Has anyone considered why cognitive behavioral therapy (CBT) is such an unpleasant experience for ME/CFS patients? Well, I think I know why CBT feels so awful.
I had just one session of CBT, but I understood very quickly what the therapist was trying to do: he wanted to implant into my brain the habits of goal setting, and objective-oriented behavior.
This seems harmless enough to a healthy person, so why does CBT seem so mentally painful, stressful, exhausting and draining for a ME/CFS patient?
I think the answer to why CBT is so awful for ME/CFS patients lies in a dysfunction of the
prefrontal cortex of the brain in ME/CFS. The prefrontal cortex is one of the main areas responsible for the
executive functions of the brain: these executive functions form the driving seat of the mind, the higher-level, overall controlling center for task planning, task initiation, problem solving, task switching, etc.
So when you set goals and follow them, you are using your prefrontal cortex.
In ME/CFS, there is evidence of dysfunction of the prefrontal cortex (ME/CFS patients have less gray matter volume in the prefrontal cortex,
ᐞ and there is a reduced oxygen supply to the prefrontal cortex during exercise
ᐞ).
So if the prefrontal cortex is weak in ME/CFS, this is likely why we find it exhausting and mentally painful to perform executive functions (such as goal setting, task initiation, and task switching), as these executive functions put strain on a weak prefrontal cortex.
I find goal setting so stressful and mentally painful that even if I attempt to set my own goals, it really feels unpleasant to me. I find that I can get involved in tasks that don't require much pre-planning or don't have a specific goal or deadline. But when there is a specific goal or deadline to meet, suddenly there is huge mental stress involved. The stress does not come from the task itself, but from my goal-oriented disposition towards the task. But if I just amble on sweetly in my own time and in my own way, there is no stress in performing tasks.
So it's not that I am not motivated; it just that goal setting feels very painful and stressful to me. Prior to getting ME/CFS, had not problems in setting goals and following them through.
I guess the idea of CBT is to try to beef up the weak prefrontal cortex forcefully (and in fact prefrontal cortex volume is apparently increased after CBT
ᐞ); but wouldn't it be better to work on the underlying biochemical cause of the weakness of the prefrontal cortex, and fix this, so that ME/CFS patients can become better at goal setting and task initiation. CBT feels like being thrown into a very harsh and cruel military training camp.
There is an article
HERE on Cort Johnsons's blog about the use of the drug Vyvanse (lisdexamfetamine) in ME/CFS. Vyvanse regulates dopamine activity in the prefrontal cortex, and if you Google search for
Vyvanse and motivation, you will find some accounts about this drug boosting people's motivation.
So this drug might be a better way to remedy the weakness in goal setting and task engagement in ME/CFS.