Coping Better With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

Cognitive Behaviour Therapy for CFS/ME

Bruce Fernie, Gabrielle Murphy

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9780367323530
• eBook ISBN:
  9780429912283
• Topic: Psychology
• Subtopic: Diseases & Allergies
• Index: Psychology

This book provides a helpful structure and framework for understanding Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) and its effects as well as practical exercises to help address some of the symptoms that patients may experience.

Chapter One

Critical incidents, vulnerability factors and maintaining factors

While we do not know precisely what causes CFS/ME, for many people there seems to be certain sets of ‘critical incidents’ that coincide with the onset of their CFS/ME, as well as certain ‘vulnerability factors’ that may have increased their chances of acquiring CFS/ME. Examining what these might be for you may seem a little like shutting the stable door once the horse has bolted, but we think that figuring out what these might be is an important part of your recovery, and may affect decisions you make in the future. Before we get on to that, we will explain what we mean by critical incidents.

A critical incident is an event or series of events that were happening in your life about the time you acquired CFS/ME. Some people might have been ill with some kind of viral infection; others might have experienced some kind of trauma or stress—like bereavement, divorce, or a loss of a job. Many people may have experienced a combination different factors. For some people, it might be difficult to identify a particular ‘trigger’ for their CFS/ME. Their CFS/ME may have gradually developed over a few years, as they experienced more and more of these stressful events.

A vulnerability factor refers to characteristics that may have helped to shape an individual’s response to a critical incident. For example, a very driven individual who places great emphasis on achievement in a work or study setting may respond to being ill (critical incident) by continuing to work, believing that they should not take time off, because perhaps it conflicts with their work ethic, or they may perceive it as a sign of weakness. A vulnerability factor can be internal (e.g. being a highly motivated and driven individual), or external (e.g. pressure from work).

We will begin by looking at a few vignettes describing the initial experiences of individuals with CFS/ME. On reading, you might find that you can relate to aspects of these histories. Also, as you read, consider what might constitute a critical incident and a vulnerability factor for the individuals.

Example 1

Vincent has been suffering from CFS/ME for eight years. He used to be a self-employed carpenter and worked very hard to get his business off the ground. He was determined that he would build an excellent reputation for producing the highest quality work and beating deadlines. Vincent picked up a viral infection just about the same time as he heard that he had won a contract to work on a new housing development. The contract was very important to his business and so he worked through his illness, ignoring his symptoms. Eventually, he could no longer continue and he ‘crashed’ and took to bed. He experienced severe fatigue, tender lymph nodes, and joint ache. He spent the best part of the next three months in bed, and although he completed the contract for the housing development, he was unable to take on any new work and his business became impossible to sustain.

Critical incidents

In Vincent’s case, it would seem that his CFS/ME may have been triggered by a combination of a viral infection, working hard whilst he was ill, and perhaps the stress of fulfilling the obligations of the new contract for his business.

Vulnerability factors

Vincent seems to have set some very high standards for himself. There is a hint that Vincent might be a perfectionist—what with his drive to always produce the highest quality work and always finish before the deadline. It could be that this vulnerability factor led him to continue to work hard despite the fact that he was ill.

In Vincent’s line of work, and especially when building up a business, it is very important to produce high quality work in order to develop a positive reputation. The consideration should perhaps have been to manage his health as a priority, as his business depended on his continued well-being.

Questions

What else could Vincent have done when he first became ill and had won the new contract for the housing development

Example 2

Anna is a 31 year old woman. About four years ago her mother became ill. Anna juggled her time between her husband, her job and looking after her mother. Two years ago, Anna’s marriage ended in divorce. Although Anna and her husband did not have any children, the divorce was ‘messy’. Around this time, Anna noticed that she was feeling more fatigued than usual. However; she did her best to continue caring for her mother. Her fatigue became worse and she began to develop other symptoms like tender lymph nodes and muscular aches and pains. She went to see a doctor, who told her that she was depressed and prescribed anti-depressants. Her mood and her fatigue improved a little, but she did not make a complete recovery. Currently, she is still fatigued and has developed a variety of other symptoms. She has had to give up work, but on good days she goes to see her mother and tries to help with the housework.

In the box below, write down what you think might have been the critical incident(s) in Anna’s case. Also, try to think what the vulnerability factors were for Anna—write these down too. Ask yourself what aspects of Anna’s character may have contributed to her taking on so much (e.g. trying to make her marriage work, keeping up with her career and taking on the care of her ill mother)? What was it about Anna that resulted in her not making other arrangements to care for her mother—even after Anna herself began to feel ill?

Now it is time to start applying these concepts of vulnerability factors and critical incidents to you. What was going on in your life about the time that you first became ill? Could any of these events be potential critical incidents? Our memories can be sketchy, so if you have a partner or close friend who knew you then, perhaps ask them to see if they can also recall what was going on in your life about the time you first became ill.

Once you have identified your own potential critical incidents, ask yourself how you responded to them. Does your response suggest anything about you? Does it suggest anything about the factors that may have made you more vulnerable to acquiring CFS/ME? In the first example above,...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHORS
• FOREWORD
• INTRODUCTION
• CHAPTER ONE Critical incidents, vulnerability factors and maintaining factors
• CHAPTER TWO Goal setting
• CHAPTER THREE Thoughts and feelings
• CHAPTER FOUR Sleep
• CHAPTER FIVE Activity
• CHAPTER SIX Energy capsules
• CHAPTER SEVEN Impact crosses
• CHAPTER EIGHT Challenging unhelpful patterns of thinking
• CHAPTER NINE Stress and anxiety
• CHAPTER TEN Core beliefs
• CHAPTER ELEVEN Symptom mapping
• CHAPTER TWELVE Planning for setbacks
• CHAPTER THIRTEEN Medical perspective