How Psychologists and Psychiatrists COULD help with ME/CFS

ME/CFS and Long COVID are biomedical illnesses. Despite decades of research and significant funding, there is no evidence of a biopsychosocial (BPS) subtype or version of these conditions as an explanation for the underlying disease. There is evidence of multisystemic dysfunction, including immune, neurological, and metabolic impairment.

Psychological and psychiatric support absolutely has an important role, just not as a treatment for the underlying illness itself.

Many people living with ME/CFS and Long COVID would benefit greatly from access to mental health professionals who understand the biomedical nature of these conditions. As an advocacy non-profit, we regularly hear from patients dealing not only with symptoms, but also with the emotional and practical consequences of chronic illness: isolation, grief, uncertainty, loss of identity, and a lack of understanding from others.

Support could include help with pacing and managing activities within their energy envelope, adapting to life with a chronic illness, developing self-advocacy skills, communicating effectively with healthcare professionals, and understanding that their illness is not caused by their thoughts, attitudes, or behaviors.

We also hear from caregivers, family members, and friends who want to help but struggle to find informed guidance. They often need support in understanding the illness, coping with uncertainty and grief, navigating changing relationships, and managing the pressures of long-term caregiving.

What is needed is not a psychological explanation of the disease that has not been supported by decades of research or clinical evidence, but access to clinicians who understand the biomedical reality of ME/CFS and Long COVID and can provide appropriate psychological and psychiatric support within that framework.

Psychiatrists and psychologists have an important role to play, but it requires aligning practice with the current evidence base and the lived reality of patients.

For clinicians seeking a clear overview of what this means in practice:

• https://doctorswith.me/me-cfs-what-psychiatrists-need-to-know/

• https://batemanhornecenter.org/providers/

Citations

• Institute of Medicine report Institute of Medicine. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. National Academies Press, 2015.

• NICE Guideline NG206 National Institute for Health and Care Excellence. Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome: Diagnosis and Management. NICE Guideline NG206, National Institute for Health and Care Excellence, 29 Oct. 2021.

• Wilshire et al. article Wilshire, Carolyn E., et al. “Rethinking the Treatment of Chronic Fatigue Syndrome: A Reanalysis and Evaluation of Findings from a Recent Major Trial of Graded Exercise and CBT.” BMC Psychology, vol. 6, no. 1, 2018, article 6. DOI: 10.1186/s40359-018-0218-3.

• Komaroff and Lipkin article Anthony L. Komaroff, and W. Ian Lipkin. “Insights from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome May Help Unravel the Pathogenesis of Post-Acute COVID-19 Syndrome.” Trends in Molecular Medicine, vol. 27, no. 9, 2021, pp. 895–906. DOI: 10.1016/j.molmed.2021.06.002.