Coping with Chronic Fatigue
Week 1: Understanding chronic fatigue
Week 1 Action Plan
Week 2: Getting to know your symptoms
Action Plan Review
Week 2 Outline
Understanding chronic fatigue and getting to know your symptoms
Learning your ABC’s
The CBT feedback loop
A CBT model of chronic fatigue
chronic fatigue and mental health
Setting goals for recovery
Skills for symptom monitoring, goal setting and managing chronic fatigue in daily life
Monitoring your chronic fatigue symptoms
Be ‘SMART’ about goal setting
General tips for managing symptoms in daily life
Week 2 Action Plan
Week 3: Learning how to manage stress and relax
Action Plan Review
Week 3 Outline
Stress management and relaxation
Understanding the stress response
The stress response and chronic fatigue
Stress and worry in chronic fatigue
Ways to calm the stress response
Rest vs. relaxation – what’s the difference?
The benefits of planned relaxation
Relaxation for chronic fatigue
Mindfulness for chronic fatigue
Sleep and chronic fatigue
Skills for stress management and relaxation
Dealing with worry
Improving your sleep
Week 3 Action Plan
Week 4: Healthy thinking, healthy self
Action Plan Review
Week 4 Outline
Healthy thinking for a healthy self
The role of thoughts in chronic fatigue
Common thoughts in chronic fatigue
A case example: Marge
Identifying your thoughts
Unhelpful thinking styles
The benefits of changing your thinking
Skills to help you identify and manage unhelpful thoughts
Using a thought diary
Examining the evidence
Is it a helpful thought?
Finding the positives
Week 4 Action Plan
Week 5: Balancing your activity patterns
Action Plan Review
Week 5 Outline
Balancing your activity and reclaiming your life
Fear of body sensations
Balancing your activity
Exercise and chronic fatigue
Skills to help you balance your activity and reclaim your life
Know your baseline
Grading your activities
Week 5 Action Plan
Week 6: Maintaining your gains and staying well
Action Plan Review
Week 6 Outline
Introduction to relapse prevention
Look how far you’ve come!
Barriers to recovery
Learning to understand your body’s cues
Lapses versus relapses
When more help is needed
Skills to continue your progress and maintain your gains
Mapping your symptoms
Learning from your lapses
Create your own staying well plan
Big changes start with small steps
Week 6 Action Plan
About This Course
Dr. Joseph and Dr. Sal, between them they have held positions as Psychiatrists and University Academics in several institutions across Australia. Epsychonline is their effort to bring low-cost access to mental health care globally. Lofty ambitions! If you want to get to know them, visit our YouTube Channel.
About this course
Learn evidence-based scientific ways of coping with chronic fatigue
In this six week course, you’ll learn about chronic fatigue treatment, specifically evidence-based psychology skills. We believe that with the right skills coping with chronic fatigue can become easier.
By taking this self-help course, you’ll develop a foundation of chronic fatigue treatment skills. Week 1 is an introduction before we dive into more advanced topics. We will cover planned relaxation, radical acceptance, dealing with worry, unhelpful thinking styles, behavioural experiments, time-based pacing, and so much more.
If a lot of these terms are new to you, that’s okay. Our team has taken great care to explain it all to you. Read on to learn more.
Why we created this course
Chronic fatigue is a common condition, especially among women. As a society, we don’t acknowledge it. Millions of people suffer in silence, alone and struggle to get help. Misunderstood by friends, family and even health professionals, years of chronic fatigue can cause immense hurt and frustration.
Coping with chronic fatigue or chronic fatigue treatment skills, we believe, can be taught. With the advances in technology, we believe it can effectively be taught online.
How this course is different
Each week of this course is divided into five parts:
- Educational lessons at the start,
- Quiz to aid self-reflection,
- Aided self-reflection questions to get you thinking more,
- Tailored suggestions,
- Action plans and worksheets.
Depending on how you answer the questions in our quiz, you will get specific feedback and suggestions each week. The feedback and suggestions you take away from this course will be unique to you.
If two people were to do this course, the chances of getting the same feedback and suggestion would be over 1 in 100,000.
Our IT professionals and mental health experts have worked together to create a system that provides specific feedback and suggestions.
Why do we do this?
People are unique. We want to give you answers, feedback, and solutions that best suit you.
The reasons why you and someone else might struggle with chronic fatigue will be different. The same tips and suggestions aren’t going to work for everyone, which is why we have gone to the extent of providing tailored chronic fatigue treatment suggestions.
Key aspects of this course
Coping with chronic fatigue skills such as; radical self-acceptance, a DBT skill, self-compassion, managing flare-ups, time-based pacing, alternative thoughts and others. Troubleshoot the common roadblocks to chronic fatigue management.
We also cover chronic fatigue and mental health, self-monitoring activity diaries, dealing with worry and other psychology skills. The course ends with early warning signs, stay well plans and how to manage setbacks.
Is that this course will help you with your chronic fatigue. That it will form part of your chronic fatigue treatment plan and be a tool alongside other professional and informal supports you get. We want to get you thinking, understanding and questioning aspects of your chronic fatigue. Our hope is for you to experience lasting change when it comes to your well-being.
Good News! We have opened access to Week 1 of the learning material
Topics Covered in this section
Week 1: Understanding chronic fatigue
Introduction to this course
Welcome to the Epsychonline Coping with Chronic Fatigue Course. This is a six-week, self-help program for people struggling with chronic fatigue.
Do you suffer from frequent fatigue, which doesn’t get better with rest? What about issues with concentration, memory or dizziness? Do you wake feeling just as tired as when you went to bed? Or, have your usual activities become more effortful and harder to complete since you became unwell? Do you ever ‘crash’ after doing normal things? Lastly, have you struggled to find a medical explanation for your symptoms?
If you answered yes to any of these questions, you may be suffering from chronic fatigue. This is undoubtedly holding you back from reaching your full potential and living the life you want. Don’t worry, you’ve come to the right place! Whether you suffer from mild symptoms of fatigue or severe and debilitating Chronic Fatigue, there are sources of support and effective treatment options available to you.
This course is a great place to start, and we applaud you on making it this far in your journey towards freedom from chronic fatigue. All you need to get started with this course are basic reading skills and access to the internet. A good dose of motivation and an open mind will also go a long way. For anyone under the age of 18 years, we suggest a trusted adult be present to guide you through the content. Some of this content might trigger distress, so it is helpful to have support close by.
What to expect from this course?
This course will guide you through an evidence-based information and skills package to help you manage your chronic fatigue. The aims of this course are to help you:
- Better understand chronic fatigue and how it impacts you
- Set some realistic goals for improvement
- Get to know and understand your symptoms
- Learn about and manage stress more effectively
- Learn about and change unhelpful thoughts and activity patterns
- Make a plan to maintain your gains and recover from setbacks
The course runs for 6-weeks in total, with each week broken down into three sections:
- Section 1 provides educational content to help boost your knowledge of chronic fatigue and get you thinking about how the information applies to you. It also includes activities, or ‘action plans’, to help you put the principles you’ve learned into practice.
- Section 2 guides you through an aided self-reflection in the form of multiple-choice questions and tailored feedback. This builds on Section 1 by helping you develop deeper insight into the nature of your difficulties.
Section 3 uses your responses from Section 2 to provide you with additional self-help recommendations and resources that are targeted to your unique needs.
How to get the most from this course
Having a vision for life changing improvement is great, but it is also important to have realistic expectations for this course. Learning the skills in this course will take time and practice. The more effort you put in, the more you will get out of the course. You are likely to start noticing benefits as you make changes in your life, however, your difficulties are unlikely to disappear completely or be ‘cured’ within a short timeframe. To get long lasting benefits, you will need to continue your hard work well into the future.
When addressing complex health issues, it is not uncommon for things to get worse before they get better. Growing as a human being means stepping outside your comfort zone. With that said, feeling uncomfortable is often a sign of progress. We encourage you to redefine your view of success. Down the track, success might look like being completely free from chronic fatigue. But right now, success might look like simply engaging with the course content each week and making a series of small changes in the way you think about and relate to your symptoms. You may not immediately feel better, but we encourage you not to make this your aim.
On the flip side, failure does not exist in this course. Every so-called ‘failure’ provides you with useful information. You may learn something new about yourself, a situation, or a skill that you’re trying out. Remember, knowing what doesn’t work is just as valuable as knowing what does work. So, we encourage you to reframe setbacks as ‘opportunities for learning’. When things don’t work out as planned, reflect on what got in the way and make the necessary changes to improve next time. The most important thing is that you keep trying.
A special note on chronic fatigue: the symptoms of chronic fatigue may make completing a course like this harder than normal. We have made each week slightly shorter to account for this, however, you may need to make further adjustments as needed. For example, you could break weeks down into smaller chunks and have regular breaks between them. You might also like to repeat materials, make notes and revise key concepts more regularly. Remember, what you can do one day may differ from the next, so try to be flexible and kind to yourself.
Understanding chronic fatigue syndrome (CFS)
What is CFS?
Chronic fatigue syndrome (CFS) is a serious, long term condition that disrupts many aspects of a person’s life. CFS is characterized by extreme fatigue or tiredness that doesn’t get better with rest. The fatigue is ongoing and often means that people can’t do the things they used to do. In severe cases, CFS can cause people to be bed- or house-bound. Typically, the fatigue gets worse after increased physical or mental activity and makes it difficult to complete essential daily tasks.
There are several other symptoms associated with CFS, including sleep problems, difficulties with memory and concentration, pain, and dizziness. We discuss the symptoms of CFS in more detail below. However, to receive a diagnosis of CFS, your symptoms must not be explained better by another medical condition. Misperceptions about CFS unfortunately still exist. Some people with CFS report that others think the condition isn’t ‘real’ or that it’s ‘all in their head’. Of course, this further adds to the burden of this illness.
Anyone can be diagnosed with CFS, but women are more likely to be affected than men. Young to middle-aged adults are the most commonly affected age-group. There is no ‘cure’ for CFS, however, symptoms can be managed effectively with the right treatment. CFS progresses differently for different people, so it is important to work closely with your doctor to create a management plan that is suited to your needs. As its name suggests, CFS is a ‘chronic’ condition, which means it is ongoing.
Research shows that people can and do recover from CFS, but it is not a fast process. The recovery journey often takes a matter of months or years, sometimes longer. It is not something that will happen overnight. This is important to keep in mind as you progress through this course and beyond. Generally speaking, recovery takes longer for those who are older and have more severe symptoms.
Receiving a diagnosis of CFS
To receive a diagnosis of chronic fatigue syndrome (CFS), you need to have had severe fatigue for longer than 6 months. The fatigue does not get better with rest and interferes significantly with your usual activities. For example, you are unable to work or are unable to get out of bed for days after attending an event. To receive a diagnosis of CFS, your symptoms must get worse after increased activity and you must have a few other symptoms (e.g., problems with sleep, pain, or concentration).
The symptoms of CFS are often similar to those seen in other conditions, such as fibromyalgia, multiple sclerosis, and hypothyroidism. The side effects of some medications can also mimic chronic fatigue symptoms. This often makes CFS a difficult condition to diagnose. Furthermore, there are no medical tests to screen for CFS. As such, your doctor must rule out all other potential medical causes before you can receive a diagnosis. This process can be tedious and frustrating, especially for the person who is unwell and wanting answers.
CFS can only be diagnosed by a qualified medical professional, you cannot diagnose this condition yourself. Your doctor will need to ask you many questions about your medical history, do a physical and mental examination and order blood and urine tests to rule out other problems. Questions they ask you may include things like:
- How long have you been unwell?
- What are you able to do now compared to before you became unwell?
- What makes you feel better or worse?
- What happens when you push yourself physically or mentally?
Once your doctor has all of the information, they will be able to make a diagnosis. In some cases, they might refer you to a specialist doctor for a second opinion. They may also ask you to fill in some questionnaires as a way of obtaining more information. For example, it is common for doctors to screen for mental health difficulties in people with chronic fatigue-like symptoms. As such, receiving the right diagnosis (and care for CFS) requires you to work closely with your health care team. It is important to find a doctor you trust and who understands CFS.
Common signs and symptoms of CFS
The symptoms and severity of chronic fatigue can vary between people. The primary symptom of CFS is severe fatigue, which lasts for longer than 6 months and impacts your ability to perform usual activities. Problems with sleep are also common and people with CFS often don’t feel rested, even after a full night of sleep. Symptoms tend to worsen after physical or mental activities which previously wouldn’t have caused problems. This symptom is known as ‘post-exertional malaise’ (PEM), but is more commonly referred to as ‘crashing’.
The fatigue associated with CFS is more than normal tiredness. It can be extremely debilitating and is not due to excessive physical activity or a lack of sleep. Crashes may not be predictable and can come on suddenly. For example, Mel couldn’t leave her bed for days after attending her daughter’s dance concert and Jim has to spend evenings and weekends recovering from his work, even though his job itself is not very demanding. Both Mel and Jim were physically fit and very active prior to their CFS.
In addition to the above, there are some other common symptoms in CFS. These may include:
- Difficulties with memory and concentration
- Brain fog (difficulty thinking clearly)
- Worsening of symptoms when standing up (e.g., feeling faint, weak, dizzy etc.)
- Unexplained muscle or joint pain
- Muscle weakness
- Frequent sore throat or flu-like symptoms
- Swollen or sore lymph nodes
- Digestive problems (e.g., irritable bowel syndrome, bloating, nausea)
- Night sweats
- Shortness of breath
- Heart palpitations
- Sensitivities to light, temperature, noise etc.
Not everyone with CFS will have additional symptoms. However, when present, additional symptoms can make CFS particularly severe. Chronic fatigue ranges from ‘mild’, when a person’s activity is reduced by about half of what they could do previously, to ‘severe’. In severe cases, people with CFS are confined to bed and are fully dependent on help for all daily activities. As such, some people with CFS are unable to work, study, socialise or function properly in the community.
It’s not ‘all in your head’
As we mentioned earlier, there is no test for CFS and there are often no outward signs of illness or injury. In some ways, this makes CFS an ‘invisible illness’. The challenges of an invisible illness can be complex and highly distressing. In addition, there are many myths and misconceptions about CFS. Some people with CFS believe others don’t view their illness as ‘real’. This can leave the sufferer feeling misunderstood, frustrated and alone in their pain.
Unfortunately, this experience can also occur within the medical system. Whilst knowledge and awareness of CFS is growing, patients with CFS still sometimes feel misunderstood by their doctors. Some feel as though they are not taken seriously because they don’t “look sick”. When you’re feeling unwell, it can be extremely disheartening to be left without answers. Feelings of hopelessness and despair can set in at this point. As such, it’s extremely important to have a good relationship with your doctor.
Remember, CFS is a very real disorder with serious implications for your health and quality of life. While mental health plays a role in CFS and may worsen its symptoms, conditions like depression, anxiety and stress do not cause CFS. Behavioural and psychological strategies can help the condition, but CFS most certainly is not ‘all in your head’. Scientific evidence shows that CFS is not an ‘imagined illness’ or a psychological condition. Rather, it is a complex biological disease that causes observable physical abnormalities in the body.
Possible causes of CFS
The causes of chronic fatigue are not well understood. The most likely scenario is that there are several possible causes that could interact to produce CFS. Research points to a range of factors that might trigger the illness. See if you identify with any of these as we go through the list below.
There is some evidence that chronic fatigue runs in families and may therefore have a genetic basis. However, the exact gene or genes involved in CFS are not yet known. Genetics may put you at a higher risk of CFS compared to others.
Illness or infection
Often, people with CFS report that they had an illness or infection beforehand, which they never fully recovered from. For example, viruses, the flu, and glandular fever are commonly reported. It is thought that the initial infection causes neuro-immune dysfunction in the body, which later leads to the symptoms of CFS. However, no single type of infection has been found to cause CFS.
Problems with the immune system
People with CFS may have problems with their immune system that contribute to their illness. Research has found chemical markers of poor immune function in some people with CFS. However, it is unclear whether this impairment is enough to actually cause the condition.
Stress affecting body chemistry
Stressful or traumatic life events have also been linked to chronic fatigue, including injury, physical trauma and emotional distress. The reasons behind this link are not well understood, but probably include changes in body chemistry and the stress response. Similarly, people with a busy lifestyle may be at a greater risk of developing CFS.
Personality traits definitely don’t cause CFS. However, there is some evidence that people with CFS tend to be conscientious, hardworking and perfectionistic. The presence of these personality traits may interact with the above factors to make it more likely that someone will get CFS.
As you can see, more research is needed to understand the causes of CFS. Fortunately, much more is known about what maintains CFS. This gives us ideas for what to target in treatment. You’ll learn more about the things that keep CFS going and different treatment options as we move through this course. Before moving on, try to trace your CFS back to the point that it started. Can you identify a possible trigger? Perhaps a family member also suffers from the condition?
Treatment options for CFS
As we have mentioned, there is no cure for chronic fatigue. However, many CFS symptoms can be treated or managed effectively. Of course, treating symptoms does not get rid of CFS, but it may provide considerable relief for some people. However, not everyone with CFS responds well to treatment. It can be a process of working with your family and healthcare team to create a management plan that works best for you.
Treatment should target the worst symptoms first. Have a think about which symptoms are most disruptive and disabling to you and aim to address these first. Often, benefits in one area will extend to benefits in another area. For example, when Juan addressed his sleep problems, his low mood and pain also started to improve. Secondary diagnoses, such as depression and anxiety, can also be treated to provide patients with CFS relief.
Common treatment options for CFS include things like cognitive behavioural therapy (CBT) and energy management strategies. Speaking with a therapist can also help people cope with CFS and find ways to manage its impact on daily life and relationships. In some cases, lifestyle changes are advised (e.g., dietary changes) and people should also be guided in practicing good sleep hygiene. Sometimes, medications may be prescribed to help with symptoms like pain, sleep disturbance and depression. Importantly, graded exercise therapy (GET) is NOT recommended for people with CFS anymore.
Keep in mind that the type of treatment you receive will depend on your symptoms and preferences. Your doctor should discuss each option with you, including the potential risks and benefits. With the right care, some people make a full recovery and return to their prior level of functioning. Others continue to have symptoms and require ongoing management. In either case, it is important to remain optimistic about your recovery. The fact that you’re engaging with this course means you are motivated to get better. Motivation is a fantastic starting point for recovery and a great predictor for success.
Myths about CFS
As mentioned, there are many common misconceptions about chronic fatigue syndrome (CFS). Some of these misconceptions are harmful and add to stigma surrounding the condition. CFS can be a confusing condition, with symptoms coming and going for no apparent reason. In this section, we clear up some of the misconceptions by discussing some common myths.
Myth 1: Chronic fatigue is a mental disorder – it’s ‘all in your head’
- Although chronic fatigue can be associated with psychological symptoms, it is not a mental disorder. There is a clear biological basis for this condition, which is linked to functioning of the immune and nervous systems. The mental side of chronic fatigue is important but secondary in terms of symptoms and is not a cause for the condition itself. In other words, depression and anxiety may occur in response to the primary symptoms of CFS, but primary symptoms are physical in nature.
Myth 2: Chronic fatigue is just like normal tiredness
- The symptoms of chronic fatigue include overwhelming physical and mental exhaustion. The severity of the fatigue is far greater than you would experience after intense activity or a few nights of poor sleep. In this case, you are likely to feel better after a few days of rest. However, in CFS, the fatigue is ongoing (for more than 6 months) and symptoms do not improve with rest or sleep. CFS is also associated with other symptoms that are not related to tiredness (e.g., muscle pain, headaches etc,).
Myth 3: Chronic fatigue is an excuse for laziness
- This is a particularly misinformed and harmful myth. CFS is a medical condition, not a personality trait or life choice. Symptoms often fluctuate, meaning that someone with CFS may be full of energy one day and completely exhausted the next. Ill informed people may assume changes in activity are a matter of personal choice. However, in reality, people with CFS have little control over their energy levels. Often, they simply can’t do more, even though most desperately want to.
Myth 4: Chronic fatigue only affects women
- While women are most likely to be affected by chronic fatigue, men do get the condition too. In fact, CFS affects people of all genders, social groups and ages. Children can get CFS too, which can be particularly disruptive to their school work. For men, it may be that cases of CFS are underreported. In most places around the world, men are typically less likely to seek medical care for their symptoms than women.
Myth 5: Chronic fatigue is cured by exercise
- If you’ve had CFS for a while, you’ve probably heard people say “just go and do some exercise, you’ll feel better”. Whilst they may mean well, this can be incredibly frustrating and unhelpful advice to receive. Evidence suggests that exercise worsens CFS symptoms and may cause relapse. There is no evidence that exercise is a cure for chronic fatigue. As such, exercise should be approached carefully and only under medical supervision for people with CFS. More research is needed to fully understand the link between exercise and CFS.
After reading these myths, were there any that you also believed in? Perhaps you still believe them. Either way, we encourage you to continue with this course and see if your understanding and opinions change as you learn more. The next section helps you apply what you’ve learned so far to yourself. We encourage you to think about the topics we have covered within the context of your own life and personal experiences.
Understanding chronic fatigue in your own life
We have talked a lot about chronic fatigue in general terms. In this section, we want you to apply what you’ve learned so far to yourself. Take a moment to think about how chronic fatigue presents in and impacts your own life. Below are some questions to get you started:
- How much does my chronic fatigue interfere with my life overall?
- In which areas of my life does chronic fatigue impact me the most?
- How would my life be different if I no longer had chronic fatigue?
Great job on getting this far. We have covered a lot about chronic fatigue, and you’ve done well to stick with us! In the next section, we briefly discuss Cognitive Behaviour Therapy (CBT), which forms the foundation for the remainder of this course.
What is cognitive behavioural therapy (CBT)?
Cognitive behavioural therapy (CBT) is an evidence-based psychological treatment. CBT has been tested widely by researchers to ensure that it is a safe and effective therapy. Research has shown that CBT is one of the most effective treatments for a range of mental health concerns. There is also evidence for CBT as a helpful therapy for people with a range of chronic illnesses, including chronic fatigue syndrome. In fact, the National Institute for Health and Care Excellence (NICE) lists CBT as one of its recommended treatments for chronic fatigue.
The aim of CBT is to help you identify and challenge unhelpful ways of thinking and acting. CBT is based on the idea that your thoughts, feelings, physical sensations and actions are all connected. It assumes that negative patterns of thinking and acting can keep you stuck and feeling lousy. CBT helps you deal with problems by breaking them down and challenging the negative patterns that maintain them. By teaching you new and more helpful ways of thinking and acting, CBT can help improve the way you feel.
CBT is traditionally delivered in structured, face to face settings with a trained therapist. However, access to this kind of therapy is not always convenient or available. Our online courses aim to make support more easily accessible and available to those who need it. There is growing evidence to suggest that CBT delivered in an online format is just as effective as face to face sessions. However, this course is not intended to be a substitute for therapy with a qualified health practitioner.
CBT is based on several key principles or assumptions, which are important to know and remember throughout this course. CBT involves learning skills to help reduce your unwanted symptoms. It helps you reduce unhealthy patterns of thinking and behaving, whilst teaching you new and more helpful strategies.
Here are some of the CBT principles:
- CBT is focussed on problems in the here and now, meaning it aims to solve current problems rather than delve into the past or find the origins of these problems.
- CBT requires goal setting to help guide the therapy and evaluate your progress. Goals should be realistic and related to the problems you are facing.
- CBT aims to be time-limited, meaning that you work towards overcoming your problems within a set time frame. This can help keep you on track towards your goals.
- CBT uses a variety of techniques to help you change your thoughts, actions, and mood.
- CBT encourages active participation in therapy and requires you to practice the skills between sessions. Skills practice is essential for achieving lasting change.
- CBT teaches you to become your own therapist, by involving you in the therapy process and ensuring that you understand how to manage unhelpful thoughts and behaviours. This is essential for preventing a return to old habits once therapy has finished.
Keep these principles in mind as you move through the course. Pay particular attention to the importance of active participation in CBT. We strongly encourage you to be an active participant to get the most out of this course. Each week, we will give you an ‘action plan’ to complete before you return for the following week. The aim of the action plan is to guide your practice of the skills in your daily life.
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As you’ll learn in this course, there are several factors that keep chronic fatigue going. Some factors are outside of your control, whilst others are changeable. For example, research has shown that your beliefs about fatigue and the way you manage your symptoms both play a role in how you experience chronic fatigue. This makes sense from a CBT perspective, which suggests that your thoughts and actions impact how you feel. It follows then, that by changing your unhelpful thoughts and actions, you can start to feel better.
CBT offers a useful framework for understanding chronic fatigue, which can be empowering in itself. The CBT model (covered further in Week 2) helps to acknowledge that your illness is real, whilst also giving you a clear pathway forward for improvement. CBT can help you explore and change the thoughts and actions that currently maintain or worsen your illness. It also offers you new ways of coping with difficult symptoms and emotions. Over time, CBT can help you to rebuild self-confidence and regain a sense of control and enjoyment in your life.
CBT skills for chronic fatigue include:
- Education on thoughts, feelings, actions and chronic fatigue
- Self-monitoring techniques to better understand your symptoms
- Stress management and relaxation skills to help you calm your nervous system
- Cognitive skills to address unhelpful thoughts
- Behavioural strategies to help you better manage your symptoms and regain a sense of control in your life
- Relapse prevention skills to help you maintain your gains and stay well into the future
The Epsychonline Coping with Chronic Fatigue Course is based on CBT principles. We hope that you find these skills helpful on your recovery journey. When practiced regularly, CBT skills can be life changing. Within the context of chronic fatigue, the skills you’ll learn in this course have the potential to redefine your relationship with chronic fatigue forever. However, as with any new skill, CBT requires effort and commitment. Each week, you’ll need to put what you learn into practice in your own life. The action plan tasks we provide will help you with this.
After a while, if things aren’t falling into place, you may consider speaking to a trained CBT therapist who can give you some extra support. A trained therapist will be able to work closely with you to help you overcome any barriers to your treatment and recovery.
Making a commitment to change
It is well known that any type of behaviour change can be a challenge. As we have mentioned, the tasks in this course will be no different. CBT assumes that people must commit to practicing new skills if they are to achieve meaningful improvement. This section includes some exercises to help you think about and make your own commitment to change. These exercises are included as action plan tasks for this week. So, for now just read through and reflect on the information, taking as much in as you can.
To give yourself the best chance of success in this course, you will want to keep your motivation levels high. One way to maintain your motivation is to know your reasons for change. That is, be clear about the reasons why you want to change. Revisiting these reasons will give you the push you need when things get tough. So, take a moment to think about what you would like to change and what brought you to this course.
Below, we have provided you with some example reasons for wanting to change. We also encourage you to come up with your own reasons, as these will be more meaningful to you.
For example, I want to:
- Reduce the impact of chronic fatigue symptoms on my life
- Engage or reengage in activities (e.g., exercise, work, travel)
- Improve my performance in an area of life (e.g., work, sports)
- Feel more confident in myself
- Improve my self-esteem
- Improve my mood, concentration, memory etc.
- Feel more optimistic about the future
- Be able to enjoy social activities more often
- Feel less stressed and worried
- Gain a sense of freedom and control in my life
Take a look at the pros and cons
Hopefully you have had a chance to think about your reasons for change. As a next step, we encourage you to think about the pros and cons of working to change the way you think about and relate to your chronic fatigue symptoms. Doing a pros and cons analysis can help you decide on the best course of action moving forward. We suggest you write your answers down on a sheet of paper, as this can help you clearly work through your thoughts.
In this exercise, you are aiming to compare the pros (benefits) and cons (costs) of 1) Trying the skills you’ll learn in this course, versus 2) Not trying the skills and staying the same. Once you have listed all of the pros and cons, you can weigh up each option to find out which one will get you closer to your goals. Remember to think about both short- and long-term pros and cons. Once you have chosen your option, you can come back to your pros and cons list as a reminder for why you chose that option. This can be helpful for those times when your mind asks you “what’s the point?”.
Self-contract and goal setting
If you’ve decided you’re ready to commit to change, congratulations! This is the first step on your journey towards recovery from chronic fatigue. We encourage you to formalise this commitment by making a contract with yourself. Signing a change contract means you are serious about this commitment and will be more likely to follow through with action. The self-contract will also prompt you to set some goals, which can be great tools for motivation and staying on track.
When thinking about setting goals, it is important to make sure your expectations are realistic and achievable. We suggest that you don’t make complete symptom resolution your goal, as this is an unlikely outcome of this course. Rather than focussing on what you don’t want (e.g., chronic fatigue symptoms), think about what you do want/would be doing if you had less symptoms, and make this your goal. It is often more helpful and realistic to set goals that focus on something you are moving towards or trying to accomplish.
For example, instead of saying “I want to have less symptoms”, you could say “I want to start doing regular exercise again” or “I want to leave the house more often”. Once you have your goals, you’ll need to consider the steps required to achieve them and set a reward for when you follow through. You may also want to enlist the support of friends and family on this journey, as they can help keep you accountable and on track towards success. If you feel comfortable, let them be a witness to your change contract.
Big changes start with small steps
Let’s end with a small note on a big topic. Often, we have a vision of what we want to achieve, and we expect ourselves to get there in one big leap. This is not only unrealistic, but it is simply unfair given that you’re dealing with chronic fatigue. Throughout this course, we encourage you to acknowledge each small step you take towards your goals, no matter how insignificant it may seem. This is a tough journey, so break it down and be kind to yourself along the way.
This course is a big ask for anyone, let alone when you’re feeling exhausted or down. As such, a gentle and graded approach will serve you best. This course aims to help you, so don’t let it be an additional stressor in your life. We expect you to have breaks and make mistakes along the way, in fact, we encourage it. Finding the right pace and what works for you will be a process of trial and error. Continue to remind yourself of this as you move through each week of the course and acknowledge the progress you are making simply by showing up.
Start right now by congratulating yourself on getting to the end of the Week 1 educational content. We think this is an accomplishment in itself that is worth celebrating, so see if you can set aside some time to reward yourself for your efforts.
Great job and see you next week!