13 Chapters
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CHAPTER THIRTEEN: Medical perspective

Bruce Fernie Karnac Books ePub

Advances in technology have touched many areas of our lives, from microwave ovens to mobile phones and the field of medicine is no exception. Consequently our theoretical understanding of fatigue has been enhanced. The exact process by which fatigue occurs however, and the way in which genetic and environmental factors might influence such a process, has yet to be emphatically elucidated. This remains the aim of ongoing research which will hopefully bring closer the definitive approach to prevention, treatment and cure of chronic and debilitating fatigue.

The preceding chapters have outlined the cognitive behavioural approach to dealing with fatigue and the other symptoms that occur with it in CFS/ME. In the early chapters we broached the commonly expressed concern about the use of CBT as a treatment for CFS/ME. In this chapter our intention is to consider the theoretical possibilities and the existing scientific and medical evidence for whether fatigue has a physical cause or a psychological cause, or both, and so illustrate how and why CBT may be helpful in addressing the chronicity of fatigue, whatever the cause.

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CHAPTER TEN: Core beliefs

Bruce Fernie Karnac Books ePub

So far in this book we have looked at the relationship between thoughts, feelings, behaviour, and physiology. It is now time to revisit the vulnerability factors that you identified in chapter 1. We are going to look at these factors to work out whether they still have an impact on you today. In doing so, we need to look at core beliefs and rules for living.

A core belief is a particular type of thought of which we might not be consciously aware. Such thoughts govern how we view the world, and therefore can affect our cognitions, feelings, behaviours and physiology. One of the fundamental ideas behind this concept is that we interpret and perceive the world around us based in part on what we already know.

We acquire our core beliefs through our experiences in life. For example, imagine that you are on a platform at a station as a train arrives. The train casts a larger and larger image on the retina at the back of your eyes as it moves towards the platform. If the only source of information by which we make sense of our experiences was received through our senses (e.g. throughour eyes), how would you know whether the train was getting closer, or whether the train was growing larger? Our experiences have taught us that trains stay the same size, and from this we can deduce that if the train is not getting larger, it must be getting closer. This illustrates one of our common core beliefs, that of size consistency.

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CHAPTER ONE: Critical incidents, vulnerability factors and maintaining factors

Bruce Fernie Karnac Books ePub

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).

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CHAPTER TWELVE: Planning for setbacks

Bruce Fernie Karnac Books ePub

Setbacks are a normal part of any recovery. After working through this book and implementing the strategies and tools within, you may find that things are going well for a while, and then, all of a sudden, you experience an intensification of your symptoms. This is not your body telling you to throw away this book. Nor does it mean that you have taken one step forward and several steps back. By working through this book, we hope that you have learnt some useful techniques that will have benefited you. If you do experience a setback, it is to these strategies and tools that we advise you to turn.

In fact, we would suggest that you make a plan for setbacks and relapses before they happen. It is much more difficult to work out how to deal with a setback when you are experiencing one, than when you are feeling well. Having a solid setback plan can help you shorten the duration of the flare-up of your symptoms. Remember, by working your way through this book you have furnished yourself with strategies and tools and, hopefully, you have developed a greater understanding of your CFS/ME. You are in a better position now to deal with any setback than you were before you picked up this book.The very first thing to remember if and when you experience a setback is not to panic. It is likely that you have noticed yourself the effect of anxiety and stress on your symptoms. Anxiety and stress-provoking thoughts like ‘I will never get better’ or ‘I am right back to square one’ need to be challenged, and now you can take the iTEST to help you do this.

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CHAPTER THREE: Thoughts and feelings

Bruce Fernie Karnac Books ePub

One of the central ideas behind CBT is that there is a relationship between our thoughts and our emotional state. In later chapters, we will expand on this to include the relationship between our thoughts, emotional state, physiology and behaviour.

The idea is that it is not situations themselves that upset us, but instead it is how we interpret them. There tends to be more than one way of interpreting any situation, and the interpretation that we make has consequences for our emotional state.

It may seem that other ways of interpreting a situation are less true or even not true at all; this does not mean however that there are no alternative potential interpretations of a situation. We will look at why people might have a tendency to interpret a situation in a particular way in a later chapter. For now, we will try to illustrate the relationship between our thinking and our emotions.

Sometimes the thoughts that we have occur so quickly we are almost not consciously aware of them: these are known as ‘automatic thoughts’. Thoughts become automatic through

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