The Procedure. Cognitive therapy may be expensive and not covered by insurance. It is usually performed over 6 - 20 sessions, each which last about an hour. Patients are also given homework, which usually includes keeping a diary and attempting tasks that they have avoided because of negative attitudes.
A typical cognitive therapy program may involve the following measures:
- Keep a Diary. The patient is almost always asked to keep an energy diary, which can be a key component of CFS cognitive therapy. The diary serves as a general guide for setting limits and planning activities. The patient uses the diary to track any factors, such as a job or a relationship that may be making the fatigue worse or better. It is also used to track the times of day when energy levels are at their highest and lowest peaks.
- Adjust Schedule. The patient adjusts schedules to conform to energy peaks and valleys recorded in the diary. For instance, the patient may plan low-energy times for taking a nap and high-energy times for planning important activities. Developing fairly rigid daily routines around probable energy spurts or drops may help establish a more predictable pattern.
- Confront Negative or Discouraging Thoughts. Patients are taught to challenge and reverse negative beliefs (e.g., "I'm not good enough to control this disease, so I'm a total failure.") to using coping statements ("Where is the evidence that I can control this disease?")
- Be Flexible. Energy levels will most likely never be entirely predictable. Patients must also be prepared to adapt to energy variations. Instead of a long nap, for instance, patients may need 5 - 10 minutes rest periods every hour or more, during which time relaxation or meditation methods are useful.
- Set Limits. Limits are designed to keep both mental and physical stress within a manageable framework so that patients do not get discouraged by forcing themselves into situations in which they are likely to fail. For example, tasks are broken down into incremental steps and patients focus on one at a time.
- Prioritize. Patients learn to drop some of the less critical tasks or delegate them to others.
- Manage Impaired Concentration. Patients seek out activities that are appealing, focus attention, and help increase alertness. They learn to request instructions given as concise simple statements. External distractions, such as music or talking, are kept to a minimum.
- Accept Relapses. Over-coping and accomplishing too much too soon can often cause a relapse of symptoms. Patients should respect these relapses and back off. They should not consider them a sign of treatment- or self-failure.
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