5 ways a psychologist or therapist can help with chronic fatigue
Living with a fatigue-related health condition can be deeply confusing, isolating and overwhelming. Conditions like myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long Covid come with a dizzying constellation of persistent symptoms, of which fatigue is just one (Journal of Infection, 2024). People living with these conditions commonly experience a reduction or total loss in their ability to work, engage in social activities, care for others, and to care for themselves.

If these challenges weren’t enough, ME/CFS and long covid are not well understood from a medical perspective. Researchers have not been able to find consistent diagnostic biomarkers - biological signs of disease - to help diagnose and treat these chronic health conditions (BMC Medicine, 2023). Tragically, people living with ME/CFS have historically faced disbelief from some doctors, as revealed in a study by the University of Manchester. Ignorance around the causes and mechanisms of these conditions has contributed to prejudicial social attitudes. Many people living with ME/CFS have been told that their physical symptoms are somehow “all in their head”.
Since the pandemic, nearly two million people in the UK have developed persistent symptoms following a covid infection (ONS, 2023). As a result, there has been a new surge of awareness and research into these conditions. This has brought increased hopes for better understanding and treatments. In the meantime, however, people living with long covid and ME/CFS routinely struggle to access meaningful support, highlighted in news from the ME Association.
These conditions are multifactorial (Frontiers in Immunology, 2024) - they have multiple different risk factors and impact various bodily systems. It, therefore, makes sense that people living with them may benefit from the support of a range of professionals, not only including medical doctors, but also psychologists and therapists.
The prospect of working with a psychologist or therapist for physical health conditions like ME/CFS and long covid might seem strange at first. However, as a clinical psychologist who has successfully recovered from ME/CFS and long covid, and who now supports people living with these conditions, I would like to share five important ways that psychological therapy can be helpful.
5 reasons therapy can support people with chronic fatigue
1. Living with an invisible chronic illness is psychologically distressing
People living with ME/CFS and long covid can experience a profound sense of grief over the loss of their lives as they once knew them. The severity and persistence of symptoms can take people away from the things that offer them meaning in life: family, friendships, work, physical exercise, and other activities. It is therefore unsurprising that one study showed higher than average rates of anxiety (42%) and depression (33%) among people living with ME/CFS.
Working with a psychologist or therapist can offer a rare lifeline for someone living with a fatigue-related condition to feel genuinely seen and heard. It can be profoundly stabilising to have someone to deeply listen to, bear witness and validate painful feelings accompanying these conditions, such as terror, hopelessness, anxiety and despair.
However, more than just helping you to cope, feeling genuinely understood by another human can aid physiological regulation by calming the autonomic nervous system. This process is known as co-regulation. As neuroscientist, Lisa Feldman-Barrett has written: “The best thing for your nervous system is another human. The worst thing for your nervous system is… also another human.” The double-edged nature of this observation shows how important it is to find a psychologist or therapist who truly understands you and your health condition.
2. The mind and body are deeply interconnected
The symptoms of ME/CFS and long covid are undeniably physical, and real. However, research also shows that “the body keeps the score”, and that psychological stress contributes to physical ill health. As we experience stress, our nervous, immune, endocrine, digestive and metabolic systems can all become dysregulated. This can directly contribute to a state of imbalance across the entire organism, resulting in persistent physical symptoms.
Indeed, many people report having experienced significant stress in their lives in the period before developing ME/CFS and/or long covid. Therefore, working with a psychologist or therapist who has a sound understanding of the mind-body connection can be a valuable intervention. Working on the stressors in your life, as well as the ways that you respond to them, can be profoundly healing for the body as well as the mind. As Monty Lyman has written in his recent book, The Immune Mind, “A well-targeted psychological therapy with a clued-up, understanding clinician, is, ultimately, a powerful biological treatment”.
3. Neuroscience is beginning to transform our understanding of chronic symptoms
In recent years, neuroscientists have made some mind-blowing discoveries about the way the brain makes sense of the world. Research increasingly suggests that our experience of the world - what we see, hear, touch, taste, smell and even feel - is not exactly what it seems. We used to assume that sensory information travels from our sense organs - our eyes, ears, tongue, skin, and nose - to the brain, which in turn converts this information into faithful representations of these signals, enabling us to experience reality accurately. However, a new theory of human experience, called predictive processing, suggests that the brain actually predicts what it expects us to see, hear, touch, taste, smell and feel, based on templates of past experience.
As such, it is now thought that our sensory experience is actually the result of an ongoing dialogue between the brain’s predictions, and raw sensory data being sent to the brain. When you think about it, this is actually a much more efficient way of interacting with the world than having to analyse every new piece of sensory data out there in the world, and inside our body.
So, how does this new research on the predictive nature of the brain help us to make sense of persistent physical symptoms? Well, it is hypothesised that the brain’s ability to make predictions can become less accurate after stressful or overwhelming events, including not only psychological traumas but physical ones such as viral infections like covid or glandular fever (both of which are common triggers for long covid and ME/CFS).
As a result, it may be that the brain of someone who is in this stress response may continue to predict danger long after the threat has passed. In such cases, the brain may continue to prompt the body to respond with symptoms which are adaptive in times of threat - whether the threat is physically large (e.g. a predator) or small (e.g. a pathogen). The resulting symptoms, including fatigue, nausea and brain fog, are actually very useful in prompting us to rest and recover in times of acute sickness. However, when the brain keeps producing these symptoms even after the danger has passed, the result can be a chronic state of ill health (Frontiers in Human Neuroscience, 2016).
The good news is that this exciting knowledge is already being applied by some practitioners to support people living with chronic symptoms, with positive effects. In particular, researchers and clinicians in the field of persistent pain have used the knowledge of predictive processing to influence the development of treatments which directly seek to reverse the vicious cycle described above. Working with a psychologist or therapist who understands this emerging science can be a game changer in helping an individual with ME/CFS or long covid establish a more coherent understanding of their health condition.
4. Working through trauma can help regulate your nervous system
Research clearly shows that people who have had adverse childhood experiences (ACEs) are at greater risk of developing a chronic illness later in life. One possible reason for this is that traumatic or overwhelming experiences can predispose an individual’s nervous, endocrine and immune systems to respond to events in threat-oriented ways. Over time, this can contribute to a wider state of physiological imbalance.
Doing trauma-focused therapy to work through overwhelming memories can allow the brain and body to shift from an energy-draining survival state into a healing rest and restore state. Working with a psychologist or therapist trained in an evidence-based trauma therapy, which attends to body sensations, such as eye movement desensitisation and reprocessing (EMDR) or somatic psychotherapies, can support the body to come into greater regulation, which may aid recovery from ME/CFS and long covid.
5. Working on behaviour patterns can support recovery
Both research and clinical observation suggest that many people living with fatigue-related health conditions commonly exhibit certain rigid or extreme patterns of behaviour. These include perfectionism, being hyper-responsible, relentlessly striving to achieve, people pleasing, self-sacrificing and fear of letting other people down. It is not difficult to see how these ways of meeting the world may contribute on some level to burnout, exhaustion and fatigue.
Psychologists and therapists can support their clients to explore how and why they have adopted these patterns. Commonly, such behaviours were developed in the context of early life experiences, where parents and other caregivers were unable to fully attend to and meet a child’s needs for safety, attachment and attunement. As a result, the developing child may unconsciously develop these behaviour patterns in order to help get their psychological needs met.
Psychologists and therapists who use ideas from attachment-focused, experiential forms of therapy, such as internal family systems (IFS), accelerated experiential dynamic psychotherapy (AEDP), coherence therapy or the neuro affective relational model (NARM) are well equipped to help you better understand and achieve greater autonomy over these conditioned behaviour patterns. This can free you up to connect more deeply with their authentic desires and needs.
