Table 1 Competences to be Demonstrated by IAPT Therapists after training on ME/CFS

UNIT 3.3: Chronic Fatigue Syndrome (CFS) / Myalgic Encephalopathy (ME)

Aims: To be able to demonstrate knowledge of evidence-based interventions for people with Chronic Fatigue Syndrome, and practical skills in their application.

• Ability to draw on knowledge of the aetiology, epidemiology and presentation of CFS/ME, and of its differential diagnosis (and exclusion criteria)

• Ability to draw on knowledge of factors considered to contribute to the development of

• CFS/ME (including physical illness/ serious infections (such as glandular fever), lifestyle, stress, perfectionism and distress)17

• Ability to draw on knowledge of factors considered to maintain CFS/ME (such as patterns of activity characterised by boom and bust cycles, unhelpful fear avoidance beliefs leading to avoidance of activity), attentional biases towards symptoms) and how these link to physiological mechanisms including poor sleep and deconditioning

• Ability to help client feel that their experience of CFS/ME is being listened to and respected (i.e. acknowledging that they are experiencing real, physical symptoms)

• Ability to conduct a comprehensive assessment of the client’s symptoms, including their medical and prescription history, contextual information and main current difficulties, physical symptoms, patterns of activity and rest, coping mechanisms, the impact of CFS/ME on their life and specific concerns about symptoms, fears about engaging in activity, attentional focus and how significant others respond to symptoms

• Ability to introduce the CBT model, collaboratively identifying predisposing and precipitating factors and a vicious cycle of fatigue

• Ability to introduce and discuss planning activity and rest in the context of short and long term activity targets (establishing a consistent approach to activity initially before gradually increasing activity levels)

• Ability to ensure that a focus on graded exercise is integrated into the intervention

• Ability to help the client monitor sleep, identify specific sleep problems that exacerbate fatigue and discuss sleep strategies such as an up time and bed restriction

• Ability to employ attentional training to address symptom focussing

• Ability to work on unhelpful thoughts related to engaging in activity more consistently and perfectionism, generate alternatives and help the client test these out with gradual behaviour change and behavioural experiments

• Ability to identify and work with potential obstacles to recovery

• Ability to use standard and idiosyncratic measures to evaluate outcomes with CBT for CFS

• Ability to help clients prepare for ending therapy and maintain improvements by identifying possible indicators of relapse and strategies for their management