Chronic Fatigue Syndrome - Treatment

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The Procedure. CBT is usually performed over 6 - 20 sessions, each lasting about an hour. Patients are also given homework, which usually includes keeping a diary and attempting tasks that they have avoided because of previous negative attitudes.

A typical cognitive therapy program may involve the following measures:

• Keep a Diary. The patient is almost always asked to keep an energy diary, which can be a key component of CFS cognitive therapy. The diary serves as a general guide for setting limits and planning activities. The patient uses the diary to track any factors, such as a job or relationship, that may be worsening or improving the fatigue. It is also used to track the times of day when energy levels are at their highest and lowest.
• Adjust Schedule. The patient adjusts schedules to conform to energy peaks and valleys recorded in the diary. For instance, the patient may take a nap during low-energy times and plan important activities during high-energy times. Developing regular daily routines around probable energy spurts or drops may help establish a more predictable pattern.
• Confront Negative or Discouraging Thoughts. Patients are taught to challenge and reverse negative beliefs (such as "I'm not good enough to control this disease, so I'm a total failure."), and to use coping statements ("In what ways can I control this disease?").
• Be Flexible. Energy levels will probably never be entirely predictable. Patients must be prepared to adapt to energy variations. Instead of taking a long nap, for instance, patients may need 5- to 10-minute rest periods every hour or more, possibly involving relaxation or meditation.
• Set Limits. Limits are designed to keep both mental and physical stress within a manageable framework so that patients do not get into situations in which they are likely to fail. For example, tasks are broken down into incremental steps. Patients focus on doing one step at a time.
• Prioritize. Patients learn to drop some of the less critical tasks or delegate them to others.
• Manage Impaired Concentration. Patients seek out activities that are appealing, focus attention, and help increase alertness. They learn to request that instructions be given as concise, simple statements. External distractions, such as music or talking, are kept to a minimum.
• Accept Relapses. Over-coping and accomplishing too much too soon can often cause a relapse of symptoms. Patients should respect these relapses and back off. They should not consider them a sign of treatment failure or personal failure.

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