Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Using Healthy Thinking

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Living with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) can be hard. It can keep you from living life the way you want. It may strain your relationships with loved ones too, making it hard to be the kind of friend, parent, or partner you want to be. You may feel stressed or get depressed or anxious.

Some doctors may recommend cognitive-behavioral therapy , or healthy thinking, as part of your treatment plan. This type of therapy doesn't work for everyone with ME/CFS. More research is needed to better understand how well this treatment works for ME/CFS.

  • Cognitive-behavioral therapy is a way to help you stay well and cope with chronic fatigue by changing how you think. And how you think affects how you feel. Negative thoughts can make you feel worse. Healthy thinking can help.
  • Healthy thinking can take away barriers to being physically active, such as discouraging thoughts. This helps because light aerobic exercise, such as walking, helps some people who have ME/CFS feel more energetic and less tired.
  • Changing your thinking will take some time. Be patient with yourself as you learn healthy thinking. It may not feel right at first, because you are trying out something new. But with daily practice, it will get easier and feel more natural. And it's something you can start doing today.

How can you use healthy thinking to cope with chronic fatigue?

Many people work with a therapist or a counselor to learn healthy thinking techniques. 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. And after you learn the techniques, this is something you can do on your own.

Working on your own or with a counselor, you can practice these three steps:

  • Stop. Notice your thoughts. When you notice a negative thought, stop it in its tracks and write it down.
  • Ask. Look at that thought and ask yourself whether it is helpful or unhelpful.
  • Choose. Choose a new, helpful thought to replace a negative one. Ask yourself: What effect does believing this thought have on me? What might happen if I tried to believe the more healthy thought?

The goal is to have encouraging thoughts come naturally. It may take some time to change the way you think. You will need to practice healthy thinking every day.

Notice and stop your thoughts

The first step is to notice and stop your negative thoughts or "self-talk." Self-talk is what you think and believe about yourself and your experiences. It's like a running commentary in your head. Your self-talk may be rational and helpful. Or it may be negative and not helpful.

Ask about your thoughts

The next step is to ask yourself whether your thoughts are helpful or unhelpful. Does the evidence support your negative thought? Some of your self-talk may be true. Or it may be partly true but exaggerated. Here are a few types of unhelpful thoughts to look for:

  • Focusing on the negative: This is sometimes called filtering. You filter out the good and focus only on the bad. Example: "I've had some good days, but having one good day doesn't mean that I will have more." Reality: Just like life, not all days are good. But that doesn't mean every day will be bad. Having good days means that you are capable of having them, and more lie ahead.
  • Should: People sometimes have set ideas about how they "should" act. If you hear yourself saying that you or other people "should," "ought to," or "have to" do something, then you might be setting yourself up to feel bad. Example: "If I've been following my graded-exercise plan, then I should have more energy." "If I take all my medicines as prescribed, then I should have no pain." Reality: There's nothing wrong with expecting that your exercise plan should work. But graded-exercise is a slow process that takes patience to get the best results.
  • Overgeneralizing: This is taking one example and saying it's true for everything. Look for words such as "never" and "always." Example: "There's nothing I can do to have more energy." Reality: On some days, having chronic fatigue can seem overwhelming. But dwelling on your fatigue can make it worse. Instead, try to focus on ways you can manage your fatigue. What was different in previous times when you had more energy? How did you cope then? Can some of those strategies help?
  • All-or-nothing thinking: This is also called black-or-white thinking. Example: "I have no energy during the day, so I can't go back to work." Reality: With some creative thinking, you may be able to work out a flexible work schedule.

Choose your thoughts

The next step is to choose a more helpful thought to replace the unhelpful one.

Keeping a journal of your thoughts is one of the best ways to practice stopping, asking, and choosing your thoughts. It makes you aware of your self-talk. Write down any negative or unhelpful thoughts you had during the day. If you think you might not remember at the end of your day, keep a notepad with you so you can write down any unhelpful thoughts as they happen. Then write down a helpful message to correct the unhelpful thought.

With daily practice, more accurate and helpful thoughts will soon come naturally to you.

But there may be some truth in some of your negative thoughts. You may have some things you want to work on. If you didn't perform as well as you would like on something, write that down. You can work on a plan to correct or improve that area.

If you want, you also could write down what kind of unhelpful thought you had. Journal entries might look something like this:

Thought diary

Stop your negative thought

Ask what type of negative thought you had

Choose an accurate, helpful thought

"I have had more energy today, but I know that won't last for long."

Focusing on negative

"Sure, all days will be different. But I've had some days where I surprisingly felt less tired. So I know that not every day will be hard."

"I should be able to handle this by now. I'm not trying hard enough."


"Sometimes the standards that I set for myself are very high and hard to reach. But I'm learning new and more helpful ways to cope with my fatigue."

"There's really nothing I can do to feel less tired."


"On days when I haven't slept well, managed my stress well, or done my scheduled activities, it's easy to think that there's nothing I can do. But on days when I do these things, I feel better. There are things in my control that I can do to manage my chronic fatigue."

"Working for more than 2 hours is very hard, so there's no way I can ever go back to my job."

All or nothing

"I may not be able to return to my exact job, but I can be open to other arrangements that will allow me to continue to work in a similar way."


ByHealthwise Staff

Primary Medical Reviewer Kathleen Romito, MD - Family Medicine

Adam Husney, MD - Family Medicine

E. Gregory Thompson, MD - Internal Medicine

Specialist Medical Reviewer Martin J. Gabica, MD - Family Medicine

Current as ofNovember 29, 2017