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CBT For Chronic Fatigue Syndrome (CFS)

Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis (ME) is characterized by extreme fatigue, post-exertional malaise, and feeling generally unwell. The causes for CFS/ME are not fully understood and possible causes include viral infections, immune disturbances, or disturbances to the central nervous system. As with any human experience, CFS has a psychological component, which means that psychological approaches can form part of a support or treatment package for CFS/ME.

The Science Media Centre states that “CFS/ME is highly controversial with longstanding disagreements between the mainstream medical community and campaigners about its cause and treatment” (Science Media Centre, 2018). Interventions currently recognized by the UK’s National Institute for Health and Care Excellence (NICE) as suitable for supporting people with CFS/ME include rest and sleep, strategies to maintain and prevent deterioration of physical functioning, and cognitive behavioral therapy (CBT). Read more
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Activity Diary Worksheet with hourly time intervals

Activity Diary (Hourly Time Intervals)

Activity diaries can be used for activity monitoring during an assessment phase of therapy, symptom monitoring during therapy, correlating activity wi ... https://www.psychologytools.com/resource/activity-diary-hourly-time-intervals/

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Activity Diary Worksheet with no time intervals

Activity Diary (No Time Intervals)

Activity diaries can be used for activity monitoring during an assessment phase of therapy, symptom monitoring during therapy, correlating activity wi ... https://www.psychologytools.com/resource/activity-diary-no-time-intervals/

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Activity Menu

Helping clients to choose which activities to target during behavioral activation can be accomplished in a variety of ways: activity monitoring can b ... https://www.psychologytools.com/resource/activity-menu/

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Behavioral Activation Activity Diary

Behavioral Activation Activity Diary

Behavioral activation (BA) is an effective treatment for depression. Different behavioral activation protocols include a variety of treatment componen ... https://www.psychologytools.com/resource/behavioral-activation-activity-diary/

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Behavioral Activation Activity Planning Diary

Behavioral Activation Activity Planning Diary

Behavioral activation (BA) is an effective treatment for depression. Different behavioral activation protocols include a variety of treatment componen ... https://www.psychologytools.com/resource/behavioral-activation-activity-planning-diary/

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Behavioral Experiment

Behavioral experiments are planned experiential activities to test the validity of a belief. They are one of the most powerful techniques available to ... https://www.psychologytools.com/resource/behavioral-experiment/

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Behavioral Experiment (Portrait Format)

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment-portrait-format/

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CBT Daily Activity Diary With Enjoyment And Mastery Ratings

Activity diaries can be used for activity monitoring during an assessment phase of therapy, symptom monitoring during therapy, correlating activity wi ... https://www.psychologytools.com/resource/cbt-daily-activity-diary-e-m/

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Psychology Tools Guide To Challenging Your Negative Thinking

Challenging Your Negative Thinking

A cornerstone of cognitive behavioral therapy is that an individual’s interpretation of an event determines how they feel and behave. We all experie ... https://www.psychologytools.com/resource/challenging-your-negative-thinking/

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Exercise For Mental Health

Exercise is an evidence-based treatment for depression and anxiety and research suggests that, in the treatment of depression, exercise interventions ... https://www.psychologytools.com/resource/exercise-for-mental-health/

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Fatigue Activity Diary

Activity diaries are a crucial information-gathering tool. They can be used for activity monitoring during an assessment phase of therapy, symptom mon ... https://www.psychologytools.com/resource/fatigue-activity-diary/

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Health Anxiety Thought Monitoring Record

Individuals with health anxiety experience clinically significant distress associated with health concerns. This thought-monitoring record enables cli ... https://www.psychologytools.com/resource/health-anxiety-thought-monitoring-record/

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Health Anxiety Thought Record

Individuals with health anxiety experience clinically significant distress associated with health concerns. This thought-challenging record enables cl ... https://www.psychologytools.com/resource/health-anxiety-thought-record/

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Identifying The Meaning Of Body Sensations

Some anxiety disorders (including panic and health anxiety), are concerned with body sensations and symptoms. The Identifying The Meaning Of Body Sens ... https://www.psychologytools.com/resource/identifying-the-meaning-of-body-sensations/

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Pacing For Pain And Fatigue

Pacing is an evidence-based approach to increasing activity and fitness, and in reducing overall pain and fatigue. It is designed to prevent ‘bo ... https://www.psychologytools.com/resource/pacing-for-pain-and-fatigue/

Exercise

Pain Activity Diary

Activity diaries are a crucial information-gathering tool. They can be used for activity monitoring during an assessment phase of therapy, symptom mon ... https://www.psychologytools.com/resource/pain-activity-diary/

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Pain Diary

Self-monitoring of thoughts, feelings and symptoms is an essential skill for clients engaged in cognitive behavioral therapy (CBT). In this Pain Diary ... https://www.psychologytools.com/resource/pain-diary/

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Progressive Muscle Relaxation

Progressive relaxation training originated in the 1930’s as a treatment for tension and anxiety. Edmund Jacobsen developed a systematic and lengthy ... https://www.psychologytools.com/resource/progressive-muscle-relaxation/

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Progressive Muscle Relaxation Audio

Progressive Muscle Relaxation (Audio)

The Progressive Muscle Relaxation exercise guides the listener through a sequence in which muscle groups are tensed and relaxed. ... https://www.psychologytools.com/resource/progressive-muscle-relaxation-audio/

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Progressive Muscle Relaxation (Edition 1)

Muscle tension is one reaction to stress and anxiety. This exercise includes instructions for Progressive Muscle Relaxation, a technique for promoting ... https://www.psychologytools.com/resource/progressive-muscle-relaxation-edition-1/

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Sleep Diary

Many clients report that their sleep is disturbed, and this can be a cause or consequence of many mental health conditions. This Sleep Diary enables c ... https://www.psychologytools.com/resource/sleep-diary/

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Therapy Blueprint

Since the publication of this version of the therapy blueprint we have also developed a more sophisticated version: Therapy Blueprint (Universal) A th ... https://www.psychologytools.com/resource/therapy-blueprint/

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Unhelpful Thinking Styles

Human thinking is subject to a number of characteristic biases. Cognitive restructuring is the process of helping individuals to overcome their biases ... https://www.psychologytools.com/resource/unhelpful-thinking-styles/

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What Does Exercise Do For the Mind And Body?

Exercise is an evidence-based treatment for depression and anxiety and research suggests that in the treatment of depression, exercise interventions l ... https://www.psychologytools.com/resource/what-does-exercise-do-for-the-mind-and-body/

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Intervention

Treatment guidelines

  • Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management | National Institute For Health And Care Excellence | 2021 download archived copy

Research treatment manuals

The PACE trial was a large-scale study comparing CBT, graded exercise therapy (GET), and standard medical care for CFS. The results have been the matter of some debate, and graded exercise therapy is explicitly contraindicated in the most recent NICE guidelines (2021).

Information Handouts

Centers For Disease Control And Prevention Toolkit

Recommended Reading

  • Hartle, M., Bateman, L., & Vernon, S. D. (2021). Dissecting the nature of post-exertional malaise. Fatigue: Biomedicine, Health & Behavior, 9(1), 33-44. download
  • Larun, L., Brurberg, K. G., Odgaard‐Jensen, J., & Price, J. R. (2016). Exercise therapy for chronic fatigue syndrome. Cochrane Database of Systematic Reviews, (2). download archived copy
  • Marques, M. M., De Gucht, V., Gouveia, M. J., Leal, I., & Maes, S. (2015). Differential effects of behavioral interventions with a graded physical activity component in patients suffering from Chronic Fatigue (Syndrome): An updated systematic review and meta-analysis. Clinical psychology review, 40, 123-137. download archived copy
  • White, P. D., Goldsmith, K., Johnson, A. L., Chalder, T., & Sharpe, M. (2013). Recovery from chronic fatigue syndrome after treatments given in the PACE trial. Psychological medicine, 43(10), 2227-2235. download archived copy

What Is Chronic Fatigue Syndrome / Myalgic Encephalomyelitis?

Signs and Symptoms of CFS/​ME

CFS/​ME is characterized by disabling tiredness (fatigue) that lasts a long time and cannot be explained by other causes. CFS/ME should be considered if the fatigue prevents the individual from doing things that they used to be able to, if the fatigue gets worse after activity or gentle exercise, or if the following symptoms are present:

  • sleep problems
  • pain in the muscles or joints
  • headaches
  • sore throat or sore glands that aren’t swollen
  • problems thinking, remembering, concentrating, or planning
  • flu-like symptoms
  • feeling dizzy or sick or having palpitations
  • exercising or concentrating on something makes your symptoms worse

Psychological Models and Theory of CFS/​ME

Understanding of the causes and maintenance of CFS/​ME is incomplete. Biomedical factors likely play a role. Like any physical illness it is normal to have thoughts and feelings about symptoms and what they mean, and so psychological approaches also have potential clinical value. Models of CFS/​ME including psychological factors include:

  • Browne and Chalder (2006)
  • Burgess and Chalder (2004)
  • Vercoulen et al. (1998)
  • Harvey and Wessely (2009)
  • Roche, Dawson, Moghaddam, Abey, and Gresswell (2017)
  • Wiborg, Knoop, Frank, and Bleijenberg (2012)

References

  • Browne, T., & Chalder, T. (2006). Chronic fatigue syndrome. Psychiatry, 5(2), 48–51.
  • Burgess, M., & Chalder, T. (2004). Cognitive behaviourtherapy for CFS/​ME: PACE manual for participants. MREC v. 2. Retrieved from: https://me-pedia.org/images/7/7a/PACE-cbt-participant-manual.pdf
  • Harvey, S. B., & Wessely, S. (2009). Chronic fatigue syndrome: Identifying zebras amongst the horses. BMC Medicine, 7(1), 58. https://doi.org/10.1186/1741-7015-7-58
  • Roche, L., Dawson, D. L., Moghaddam, N. G., Abey, A., & Gresswell, D. M. (2017). An Acceptance and Commitment Therapy (ACT) intervention for Chronic Fatigue Syndrome (CFS): A case series approach. Journal of Contextual Behavioral Science, 6(2), 178–186.
  • Science Media Centre (2018). Science Media Centre Factsheet: CFS/​ME—The illness and the controversy. Retrieved from: http://www.sciencemediacentre.org/wp-content/uploads/2018/03/Science-Media-Centre-Factsheet-CFS-ME.pdf
  • Vercoulen, J. H. M. M., Swanink, C. M. A., Galama, J. M. D., Fennis, J. F. M., Jongen, P. J. H., Hommes, O. R., van der Meer, J. W., & Bleijenberg, G. (1998). The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: Development of a model. Journal of Psychosomatic Research, 45(6), 507–517.
  • Wiborg, J. F., Knoop, H., Frank, L. E., & Bleijenberg, G. (2012). Towards an evidence-based treatment model for cognitive behavioral interventions focusing on chronic fatigue syndrome. Journal of Psychosomatic Research, 72(5), 399–404.

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