Pushing through symptoms

Many people attempt to "push through" symptoms by ignoring them and trying to do their usual activities when they first become ill with myalgic encephalomyelitis/chronic fatigue syndrome - but people with ME/CFS find that exceeding their available energy - their "energy envelope" - makes their condition much worse.

Effects
When they become worse after pushing through their symptoms, people with ME/CFS then have to choose again between rest or trying again to "push through" - which causes them to deteriorate further, until eventually they physically cannot continue. Both resting and pushing through result in an "greatly lowered ability to do activities that were usual before the illness", a symptom that is required for the diagnosis of ME/CFS.

CBT and GET
Cognitive behavioral therapy (CBT) and graded exercise therapy (GET) for ME/CFS both encourage people to push through symptoms. In CBT patients are encouraged to view the fact that ME/CFS is a serious, physical illness - as the Institute of Medicine (2015) states it is - as an "illness belief" to be challenged rather than a scientific fact. In CBT patients are expected to set "realistic" goals for what they would like to achieve and work towards those goals - but with no biomarker or physical way to measure symptoms, patients are unaware of the severity of their illness - they may be working towards goals that are actually not simply unrealistic but impossible. Patients may be told that they have a maladaptive fear of or avoidance of exertion that is causing them to reduce their activities, and causing reversible deconditioning, but scientific research shows that people cannot push through their symptoms on consecutive days - the post-exertional malaise caused by ME/CFS prevents this. Patients in the UK completing CBT for ME/CFS based on this biopsychosocial model were found to remain "severely disabled". In graded exercise therapy (GET) ME/CFS patients are expected to commit to very gradually increasing their activity levels, and are told to "push through" regardless of how much their symptoms worsen - they are told increases in symptoms are temporary but evidence shows this is a false assumption. A very large survey of UK patients found this GET approach caused most people to become more ill.

Evidence
Trying to "push through" symptoms or "keep going" is a common response when people with ME/CFS feel pressured to continue working or continue their usual activities - but ME/CFS then causes symptoms to get far worse, this post-exertional symptom exacerbation and post-exertional malaise is the hallmark symptom of ME/CFS.

Patients with severe ME - which means that they either almost fully housebound or may be bedbound - report being encouraged to "push through" or "keep going" - even after they became worse.

Patients who are working when they fall ill with ME/CFS find that pushing they causes longer sickness absences from work, and any recovery is slowed down.

"Even though she feels very unwell, she tries to ignore or “push through” her symptoms, to push them out of her consciousness, and to continue her regular activities. Eventually, however, Elizabeth’s exhaustion, increased muscle pain, and headaches make it impossible for her to ignore her symptoms; she has trouble climbing the few steps into her front door."

In a survey of over 1,100 people with ME/CFS or fibromyalgia,

Notable studies

 * 2016, Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent - (Full text)
 * 2019, Why Graded Exercise Therapy and Cognitive Behaviour Therapy are Controversial in Chronic Fatigue Syndrome
 * 2020, Could Cognitive Behavioural Therapy Be an Effective Treatment for Long COVID and Post COVID-19 Fatigue Syndrome? Lessons from the Qure Study for Q-Fever Fatigue Syndrome - (Full text)
 * 2021, Experiences of Living with Severe Chronic Fatigue Syndrome/Myalgic Encephalomyelitis - (Full text)
 * 2021, Elements of Suffering in Myalgic Encephalomyelitis /Chronic Fatigue Syndrome: The Experience of Loss, Grief, Stigma, and Trauma in the Severely and Very Severely Affected - (Full text)
 * 2021, CFS patients remain severely disabled after specialist treatment with CBT in the UK - (Full text)

Learn more

 * The ME/CFS and Fibromyalgia “What Would You Have Done Differently” Survey - Health Rising