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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.

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Emotions Motivate Actions

Many clients find it helpful to recognize the range of actions that are motivated by different emotional states. This worksheet encourages clients to ...

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 ...

How Your Body Responds To Stress

Many clients identify with the concept of ‘stress’ more readily than ‘threat’ and the The How Your Body Responds To Stress information handou ...

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 'boom and ...

Understanding Burnout

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ...

Values: Connecting To What Matters

Values: Connecting To What Matters is a practical self-help guide which introduces the reader to a cornerstone of acceptance and commitment therapy (A ...

What Is Burnout?

Our ‘What Is … ?’ series is a collection of one-page information handouts for common mental health conditions. Friendly and explanatory, handout ...

Links to external resources

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Guides and workbooks

  • Pacing for people with M.E | Action For M.E.

Information Handouts

Treatment Guide

  • CBT for chronic fatigue: therapist manual | Starbuck, Loades, Chapple | 2022
  • CBT for Chronic Fatigue: Therapist Manual | Starbuck, Loades, Chapple | 2022
  • CBT For CFS Participant Manual | Burgess, Chandler | 2004
  • PACE: CBT for CFS/ME (Therapist manual) | Burgess, Chalder | 2004

Recommended Reading

  • 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.
  • Nijhof, S. L., Bleijenberg, G., Uiterwaal, C. S., Kimpen, J. L., & van de Putte, E. M. (2012). Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial. The Lancet, 379(9824), 1412-1418.
  • 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.
  • Larun, L., Brurberg, K. G., Odgaard‐Jensen, J., & Price, J. R. (2016). Exercise therapy for chronic fatigue syndrome.Cochrane Database of Systematic Reviews, (2).
  • Knoop, H., Prins, J. B., Moss-Morris, R., & Bleijenberg, G. (2010). The central role of cognitive processes in the perpetuation of chronic fatigue syndrome. Journal of psychosomatic research, 68(5), 489-494.
  • Hartle, M., Bateman, L., & Vernon, S. D. (2021). Dissecting the nature of post-exertional malaise.Fatigue: Biomedicine, Health & Behavior,9(1), 33-44.

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)


  • 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:
  • Harvey, S. B., & Wessely, S. (2009). Chronic fatigue syndrome: Identifying zebras amongst the horses. BMC Medicine, 7(1), 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:
  • 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.