"No matter how hard the past, you can always begin again".

Buddha

CHONIC FATIGUE SYNDROME

Chronic fatigue syndrome is a condition which is also known by several other names including myalgic encephalomyelitis/encephalopathy (ME), chronic fatigue immune dysfunction syndrome (CFIDS) and post viral fatigue syndrome (PVFS).

Despite the various descriptions the most popular terms in use today are ME and CFS which are often used together as though they refer to the same condition, a move deemed controversial by many sufferers and medical experts.

National Institute for Health and Care Excellence (NICE) guidelines

NICE define ME/CFS as a condition which commonly see's a previously active and healthy individual experience a complex range of symptoms including severe fatigue and malaise following mental or physical activity. The full effects of this exhaustion may only appear 24 to 48 hours after the previous activity.

The NICE guidelines state that the condition may be triggered by an infection, although in some cases there is no obvious causative factor and instead the individual may report a gradual decline in health over a period of months or years.

Guidelines (2007) from the National Institute for Health and Care Excellence (NICE) recommend that doctors consider diagnosing CFS if an individual has fatigue with all of the following:

a clear starting point
persistent and/or recurrent
a substantial reduction in activity level
unexplained by other conditions
characterised by post-exertional malaise and/or fatigue (feeling worse after physical activity).

and one or more of the following symptoms:

headaches
sore throat
dizziness and/or nausea
difficulty sleeping, or insomnia
muscle and/or joint pain without inflammation
painful lymph nodes that are not enlarged
cognitive dysfunction, such as difficulty with thinking
general malaise or flu-like symptoms
physical or mental exertion that makes symptoms worse
palpitations, without heart disease.

Not everyone will experience all of the key symptoms and there is also a whole host of 'minor' symptoms which are often not mentioned when patients describe their illness.

Recommendations from NICE with regards to the management of ME/CFS are aimed at maintaining a patient’s current emotional, physical and cognitive capacity and extending it where possible.

Different approaches will be used for different people and will be based on an individuals needs and the severity of their condition.

Some treatment options recommended by NICE include cognitive behavioural therapy or graded exercise therapy for individuals with mild or moderate ME/CFS. The decision to proceed with either treatment will be made jointly by the patient and professional.

Counselling for patients and carers

How can I help you?

With psychotherapy we can break these cycles by tackling these complex and powerful emotions and develop effective coping strategies to change the way you think, feel and behave. By identifying with me the thoughts and behaviours that lead to your unhappiness, you can begin to increase your sense of control over your condition and manage your symptoms more effectively.

I can help you to remain on track with goals including lifestyle changes and teach you relaxation techniques in order to overcome the painful and uncomfortable aspects of CFS.

I may use a specific approach such as cognitive behavioural therapy which has proven effective in reducing the stress surrounding CFS, or combine several approaches in order to tailor the therapy to your specific needs.

Aside from the physical side effects of ME/CFS the condition also has a profound impact on emotional and psychological health. Those for whom the condition is moderate or severe may find they either lose or have to relinquish jobs, plans for the future, financial security, hobbies, relationships and any spontaneity they once had.

Both ME/CFS patients and their carers will have to make huge adjustments and coping with all of these changes will pose huge challenges for both parties. Below are just a few of the issues a counsellor may be able to help patients and carers overcome:

Guilt and self-blame – Many individuals blame themselves for having ME/CFS or not recovering from it and feel guilty that others in their lives have to make sacrifices to care for them.
Feelings of powerlessness – The inability to now carry out tasks which used to be possible can lead to a great deal of frustration.
Pressure to increase activity – Feeling pressured to increase physical activity faster then the body allows can cause frustration, disappointment and can worsen the condition.
Wanting to rewind the clock – Understandably ME/CFS sufferers wish to return to their previous level of mobility but this type of drastic recovery can't be guaranteed and is often unrealistic. Sufferers that dwell on who they used to be may develop feelings of self-blame, believing they could have done more to prevent the condition and it is these thoughts which prevent them from moving forward.
Frustration – There is a common misconception that those with ME/CFS don't have the inclination to carry out activities. In actual fact it is the opposite for most patients, many of whom want to undertake activities but are prevented from doing so because of their symptoms.
Fear - It is not uncommon for patients to fear the prospect of their condition remaining unimproved. In addition, a carer may also have similar fears to the person they are caring for. Worries about employment, financial insecurity, social life and relationships are completely natural but carers often mask these thoughts for fear of appearing selfish.