It is still unknown what causes CFS. There is an ongoing debate about the extent to which it is a physical or psychological condition. CFS symptoms may have been preceded by a physical illness or a period of stress and are influenced by predisposing, precipitating, and maintenance factors.

Some of the predisposing factors may include:

  • Hidden negative thoughts about your performance that serve as a self-fulfilling prophecy.
  • Emphasis on achievement and performance
  • Strict rules for living
  • Comparison of current performance with previous high standards causing negative feelings
  • Excessive concern about the opinions of others
  • Mind reading biases where you may assume that others judge you negatively
  • You may have a need to meet high standards
  • You may have difficulty admitting and accepting weaknesses
  • Inability to describe and express emotion implicated in psychosomatic disorders.

Some of the precipitating factors may include:

  • Major life event
  • Illness, glandular fever, cervical lymphadenopathy, positive monospot, bed rest, increased immune activation and psychosocial stress create additional stress on the body and mind. It may happen that healthy individual begins to experience symptoms of CFS due to exhaustion.
  • Increased introspection and physical monitoring
  • Poor physical fitness associated with reduced volumes of oxygen in the body, reduced muscle metabolism, and reduced muscle blood flow.
  • Increased workload

Some of the maintenance factors may include:

  • A belief that one has a disease, with little recovery chances
  • Fear of exhaustion
  • Being overweight and poor diet
  • Ignoring CFS problem
  • Unhelpful behaviours that may include rumination, giving up pleasurable activities, self-criticism, alcohol or substance
  • Unhelpful responses to the symptoms of CFS
  • Overemphasis on what one cannot do
  • Avoidance of activities due to performance anxiety
  • Emotional problems such as anxiety especially overpredicting future bad outcomes, depression
  • Poor sleep leads to tiredness
  • Lack of activity/rest balance
  • Excessive exertion during a period of wellbeing leading to frustrating effort and ineffectual rest
  • Hidden emotional gain and disadvantages of getting better, for example, increased care from others
  • Core beliefs about own inadequacy influence mood and the energy levels

Every person has a unique combination of influencing factors and some of the maintaining factors could be precipitating and vice versa. Although there is no standardised treatment plan, because every individual experiences the condition differently, your psychotherapist will assess your unique situation by asking questions about your family and medical history, onset, triggers, the experience of CFS, and any underlying or co-occurring mental health difficulties. It is expected that you have already visited your GP for a health check-up or you will be advised to do so to eliminate any organic causes.  At the assessment stage, each factor’s impact on CFS symptoms will be evaluated. Your psychotherapist will guide you through a comprehensive treatment plan addressing any related to CFS difficulties such as psychosocial problems, limiting beliefs, perfectionism and high standards, self-sacrificing, sleep problems, or hyperventilation. Your treatment plan will include interventions that cover aspects of physiology and psychology. Your therapist will use the latest medical research in combination with interventions from cognitive behavioural therapy and psychoanalytic therapy depending on your presentation.

You will set goals and learn physical and psychological strategies designed to alleviate your suffering and design graded activity and rest schedule at a level that does not cause severe symptoms. Some of the initial suggestions you may choose to practice before your therapeutic session are:

  • Take vitamin D. Fatigue can be due to vitamin deficiency.
  • Delegate more tasks and identify areas where you could reduce demands on yourself
  • Setting priorities
  • Take breaks at work to eliminate boom and bust pattern of extreme productivity followed by extreme fatigue
  • Create time for yourself where you engage in pleasurable activities
  • During rest times, engage in relaxing your mind as well as the body since the mental activity is also tiring.
  • Plan your week and stick to the plan even though there is a temptation to do more
  • If you do overdo it, do not “crash out”, but try to stick to the original program of behaviour and you will see your stamina and energy levels
  • Divide tiring activities into chunks that you can complete throughout the day ensuring that CFS symptoms are not so extreme.

Your psychotherapist will help you to understand what is your optimum functioning levels where you can perform tiring tasks without crashing and maintain consistent performance over time. This will include dividing tiring activities throughout the day.