The Role of Psychotherapy in the Care of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

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.