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Problems with mood and motivation

This section looks at how our attitude towards a situation can affect our ability to deal with that situation. Imagine a typical day. There are a number of things to be done - say some house work, then a visit from a friend, then a meal to be cooked and then a form to be filled in. As a situation this is neutral.
Now add an attitude to that situation:
  • There is too much housework to be done, I don't know where to start, I haven't got the energy to do any.
  • I can't see that friend today, I feel too miserable, it will only make me feel worse. I don't like myself, why should she.
  • Why bother cooking, it's only for me anyway.
  • That form is too difficult, I can't do it.
or
  • OK, I'll do the washing up this morning, it's a start and at least the kitchen will look better.
  • It might be good to see her today, and even if I'm not my usual self she won't mind. It might cheer me up.
  • I could cook something simple. I quite enjoy cooking once I get into it.
  • Those forms are stupid, but I'll start filling in the bits I can do and spend about an hour on it this evening, then I'll watch some telly. It will be OK.
Now not only is the attitude different, but the outcome of those two scenarios will be very different too. In the first, the belief that nothing can be done or attempted results in nothing being attempted. So nothing gets done. This confirms the feelings of hopelessness. The tasks don't go away but grow, the person feels increasingly de-moralised, the problems increasingly big. Social contact is reduced and they feel even more isolated and hopeless.

In the second scenario, having made a start on some things, the person begins to feel a bit more on top of them. This feels encouraging. Once the start is made the problems feel smaller, feel "in hand". The sense of uselessness and hopelessness begin to recede. The social contact is affirming and supportive. At the end of the day, the sense of achievement brings some contentment, some hope. The point to realise is that our attitude affects our feelings, our feelings affect what we do or don't do and this in turn affects our attitude and our feelings. If we believe we can't do anything we feel hopeless and low, we give up, do less and this in turn confirms our feelings of hopelessness.

So what can be done? Well what this section aims to do is to give you some tools to become aware of and change any attitudes that you see as unhelpful. Although you may not be able to change your situation directly, changing the way you feel about and deal with it can make a difference in the long run.

Becoming aware of our thoughts and feelings
Common areas of concern
Ways of thinking
Putting your thoughts on Trial
Implementing the alternatives

Becoming aware of our thoughts and feelings

Now this may sound strange. Aren't we always aware of our thoughts and feelings. Actually no. A lot of our thinking and attitudes are fairly automatic and unconscious, a lot of our judgments about ourselves, our abilities and the world are already formed - we do not need to think about them. So becoming aware of them can be initially quite difficult. It is almost like they form the background to our more conscious thinking. Like the wallpaper, we begin to take them for granted and forget that they are there.

Initially it may be easiest to become aware of them through our feelings. Start off by noticing when your mood changes. You may be doing something, feeling quite OK, when suddenly or gradually, your mood changes. It may be anxiety or sadness or despair. Now, chances are, is that at this point you begun to think about something else. "Replay" this moment in your head. What changed, what were you thinking. It may be that you suddenly thought about a social engagement, or a task to be done. But why the anxiety? Were you also thinking that you wouldn't cope, could never get it done. Were you imagining some awful consequences? Try and be as objective as possible.

Now look at the form - "Recording thoughts". Try an write down as much of the above as you can. In the left hand side record the time and the situation. In the left hand side record the thought and the feelings that went with it. Now record how much you believe the thoughts. Say it was "I'm not going to be able to cope, it will be a disaster". Do you 100% identify with that? Or does part of you think differently. Maybe you only believe it 80%. This is all you have to do for a couple of weeks. Now a few words of warning.

Focusing on the kind of thoughts that lead to low or anxious states can be initially overwhelming. It may make you feel even worse. So bear in mind the following: The ultimate aim is to become more objective about your thinking, to achieve some distance from it so you can evaluate it more rationally. Writing them down and evaluating how much you believe them is the first step in this process.

Remember, they are only thoughts. Thoughts about not being able to cope are not the same as actually not coping. Thoughts about being a failure are not the same as actually being a failure. The thoughts may have a strong emotional punch, but the more you can stand back from them and evaluate them, the less power they will begin to have to influence you. So for a couple of weeks record the kinds of thoughts that "get in the way", make you feel low or negative, stop you doing things that you intended to do. Now take a look back over this couple of weeks. Are there any patterns that emerge?

Below are some hints on how to begin to see how your thinking is influencing how you feel and what you do. First we will look at common areas of concern. Secondly we will look at common ways of thinking about these situations that may be unhelpful.

Common areas of concern

Thoughts and feelings around the illness
CFS is a very confusing condition. There are a lot of conflicting views as to what is going on, as to what makes it better or worse. Sufferers often feel that they have no control over the situation. Any attempt to change things, to do more, may be met by an increase in symptoms which the sufferer may believe means that they are doing themselves permanent damage.
Kinds of thoughts and feelings that can occur in this are:

- I will never get better, there is no hope (hopelessness.)
- Walking only made my legs feel worse, maybe I shouldn't walk anymore (fear, worry, confusion).
- My system must be permanently damaged; there is nothing I can do about this (despair, resignation).

Thoughts about how you are
  • I feel really useless, I can't cope with anything (despair, hopelessness, low self esteem)
  • My life is a mess, I can't do anything about it (hopelessness)
  • I'm just a failure, why bother trying anything ( despair, giving up).

Thoughts about how you should be
  • I should be able to do more than this, I can't even walk to the shops anymore (frustration, despair).
  • I should be able to read more than a page, I can't concentrate on anything anymore (frustration)
  • I should be able to this much better than I can, there is no point in even trying (despair, giving up).
Thoughts about others
  • No one understands my condition, no one gives me the kind of care I need (isolation, frustration).
  • People have seemed off with me recently, no one like me (feelings of rejection, loneliness)
Thoughts about the world and the "way things are"

  • Things shouldn't be as they are, this situation is so unfair (anger, frustration)
  • I must have done something terribly wrong to be feeling like this, I probably deserve it (guilt, punishment)
These are some of the areas of concern, and the kind of emotions that can go with them. Next are ways of thinking about these situations that can make them worse.

Ways of thinking

All or nothing thinking
If everything isn't right, then nothing is. This is a particularly common thinking style in people with a tendency to perfectionism. Is something is not 100% as it should be, then it is a disaster, there is no middle ground, no shade of grey. The consequences of this kind of thinking is that things are often not attempted because they can never be perfect, or any sense of achievement from a task completed is de-valued because it is not as it should be.

Or again, in social situations, someone either like you or hates you. In an interview, if you didn't perform brilliantly, then it was a disaster. If the meal cooked wasn't the best ever, then it's the worst ever.

Over generalising
This is where one bad apple spoils the barrel. If you didn't cope once with a situation, then you will never cope again. If a walk was difficult once, then it will always be difficult. If someone criticises one thing about you or your work that means everything about you and your work are wrong.

Eliminating the positive
This can be a natural consequence of the above two. The negative is dwelled on and anything positive is discounted or ignored or attributed to someone else. This is the mental state where the bottle is half empty rather than half full. Looking back on your day it seems terrible. Any achievements are ignored, forgotten, discounted.

"Should" thinking
This is where you have expectations of yourself or others that are not met. The common emotion associated with this is frustration. I should be able to do more, he should (or shouldn't) have said that, I should be able to do this better; I should be able to walk further. This style of thinking often leads to giving up, or not taking any pleasure or achievement from what did happen, because it isn't the same as what should have happened.

Catastrophising
This is where one bad apple destroys the entire orchard. This kind of thinking is often associated with anxiety, panic and despair. Beginning with a single incident - say a slightly cold interaction with a friend - the mind spirals off into an emotionally laden scenario of the end of the friendship, complete rejection, despair and isolation. Or an increase in symptoms, feeling more tired, becomes irreversible damage to the system, permanent disability and hopelessness.

Emotional Reasoning
Or confusing feelings with facts. Because you feel like a failure, you decide that you are a failure. Because you feel rejected by a partner or friend, you decide that you have been rejected, and perhaps act accordingly. This can be one of the most insidious forms of thinking, when something feels overwhelmingly true, it is hard not to believe that it is true.

Putting your thoughts on Trial

Taking the last two weeks records of thoughts, set aside some time to go through them.
First of all, try to divide them up into different problem areas. Were they thoughts about your illness, thoughts about your self, thoughts about how you should be, or thoughts about others and the world in general. Now using the list above, go through them and see if you can identify any of those thinking styles in those thoughts. Were you over-generalizing from one incident? Were you only looking at the negative at the time? Did you panic and get things out of proportion?

It can be useful to do this retrospectively initially. The time since the original thought may have shown that it was not quite true, that things were not how they seemed at the time, or that you coped better than you anticipated. So go back to these initial thoughts and begin to evaluate them more objectively. Use the list of thinking styles and the light of experience. Now re-rate them. How much do you believe them now? Probably you believe some of them less than you did at the time. You may be able to see in retrospect how that way of thinking actually made things worse at the time.

Coming up with alternatives
Now you want to begin to put these thoughts on trial. It may help to give you some distance from them if you imagine that it was your best friend who was thinking like that. We are often more critical of ourselves than we would be of those we care about.
Put these questions to the thoughts you recorded in the last two weeks:
  • What is the evidence for and against?
  • Are any of the thinking styles outlined above at work here?
  • Are there any other ways of looking at the situation?
  • What were the consequences of thinking like that, i.e., how did that make me feel, how did that change the way I handled things?
  • If I had thought differently about it, would that have changed things?
Again re-rate the beliefs. Now initially you may find it difficult to come up with alternative thoughts. Here are some hints on how you can begin to overcome some of the habits of thought that go along with particular thinking styles.

All or nothing thinking
Begin to try the idea of grading. If you decided that a meal, an interaction, a task was awful and consequently felt awful yourself, go back and rate the task on a scale of 0-100. Maybe it was good enough, OK it wasn't 100%, but maybe it was 80%. Try to become aware of this in your day to day life. Are you always expecting 100%. Perhaps it would be easier to lower your standards in some areas.

Over generalising
If you were basing your conclusions on one or two events, look for other events that are evidence against your conclusions. If a friend was a bit cold on one day, were there other days when they weren't, could there have been other reasons why they were like that? If walking one day made you feel more tired, were there other days when it didn't?

Eliminating the positive
Go back over the events that seem awful, hopeless. Was there any moment or incident that was OK. Was there any achievement that you discounted?

Should statements
With these it is best to become aware of when they are operating, and to evaluate how useful they are at the time. Are you expecting too much of yourself or other people? Are you only increasing your sense of frustration. What would be a more realistic expectation within your current limits?

Catastrophising
How likely is the imagined outcome? Is there any evidence that it might be otherwise? How else might the situation turn out?

Emotional reasoning
Again the key is evidence. You may feel that something is true, but put that thought on trial. Is there any evidence against it being true? Use the above set of questions to generate as many alternative ways of thinking as you can. It doesn't matter how much you believe them at the moment, but rate how much you do believe them. Like any other habit, thinking about things in a particular way can take a while to change.

You won't let go of the old way quickly. You won't believe the alternatives immediately. See it as an experiment to try for a while to see if it makes any difference. OK, so you have practiced challenging your thoughts from the last couple of weeks. Now you want to begin to implement this on a daily basis.

Implementing the alternatives

Now that you have some practice at challenging thoughts in retrospect, you want to begin to try and do it "in the moment". This wont be easy at first. You will still probably have to write things down and challenge them later. The trick is to keep this process up until it becomes automatic, until you begin to become aware of thoughts as they occur and can choose to think differently.
Do what you have done for the last two weeks. Record thoughts as they occur, or as close to the event as possible. Rate the belief and emotion associated with the thoughts. Now try coming up with alternatives. Write down as many as you can think of. Remember, it may help to think of yourself as your best friend, and to see the thoughts as things to be put on trial. Now rate how much you believe the alternatives. The re-rate the original thought and feeling. Have they changed? Has trying to think about things differently improved things?

Keep this process up
Again at the end of two weeks, sit down and evaluate how it has gone. You will probably still be able to be more objective after the event. Are there alternatives you can think of now that you couldn't at the time? Has experience provided evidence that disproves the thought? Persistence with this process will enable you to challenge unhelpful ways of thinking as they happen, more and more easily. As with everything else in CFS, this change will not happen overnight, but with persistence, gradual sustained change will happen. Good luck.

Author: Vincent Deary
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