Figure 2.1 a vicious circle of fatigue

My vicious circle of fatigue

  PART TWO

Learning How To Cope

Introduction

In this part of the book we aim to help you to tackle some of the things that may have been contributing to keeping your chronic fatigue syndrome going. We hope that, as you follow the strategies outlined here, your symptoms will become less intense or even go away; and that, if some of them do not, you will feel more able to cope with them, so that you will be able to do more of what you would like to do.

The first three chapters in this part set out the framework for the practical work that follows. These will give you a solid foundation on which to base your efforts, and we do recommend that you read through them two or three times before embarking on the following sections.

First, in Chapter 3, we talk about cognitive behavior therapy (CBT) as a treatment for chronic fatigue syndrome. It is important that you know that the techniques included in this book have been used effectively to help people with CFS in research studies, as well as by a variety of specially trained health professionals. We then outline what is involved in applying CBT techniques in a self-help program designed to help overcome CFS. In Chapter 4 we show you how you can gather and record information about your own condition and how you actually live at the moment; for example, when and how you rest and sleep, how much activity you take and when. In Chapter 5 we show how you can set realistic and appropriate targets for yourself. These chapters will enable you to know exactly what you are aiming to achieve and to measure your progress step by step. We then move on in Chapters 6–11 to describe the various techniques that will help you to change or adapt the way in which you manage your illness.

  3

Cognitive behavior therapy for chronic fatigue syndrome

In this chapter, after outlining a few facts about cognitive behavior therapy and how it has been used to treat chronic fatigue syndrome, we discuss what you will be doing to help yourself to overcome your chronic fatigue problems in the next few months. We would like you to pay particular attention to the short section on this page entitled ‘A few words of warning!’, as it will help you to clarify whether this is the right approach for you and whether you need to see your doctor before you make a start.

What is cognitive behavior therapy?

Cognitive behavior therapy (CBT) is a treatment that has been found to be valuable and effective in helping people with many illnesses and disorders, including chronic pain, irritable bowel syndrome, and diabetes, as well as depression, eating disorders, and conditions related to anxiety. CBT focuses on identifying and changing not only patterns of behavior but also the patterns of thought that keep them going – hence the ‘cognitive’ element alongside the ‘behavioral’ element in the name.

In the course of their work with various illnesses and conditions, cognitive behavior therapists became aware that many people who could benefit from the approach do not have access to qualified therapists in their area, and that the efforts individuals make to overcome their own problems often actually have the reverse effect, keeping those problems going and sometimes even making them worse. With this in mind, self-help programs have been developed using the methods and techniques applied in CBT, and these have been found to help many people reduce or eliminate the symptoms of various disorders without recourse to individual therapy (see the front of this book for a list of the disorders tackled by the Overcoming series.). This book offers such a program, aimed at helping individuals to overcome their symptoms of chronic fatigue by following strategies that we have designed according to the principles of CBT and used in our professional therapy practice.

Although many people have been helped to overcome many different illnesses and disorders by using these self-help programs, there are some people for whom they are not appropriate; so again, we urge you to read and consider the section ‘A few words of warning!’ before you embark on the work set out in the following chapters.

Has any research shown that CBT is helpful in CFS?

The effectiveness of CBT in treating CFS has been evaluated in three well-conducted research studies undertaken since the 1990s. All three were conducted as randomized controlled trials; that is, trials in which there are more than one treatment group, and participating patients do not know which group they are in. CBT was found to produce better results than the other treatments with which they were compared.

Two of the trials were carried out in the UK. The first, conducted in Oxford, compared CBT with seeing a doctor for ‘usual’ medical care. At the end of the one-year follow-up period, two-thirds of the participants who had had CBT were functioning at satisfactory levels, compared with only a quarter of those who had been given ‘usual’ medical care. The second trial, carried out at King’s College Hospital, London, compared 13 sessions of CBT with a similar number of sessions of relaxation therapy. Here, too, at the six-month follow-up stage, about two-thirds of patients who had been given CBT achieved satisfactory levels of functioning, compared with about a quarter of those who had received relaxation therapy. At the five-year follow-up point, many of those who had improved through CBT had sustained that improvement.

A third study, carried out in the Netherlands, divided participants into three groups, one receiving CBT, one taking part in a support group, and one receiving no treatment. At the eight-month follow-up, CBT was found to be significantly more effective than either of the ‘control’ options: approximately half of the patients who had received CBT had improved to a satisfactory level of functioning. There was no difference in outcome between the two control groups.

What will I have to do?

Chapters 4–11 will guide you through the procedures necessary to help you to deal with the various problems associated with your chronic fatigue syndrome. This section summarizes the components of the program.

Monitor your activity levels

To help you to build up an accurate picture of what you are doing each day, you will be asked to complete activity diaries every day for at least a few weeks. These diaries will help you to see at a glance whether there are times when you are doing too little or too much.

Monitor your sleep pattern

To help you to build up an accurate picture of your sleep, you will be asked to complete a sleep diary for a few weeks. This will help you to see at a glance whether or how often you have difficulties with your sleep; for example, taking a long time to go to sleep, waking frequently in the night, sleeping for many hours on some nights and only a few on others, etc.

Set your own targets

Setting targets will help you to focus on what you would like to work towards during the next few months. It is a good idea to have targets across a range of areas of life – including, for example, leisure interests and pursuits as well as work and home tasks – so that you are aiming to construct a balanced lifestyle.

Use a variety of strategies to improve your sleep

The strategies that you use to improve your sleep will depend on your particular sleep problem(s). For example, if you have no set times for going to bed or waking up, you may find it helpful to learn how to establish a routine. If you have problems going to sleep at night, you will learn strategies to help you to get to sleep more quickly: these may involve developing a routine before going to bed, reducing sleep in the day, and learning to cope with worries that may be keeping you awake.

Stabilize your activity and rests

This will involve planning a program of scheduled activity and rest, which you will review and change every couple of weeks or so. The aim is to carry out the same amount of activity and rest each day, avoiding bursts of activity when feeling well and long periods of rest when fatigued. Introducing short periods of relaxation will be important if you generally do too much.