‘I need to start listening to what my body is telling me.’: Does mindfulness-based cognitive therapy help people with Chronic Fatigue Syndrome? by Bridie O’Dowd & Gemma M Griffith in Human arenas 2020, July 16 [https://doi.org/10.1007/s42087-020-00123-9]
Mindfulness-Based Cognitive Therapy (MBCT) was lightly adapted for participants diagnosed with chronic fatigue syndrome (CFS). The aim of the study was to explore participants’ experiences of the MBCT course, with a particular focus on how they applied MBCT to living with and coping with the symptoms of CFS.
Nine participants with CFS who completed the MBCT course were interviewed using semi-structured interview methods. Inductive thematic analysis, a methodology designed to generate themes from the ‘bottom up,’ was used.
Four superordinate themes were generated from the data: (1) awareness of unhelpful
behavioral patterns associated with CFS, (2) benefits of group solidarity, (3) use of mindfulness tools to facilitate shifts in behavioral patterns, and (4) a sense of change and agency.
Participants became aware of three specific transformative changes that contributed
to a more skillful way of living with CFS: development of acceptance, improved self-care and self-compassion, and reduction in heightened stress response. MBCT appears to enable people with CFS to actively work with their symptoms, and make transformative changes in their behavioral patterns, resulting in benefits to well-being.
Excerpts from Discussion:
During the course, participants described how they became aware of specific vulnerabilities that are particular to CFS, and with the support of the group and specific mindfulness tools, reported a change in habit patterns which maintain and perpetuate CFS, such as perfectionism, being driven, people-pleasing, and tendency to catastrophize. There were three very specific transformative changes that occurred as a result of the MBCT course, which were supported across the four superordinate themes. These were the development of acceptance, a cultivation of self-care, and a reduction in heightened stress reaction.
Development of Acceptance
Given the chronic, unpredictable nature of CFS and the lack of curative treatment, cultivating a stance of acceptance of “what is,” shifted the participants’ agenda from a goal of “getting rid” of their condition to working skillfully with it. Crane (2008) describes the goal-driven “doing” mode as being cognitively focused and future orientated. This creates a tendency to discrepancy monitor, that is, monitoring the mismatch between where one actually is and the goal of where one wants to be (Bishop et al. 2004; Segal et al. 2013). The participants developed awareness that this striving to close the gap of how they found themselves and how they wished themselves to be, often demanded large amounts of draining energy.
The shift to acceptance, as a valid mode of coping with CFS, was enhanced by the mutual, supportive learning environment of the class. For some participants, acceptance involved acknowledging the fundamental truth of their current disability. For others, it was a recognition of the impossibility of meeting previous high standards and a welcome letting go of the exhausting maintenance of habit patterns. After the course, participants recognized that these patterns such as perfectionism, people pleasing, and feeling guilty were not only counterproductive but also potentially instrumental in the etiology of their condition (Hambrook et al. 2011; Luyten et al. 2011; Van Houdenhove and Luyten 2008).
Cultivation of Self-Care
The extant research which explores MBPs for CFS populations reported significant shifts in self-reported measures of anxiety, somatization, and unhelpful cognitions and behaviors (Rimes and Wingrove 2013; Sampalli et al. 2009; Surawy et al. 2005). However only the latter of these studies measured and reported improvement in self-compassion scores (Neff 2003). This study showed that increased self-care and self-compassion were fundamental to the shift participants experienced in managing their CFS.
This shift to enhanced self-kindness appeared to arise from a willingness to step out of the driven, energy-draining personality traits of perfectionism, high standards, conscientious, driven working style, and a strong susceptibility to self-criticism (Hambrook et al. 2011; Luyten et al. 2011). The mechanisms by which the mindfulness training enabled this shift appeared to be threefold. First, there was an increased awareness and an intention to “listen” to symptoms rather than ignore them. This led to a more gentle, kindly, and forgiving attitude towards their bodies experiencing fatigue and pain.
Second, the participants developed metacognitive awareness (Bishop et al. 2004; Teasdale 1999), allowing them to observe their thought processes more clearly. This allowed them to recognize the critical, driven nature of their self-narrative and enabled them to create a kinder less judgmental inner-dialog. Third, the kindness and care developed within the group acted as a medium in which a “permission to self-care” was cultivated. This permission frequently translated into a license to rest, previously un-granted because striving and pushing was so ingrained and prevalent. This shift frequently resulted in protection and preservation and replenishing of limited energy.
Reduction in Stress Reaction
As the course progressed, many participants became aware of an exaggerated stress response, felt physically in the body as pain and fatigue, emotionally as anxiety, and cognitively as fast, racing thoughts. This awareness led participants to actively apply mindfulness to reduce their stress response. First, they found the breath gave them a sense of grounding, calming, stepping back, and providing rest from stressful experiences and reactions. Second, they found everyday mindfulness allowed them to shift attention from catastrophizing thoughts, which would inevitably generate a high stress response onto the more neutral actuality of what they were doing in that moment. Third, they developed a self-soothing inner-dialog that encouraged them to move attention to the breath, remember that thoughts are not facts, and recognize that there may be a habitually exaggerated response going on that they could disengage from. As a result, many of the group reported a reduction in pain and fatigue.