Psychological aspects of treating CFS and ME
[UPDATED JULY 2023]
Clarification - CFS versus ME
- Chronic fatigue syndrome [‘CFS’] is characterised by poor energy delivery mechanisms.
- Myalgic-encephalitis [‘ME’] is characterised by poor energy delivery mechanisms AND inflammation.
Poor energy delivery is caused by poor diet and gut function, poor breathing, poor sleep, mitochondrial failure, and poor adrenal and thyroid function.
Inflammation occurs when the immune system is activated. The immune system is activated in allergy, chronic infection and auto-immunity.
In both CFS and ME there may also be an emotional hole in the energy bucket.
Please see Overview of CFS/ME protocol for more detail on these various components.
Introduction - are CFS and ME psychological or physical disorders?
This seemed such a stupid question that I never bothered much to consider it. I estimate I must have now (2023) seen well over 10,000 patients with CFS and ME and it is clear that both CFS and ME are physical disorders. It is only when patients have been ill for several months or years and have been told by their physicians that nothing is wrong, that they get secondary psychological problems. The only place where CFS and ME do not exist is in the brains of small-minded doctors. The central cause and lesion in CFS and ME is mitochondrial failure - see CFS - The Central Cause: Mitochondrial Failure.
This is why psychological interventions do not effect a cure
The new NICE Guideline, after reviewing hundreds of medical papers, have finally endorsed this view, especially with regard to Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET)
The committee wanted to highlight that cognitive behavioural therapy (CBT) has sometimes been assumed to be a cure for ME/CFS. However, it should only be offered to support people who live with ME/CFS to manage their symptoms, improve their functioning and reduce the distress associated with having a chronic illness. [NICE, NG206,Box 5]
And also that:
CBT for people with ME/CFS: (1)aims to improve their quality of life, including functioning, and reduce the distress associated with having a chronic illness (2) does not assume people have 'abnormal' illness beliefs and behaviours as an underlying cause of their ME/CFS, but recognises that thoughts, feelings, behaviours and physiology interact with each other. [NICE NG206, 1.12.32]
The Guideline went further on Graded Exercise Therapy (GET) and stated that:
Do not offer people with ME/CFS:....any programme ...that uses fixed incremental increases in physical activity or exercise, for example, graded exercise therapy [NICE NG206, 1.11.14]
Reference - NICE Guideline NG206 - "Recommendations"
GET can cause serious harm to CFS and ME sufferers
Evidence of harm caused by GET was submitted as part of the NICE [NG206] review of ME/CFS guidance –
Fifty-one percent of survey respondents (range 28-82%, n=4338, 8 surveys) reported that GET worsened their health
[So, in one of the 8 studies reviewed an astonishing 82% of patients reported a worsening of health following GET.]
...graded exercise therapy brings about large negative responses in patients (54%–74%)
But well delivered psychological interventions can help...
If there are "Emotional Hole" issues, please do not ignore them as dealing with them can help to make life more bearable. Please see:
Also, consider counselling or other psychotherapy, where you feel this would be helpful. See:
- U and I counselling is a voluntary counselling service run by professional counsellors, working to the BACP code of ethics. It is based in Oswestry, Shropshire.
- British Association for Counselling and Psychotherapy - Therapist Directory
Look for a practitioner who REALLY understands CFS and ME - you will find some great (especially Experienced Patient) practitioners here - Natural Health Worldwide
Are CFS and ME psychological conditions or a physical illnesses?
They are both physical disorders.
See also
Related Articles
- CFS - The Central Cause: Mitochondrial Failure
- Healing the Emotional Hole in the Energy Bucket
- Balancing
- CFS and ME - Psychological or Physical?
- Overview of CFS/ME protocol
- Natural Health Worldwide
External Links
- NICE Guideline NG206 - "Recommendations"
- U and I counselling is a voluntary counselling service run by professional counsellors, working to the BACP code of ethics. It is based in Oswestry, Shropshire.
- British Association for Counselling and Psychotherapy - Therapist Directory
References
- ‘Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome’
- ‘Myalgic encephalomyelitis/chronic fatigue syndrome patients’ reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments: Analysis of a primary survey compared with secondary surveys’
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