Cognitive-behavioral therapy teaches you how to change your thinking and fears that prevent you from planning and managing your activities realistically. Research shows that people with chronic fatigue syndrome (CFS) can improve when they learn about their ability to control their health and then take steps to do so.^{Reference 1}

Some facts about cognitive-behavioral therapy:

• It is not psychoanalysis. You will not be asked to lie on a couch and delve into your subconscious and your dreams.
• It's more like coaching or counseling. You and your therapist will talk about what your goals are and ways to reach them.
• It's not about fooling yourself into thinking positively. It's about learning how to think accurately about your situation instead of letting fear guide your feelings and your behavior.
• Therapists teach self-help strategies, such as gentle exercise, improving sleep habits, learning to pace daily activities, getting support from others, and daily meditation and relaxation exercises.

The people with chronic fatigue syndrome (CFS) who have the best chance of improvement are those who remain as active as possible and who seek to have some control over their illness. A therapist can help you do that. For example, you may believe that any activity that causes fatigue will make your illness worse. You may be afraid to expend energy for fear of having a relapse.

Because a cognitive-behavioral therapist helps you work on your thinking patterns and on the way you react to problems, you can learn to let go of beliefs and fears about CFS that may be contributing to inactivity and despair. With therapy, you can learn how to calm your mind and your body so that you can feel better, think more clearly, and make better decisions.

For most people, therapy usually consists of weekly one-hour visits over the course of just a few weeks or months. Longer-term and/or more frequent therapy is available for those who need it. Here are some of the techniques a cognitive-behavioral therapist may teach you:

• Keeping an energy diary. This can serve as a guide for what limits you should set on your activities and how to plan your day according to how your energy level changes throughout the day.
• Confronting discouraging thoughts. This will help you move from the idea that "I'm not strong enough" to the idea that "I will find evidence to show that I can control this disease."
• Learning to be flexible. This can help you adapt when your energy levels vary from their usual pattern.
• Setting limits. Many people with CFS need to learn how to pace themselves to avoid over-exercising and bringing back their fatigue.
• Prioritizing and delegating tasks. You can identify jobs or activities that are more important for you to perform and assign family and friends to perform others.
• Accepting relapses. It’s easy to do too much too soon, and it’s important to accept what happens when you do that— and then move on.

Therapy can be expensive and may not be covered by insurance, but the fact that it is usually short-term helps keep the cost down.

Talk with your doctor

If you're wondering whether cognitive-behavioral therapy is for you, take this information with you when you visit your doctor and talk about it.