Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is largely considered to be a physical condition, characterised by long-term fatigue and pain, as well as sleep disturbances and 'brain fog', or difficulty concentrating. However, because of the psychological impact of the condition, the National Institute for Health and Care Excellence (NICE) recommends that Cognitive Behavioural Therapy (CBT) - a psychological therapy more commonly associated with depression, anxiety, and other mental health conditions - can be an effective treatment.
We asked Accredited Counsellor Darren Magee, who lives with ME himself, to explain what CBT is, and how it can be used to effectively manage the symptoms of Chronic Fatigue Syndrome.
CBT works by identifying your unhelpful thinking patterns and behaviours, and allowing you to develop healthier ways of managing. CBT therapists use reframing techniques and exercises to help you recognise that when something happens you will form a particular belief about it - you filter the event in a particular way, but there are different perspectives, and there are consequences for how you filter each event. It's not about you being right or wrong, it's just about encouraging you to recognise your thought processes and consider alternative perspectives. CBT also often uses handouts to help you identify your thinking habits, like catastrophising and emotional reasoning, so when you can see those patterns and have a visual cue for your thought processes then you can maybe begin to recognise what you're doing, which makes it easier to step back and reassess.
All illnesses have a psychological aspect to them; with CFS, because of the persistent disturbed sleep, low mood, brain fog, pain and fatigue that comes with the condition, it can be easy to get into unhelpful thinking and behavioural habits. CBT can help you develop ways to monitor and pace your activity, set goals and problem solve, shift the focus of your attention, and defuse any anger and frustration you feel about the condition. People with CFS tend to go through a lot of emotional reasoning - 'it's true because I'm thinking it', 'it's true because I'm feeling it', 'it's true because I heard it', and so on - which really exacerbates the CFS symptoms when you go into a bad spell. The worse those physical symptoms get, the worse your mood, and again, the worse your mood, that feeds into your pain levels, and so on. Another symptom of CFS is commonly referred to as 'brain fog', where it's difficult to concentrate or hold a conversation, so CBT can be very good for psychoeducation - educating people about the nature of the condition and, with that information, helping you to start building up plans, setting goals, looking at regulating and monitoring, or 'pacing' your activities.
NICE recommends CBT for Chronic Fatigue Syndrome. The number of sessions will vary depending on your needs.
As with all kinds of therapy, whether CBT or otherwise, it's really about the work you put into it. I'm a big believer that you can't frogmarch somebody into being helped - it's not something that's done to you - so you need to be engaged and accept the fact that some of the interventions might not work. That doesn't mean it's failing, it just means you may have to look at something else. Having seen both sides, as a therapist and someone with CFS myself, I know there's a lot of controversy around viewing chronic fatigue illnesses like ME and fibromyalgia as mental illnesses, so whenever therapy gets suggested immediately a lot of defence mechanisms go up. I think it's important to recognise that no, it's not a mental illness, but there is that psychological aspect. From my perspective, I've found that CBT works as part of a combination of many treatments.
Again, as with all kinds of therapy, it's not a cure, so the outcome is more about learning to manage - even learning to ask for and accept help, because sometimes that can also be an obstacle. One thing I've found is that CBT can help people recognise that the pain, the fatigue, the lack of sleep, and so on, really can compound your mood and make you depressed, and that as your mood deteriorates, so does the physical side. Educating people about that cycle is an important outcome.
All therapists on rscpp.co.uk are accredited, registered or chartered by a UK professional body. Therapists who offer Cognitive Behavioural Therapy will in addition have completed a course in cognitive behavioural practice.
It can be helpful to have a therapist who has experience working with chronic fatigue conditions. Because CFS is a very difficult thing to diagnose, often when I hear other people talk about it they seem to have had very poor experiences with their doctors or medical professionals. Some GPs get it, they understand, and they'll work with it as best they can; others can be very blunt and say I don't believe in this illness. Therapists are always trained to be understanding and empathic, and to work with whatever you bring to the sessions, so I don't think it's necessarily a barrier if your therapist doesn't have direct experience with CFS - I believe our clients always educate us anyway - but I do think it can be helpful if the therapist has an understanding of the many different aspects of the condition. It's not just fatigue, there's also a lot of pain associated with the condition - headaches, light and sound sensitivity, poor diet, and sleep's completely disrupted, so there are so many different things to work with and look at.