeptides, or chemical messengers.  This chemical reaction is the link wherein mind affects matter, which then feedsback onto the physical organism in a vicious cycle.  The more this cycle is reinforced the more fixed it becomes in the mind/body.  The energy becomes solidified when we hold a set of fixed beliefs around it.  Different or new information cannot flow in or out; consciousness then becomes less fluid.

Thus, the particle is essentially a belief.  When we look at our own experience, we can notice that when we believe something is true, we feel it is true, and it becomes subjectively true for us.  All the events in the world that seemingly happen to us are funneled through that belief-system.  This reinforces the standard we have of the world and ourselves.

By judging our experience as good, bad, or neutral we begin to solidify our own perceived realities.  The more we continue to access these realities and label them, we create more density and mass in our thoughts and emotional patterns.  We believe the reality we create is the true one.  As this energy continues to be labeled, the belief in our internal reality and its perceived nature solidifies.

The latest research on the molecules of the mind bears out this notion that beliefs manifest as physical particles.  Information initiates and controls the process.  According to Candace Pert:

“In a network, there is a constant exchange and processing and storage of information, which is exactly what happens, as we have seen, as neuropeptides and their receptors bind across systems. . .So what we have been talking about all along is information.  In thinking about these matters, then, it might make more sense to emphasize the perspective of psychology rather than of neuroscience. . .[The mind] may be said to have a nonmaterial, nonphysical substrate that has to do with the flow of that information.  The mind, then, is that which holds the network together, often acting below our consciousness, linking and coordinating the major systems and their organs and cells in an intelligently orchestrated symphony of all life.  Thus, we might refer to the whole system as a psychosomatic information network, linking psyche, which comprises all that is of an ostensibly nonmaterial nature, such as mind, emotion, and soul, to soma, which is the material world of molecules, cells, and organs.  Mind and body, psyche and soma.”

Thus, the classically separated areas of neuroscience, endocrinology, and immunology (with their various organs) are actually joined to one another through a multidirectional network of communication, linked by information carriers known as neuropeptides.  Peptide-producing cells like those in the brain also inhabit the bone marrow, where immune cells are “born.”

“When researchers found brain peptides in the immune system, they went looking for neuropeptide receptors there.  They discovered that every neuropeptide receptor found in the brain is also on the surface of the monocyte. . .These emotion-affecting peptides, then, actual appear to control the routing and migration of monocytes, which are very pivotal to the overall health of the organism. . .they help the immune system launch a well-coordinated attack against disease. . .Immune cells also make, store, and secrete the neuropeptides themselves.  In other words, the immune cells themselves are making the same chemicals that we conceive of as controlling mood in the brain.  So, immune cells not only control the tissue integrity of the body, but they also manufacture information chemicals that can regulate mood or emotion.  This is yet another instance of the two-way comunication between brain and body.” (Pert, 1997).

These chemical messengers even have a way of breaching the blood-brain barrier.  They bind on receptors on the surface of the brain in such a way they affect the permeability of the brain’s surface membranes.  From there they propagate a signal that gets picked up by other peptides and receptors deep within the brain.  The questions is:  What is the purpose of such communications?

Information generated in the body at large is fed back directly to the brain, which Pert has laughingly described as “a big hormone bag!” inundated with peptide juices.  This is a paradigm shift from the old synaptic model to one of information exchange.  The mind in the body is concerned with filtering, storing, learning, remembering, and repressing.  Neuropeptides are the cues for our bodymind to retrive or repress emotions and behaviors.

Emotions help us decide what to remember and what to forget.  And these memories are state-dependent on the various neuropeptides which created the emotional states or mood.  Feeling is also a mechanism for activating a particular neuronal circuit--simultaneously throughout the brain and body--which generates behavior involving the whole person, with all the necessary physiological changes.  Pert concedes that the sum of the peptide secretions in our brains and bodies biases our memory and behavior so we automatically get what we expect.

However, healing feelings and happiness can also result from natural hormones, in a rapid feedback loop during therapy.  Pert believes that, “happiness is what we feel when our biochemicals of emotion, the neuropeptides and their receptors, are open and flowing freely throughout our systems, organs, and cells in a smooth and rhythmic movement.  Health and happiness are often mentioned in the same breath, and maybe this is why: Physiology and emotions are inseparable.  I believe that happiness is our natural state, that bliss is hardwired.  Only when our systems get blocked, shut down, and disarrayed do we experience the mood disorders that add up to unhappiness in the extreme.”

The question becomes, “How quickly do you let go of learned fear?”  That takes an intentional, conscious intervention on unhealed feelings.  It includes becoming conscious, accessing the psychosomatic network, tapping into your dreams, getting in touch with your body, reducing stress, adopting a healthier lifestyle, and spiritual healing.

The Consciousness Restructuring Process is highly effective for leading clients passed their perceived fears and psychophysical pains, and in reeducating the emotional brain.  This emotional relearning leads to recovery from trauma.  It restores the sense that they need not be completely at the mercy of the emotional hijacking and alarms that flood them with anxiety, sleeplessness, and nightmares.  Brutalized emotional circuitry rediscovers that life is not a threat and helps restore a sense of security and self-identity.

The limbic system is involved not only in higher order regulatory structure and the neuroendocrine immune network, it is implicated in consciousness and the interface of mind and body.  Therefore the therapeutic effect of dream journeys can be immediate.  Diffuse projection systems such as exist for dopamine, norepinephrine, serotonin, and acetylcholine could be rapidly modulated, taking only seconds to occur.

Most CFS sleep is non-restorative.  Jet lag and shift work cause greater difficulty for sufferers.  However, CFS patients report very vivid dreams, which can be used as therapeutic starting-points.  The cause of alpha-EEG sleep abnormalities in CFS and fibromyalgia (FM) is unknown.  They are also prone to “somatosensory amplification,” which can be utilized in the therapeutic intervention.

Cognitive, behavioral, and attitudinal changes can alter the state of limbic elements, producing biological changes in neurotransmitter production and deployment.  In the psychoneuroimmunological postulate, psychological influences can do most things that viruses can do; the virus may simply provide a bridge between the “psychological” and “organic.”  CRP interrupts this somatization disorder, modulating not only the biology, but the individual’s primal self-image.

CONVENTIONAL TREATMENT PROTOCOLS

In the mid-1980s, when doctors found that many people with CFS had high levels of antibodies to the Epstein-Barr virus (EBV), which causes mononucleosis, in their blood, they thought they had found the culprit.  But it turned out many healthy people also had high EBV counts.  Scientists also found high levels of other viral antibodies in the blood of those with CFS.  It is now conjectured that a combination of viruses may trigger CFS.  There is still no single known cause for CFS, and there is no cure, but many treatments are available to help relieve the symptoms.

The role of psychological problems in CFS is very controversial.  Because many with the syndrome are diagnosed with depression, some conclude that the symptoms are psychological.  But without evidence of psychological disorders prior to onset, we can conclude the depression is a result of mood-altering neurohormones created in the disease process, as described in extensive PNI research.

Treatment programs are individualized to each person’s particular symptoms and needs.  The first treatment is generally a combination of rest, exercise, and a balanced diet.  Prioritizing activities, avoiding overexertion, and resting when needed are keys to maintaing existing energy reserves.  Moderate exercise helps conditioning, but too much can worsen fatigue and other CFS symptoms.  Counseling and stress reduction techniques also help many.

Many medications, nutritional supplements, and herbal preparations have been used to treat CFS.  Conventional drug treatment includes NSAIDS, nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen, to relieve pain and reduce fever.  Flexeril is prescribed for pain and muscle spasm.

Depressive symptoms are treated with antianxiety drugs.  Florinef, a synthetic steroid, helps the body retain salt, increase blood pressure and stave off hypotension.  Beta-blockers, gamma globulin, and Ampligen are also employed, as needed.

Integrative treatments include vitamin and mineral suppliments, immune-boosting herbs (astragalus, echinacea, garlic, ginseng, gingko, shiitake mushroom extract, borage seed oil, and quercetin), and stress reduction techniques (biofeedback, meditation, acupuncture, yoga).

The course of CFS varies widely.  Some people get worse over time, while others gradually improve.  Some individuals have periods of illness that alternate with periods of good health.  While many never fully regain their health, they find relief from symptoms and adapt to the disorder by getting adequate rest, nuturtion, exercise, and other therapy.

CONSCIOUSNESS RESTRUCTURING PROCESS

The Institute for Applied Consciousness Science (IACS) has developed and uses a Consciousness-Restructuring Process (CRP) to treat Chronic Fatigue Syndrome.  It utilizes REM-dream consciousness.  A brief description of the process follows:

Imagination-REM based, the process explores the sensory nature and roots of a dream, feeling, or symptom.  REM is attained through breathing techniques.  Using imagination in this state, the patient begins to notice and identify images and/or sensations suggested by a dream symbol, feeling or symptom itself.  These sensory images of what the experience is like are followed to their source, that is, to the consciousness structure that shaped an formed them.  This process is often described as a “Dream Journey,” and we used to call this therapy Dreamhealing.  But not all journeys begin with dream material, however they all take place in REM.

People’ lives, behaviors and physiology are based on perceptions of self and its relationship to the world.  Past and present experiences create consciousness structures that are stored as the neural patterns and shape these perceptions.  This body-mind phenomenon underlies our personal and unique experience of self and reality.

CRP allows the experience of this structure as a primal self image.  It is a sensory, existential, (meaning self, the world and the relationship between them), self-image; becoming aware of and accepting it as self presents the means to restructure it.  Studies at IACS demonstrate that fear-based patterns of consciousness such as these seem to be the body-mind’s foundations of illness of all types.

Dreams occur in REM sleep while the brain is in its most complex and chaotic synaptic firing dynamics.  In this extremely complex neural state, it is generally thought that the brain is organizing the stimuli experienced from daily activities, and developing new neurological firing patterns in the nervous system to help assimlate, integrate or deal with them.  These dream state or chaos/complexity brain dynamics are needed to balance and heal our complex organism.

Our dream experience is shaped by these inner, consciousness patterns (neural firing patterns) that also shape our behavior and physiology.  Every dream, among other things, is a self-portrait, but an impressionistic one.  Each dream element represents different aspects of self, although since dreams are holographic in nature, any part or symbol in a dream also contains the whole.

By imagining the sensory experience of becoming one of the dream symbols and following this sense of being to its source, we directly experience the consciousness dynamics and patterns underlying it.  These dynamics at this primal level incorporate the disease patterns.  This “exploration” is accomplished using imaginary sensory images that arise spontaneously from the subconscious.  Using CRP as the primary treatment modality, one dreamhealing participant lowered her EBV count from 900 to 90, over a period of time; “normal” count is 100.

Gale Encyclopedia of Medicine

Goldstein, Jay A., M.D. CHRONIC FATIGUE SYNDROMES: THE LIMBIC HYPOTHESIS, Haworth Medical Press, New York; 1993.

Goleman, Daniel, EMOTIONAL INTELLIGENCE, Bantam Books, New York; 1995.

Swinney, Graywolf, HOLOGRAPHIC HEALING, Asklepia Foundation, c1999.

Pert, Candace B., Ph.D., MOLECULES OF EMOTION, Simon & Schuster, New York; 1997.