Psychotherapy and ME/CFS

A group of European psychologists and researchers say that although ME/CFS is a physical, not a psychosomatic illness, psychotherapeutic help could improve the mental well-being and coping strategies of numerous people with ME/CFS. They suggest a form of ME/CFS-adapted psychotherapy that tackles emotional needs and supports pacing to minimise post-exertional malaise (PEM).

Psychotherapy is the general term for treating psychological disorders and mental distress through verbal and psychological techniques… also commonly known as talk therapy, counselling, psychosocial therapy, or simply therapy… almost all types of psychotherapy involve developing a therapeutic relationship, communicating, and working to overcome problematic thoughts or behaviours. [Simply Psychology]

The Role of Psychotherapy in the Care of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, by  Tilman Grande, Bettina Grande, Patrick Gerner, Sabine Hammer, Michael Stingl, Mark Vink and Brian M Hughes, in Medicina Vol 59 Issue 4 [DOI:10.3390/medicina59040719]  6 April 2023 (This article belongs to the Special Issue Advances in ME/CFS Research and Clinical Care)

Article abstract:

Myalgic encephalomyelitis/chronic fatigue (ME/CFS) is a post-infectious, chronic disease that can lead to severe impairment and, even, total disability. Although the disease has been known for a long time, and has been coded in the ICD since 1969 (G93.3), medical research has not yet been able to reach a consensus regarding its physiological basis and how best to treat it.

Against the background of these shortcomings, psychosomatic disease models have been developed and psychotherapeutic treatments have been derived from them, but their empirical testing has led to sobering results. According to the current state of research, psychotherapy and psychosomatic rehabilitation have no curative effect in the treatment of ME/CFS.

Nevertheless, we see numerous patients in practices and outpatient clinics who suffer severely as a result of their illness and whose mental well-being and coping strategies would benefit from psychotherapeutic help.

In this article, we outline a psychotherapeutic approach that serves this need, taking into account two basic characteristics of ME/CFS: firstly, the fact that ME/CFS is a physical illness and that curative treatment must therefore be physical; and secondly, the fact that post exertional malaise (PEM) is a cardinal symptom of ME/CFS and thus warrants tailored psychotherapeutic attention.

Conclusion

There are several important and clear distinctions to be made between the pacing-led ME/CFS treatment approach that is outlined above and in many of the so-called ‘standard’ psychotherapeutic techniques that are often used with patients in health contexts.

Challenging patients’ cognitions and stress limits is so elementary to routine psychotherapeutic/ psychosomatic care that doubts about so-called ‘modifications’ in the sense of a ‘particularly careful’ approach to ME/CFS patients are, in our opinion, justified. However, conventional approaches involve unfulfillable therapeutic promises and the serious danger of deterioration.

We, therefore, believe that a radical paradigm shift is needed in psychotherapy, health psychology, and other fields where psychosocial and behavioral support is provided to ill people, and which recognizes the somatic nature of ME/CFS and adjusts therapeutic goals accordingly. A particular imposition of ME/CFS is the phenomenon of PEM, whose control by means of pacing demands a high degree of vigilance, discipline, and renunciation from the patients. This means an enormous challenge for those affected, which is not encountered in this specific way in other chronic diseases.

A psychotherapy that takes these realities into account and offers help in coping with them can make an important and, in our view, an indispensable contribution to the care of ME/CFS patients