ME/CFS and Fatigue
Understanding the condition
Historically there has been a great deal of conflict between medicine and people who suffer from ME/CFS and related fatiguing disorders. It is very common for people to feel disbelieved or to come away from medical appointments with the feeling that their problems are somehow “all in the mind”.
Older approaches
Psychology and psychiatry have, at times, had a difficult relationship with people who suffer from ME/CFS. Older theories suggested that people were misinterpreting normal tiredness, avoiding activity because of anxiety, or becoming unwell through deconditioning. This led to treatments such as Graded Exercise Therapy which many people experienced as unhelpful and, in some cases, harmful, particularly where post exertional symptom worsening was not properly recognised.
ME/CFS is real and physical
My own view is that ME/CFS is a complex, multisystem, neurophysiological condition that is not under conscious or voluntary control. The symptoms are real, physical, and can be profoundly disabling. I do not believe the condition can be adequately explained simply in terms of anxiety, low mood, personality, or “not thinking positively enough”.
Management and recovery
Unfortunately, at the time of writing, there is still no definitive diagnostic test and there is no simple curative medical treatment. That can leave many people feeling frightened, frustrated, or abandoned. However, although there may not currently be a cure, there are ways of understanding and managing the condition that may help people gain more stability, reduce setbacks, and improve quality of life. Some people also do appear to recover substantially over time, although we still do not properly understand why this happens for some people and not for others.
How Therapy may help
So what does psychology have to offer for a long term medical condition?
What are Clinical Psychologists?
Clinical Psychology is the science of how people function and adapt at every level, from the brain and nervous system, through to emotions, behaviour, habits, stress, relationships, and the wider social world in which people live. Clinical Psychologists are trained to understand how people respond to illness, uncertainty, pain, fatigue, trauma, and major life change, and how those responses can sometimes unintentionally improve or worsen quality of life over time.
Understanding responses
Although ME/CFS is not simply caused by psychological factors, The ways in which people understandably respond to the condition can still have a very real impact on symptoms, functioning, and wellbeing. This is not about blame. Most people with ME/CFS are trying extremely hard just to get through the day. But living with a poorly understood and fluctuating illness can place enormous strain on people physically and emotionally.
Boom and bust cycles
Many people become trapped in “push-crash” cycles where they overdo things on better days, only to pay for it afterwards with a significant worsening of symptoms. Others become understandably cautious about activity because of the consequences of getting it wrong. Sleep can become disrupted. Confidence in the body can be lost. People often experience grief for the life they once had, anxiety about the future, pressure from work or family, or guilt about not being able to function in the way they once could. All of this can add further stress to an already overloaded physiological system.
The role of Therapy
Psychology cannot simply cure ME/CFS. However, it may help people better understand symptom patterns, develop more sustainable pacing strategies, reduce boom and bust cycles, manage stress more effectively, rebuild confidence, and cope with the emotional impact of living with a long term condition. Therapies such as Acceptance and Commitment Therapy (ACT) can also help people build a meaningful and worthwhile life alongside difficult symptoms, rather than life becoming completely dominated by illness.
What you can expect from me
The approach that I take is collaborative, practical, and grounded in current evidence. It starts from the position that ME/CFS is a real and serious physical condition, while recognising that psychological science may still have useful things to offer when it comes to reducing suffering and improving quality of life. Therapy is adapted to the individual, the severity of symptoms, and the realities of living with a fluctuating condition.