Managing anxiety & improving fatigue symptoms through GET & CBT: Nick's Story

Symptoms

It started with a bad case of flu in Dec 2017. I'd moved down south for a new and demanding job and had been doing a lot of travelling. I was enjoying the new role and life but was certainly ready for the Christmas break and had for some time been having trouble sleeping.

Initially I had a week off work then went back but two weeks after that I started to feel flu-like symptoms again so had a couple more days off. I was back for the last week of work before Christmas but managed to see it out as it was only a short week. I was feeling extremely worn out and glad to get up to Mum’s for the Christmas break. I continued to sleep very badly over the break and started to get tired quickly during the day after a certain amount of exertion.

I visited the GP a few times over that period and was advised that it can take up to two months to get over flu so just to rest up. 

However, things seemed to be getting progressively worse and I didn't go back to work at the start of January. My symptoms were mainly a heaviness and fatigue of the body and general tiredness which came in waves, but I came to associate it with activity. When I did more, I felt worse. Alongside that, headaches, chest pains, nausea and dizziness.

Diagnosis

I started to spend more time at Dad's in Ealing and things got significantly worse for me following a couple of GP visits in January. They had done some extremely thorough blood tests and examinations and found nothing. At that point they gave me a diagnosis of chronic fatigue syndrome.

The next week I saw the GP again to discuss treatment plans. She advised me that nothing was offered on the NHS in the Bracknell area (where I was registered) but to keep coming in to see her every couple of months. She explained that doctors don't really understand what chronic fatigue syndrome is, what causes it and that there is no cure. She said in terms of prognosis, most people never fully recover but come to manage it. She prescribed me sertraline as an anti-depressant/anxiety medication and wished me good luck!

Deterioration and anxiety

At that stage my symptoms got significantly worse. Prior to that I had been still up and about for periods of time, going to the shops or cinema etc... a couple of weeks after that consultation I was in bed 24/7. I was urinating into a bottle at the side of the bed, eating off my pillow and dashing to the toilet for one desperate shit per day. I'd stopped watching my laptop or playing on my phone because the noise seemed to irritate me and tire me more.

The symptoms culminated with two panic attacks. Dad pointed out at that point that I must be very anxious. I didn’t agree!

Graded exercise therapy & CBT

In the meantime, he had done some research and signed me up to a private treatment programme run over Skype of graded exercise therapy. However due to the panic attacks the service recommended I had cognitive behavioural therapy alongside a full graded exercise/activity programme. I spoke to the CBT therapist Andy over Skype and we talked through my anxiety. The first thing was that until I'd had a panic attack, I hadn't even realised that I was anxious - it was hard to deny after that!

A faulty nervous system alarm

We discussed the physical effects anxiety has on the body; because it essentially ignites the fight or flight instinct the body prepares itself for action and breathing becomes shallow, muscles tense up and become twitchy, the eyes dart around looking for danger and noises, light headedness sets in as the body is taking on extra oxygen for exercise but then not using it and the body becomes more sensitive to light and sound. The mind also becomes irritable and quick to anger to deal with any potential threats. 

We considered what among these symptoms I might be showing (all the above).  We also discussed how these effects of anxiety would contribute to fatigue. It takes a lot of energy for the body to be in such a heightened state and I was sleeping for about 12 hours a day (although not feeling refreshed by the sleep).

Slight improvement

That first session and conversations with Dad on the subject were a revelation. Having barely left bed for weeks I got up and walked around the house for the first time and felt a noticeable decline in my symptoms. Of course, that was a relative decline, I still felt extremely ill.

Setting a baseline activity and increasing it

At the same time, I was speaking to Bev who is an Occupational Therapist specialising in chronic pain and fatigue. To begin with we set a baseline of activity that I was happy that I was already capable of doing. The theory was to stick with that rigidly each day for a week and then increase the amount of activity by 20% the next week. 

The first week just involved being sat up for 5 minutes at a time 7 times a day and having a 5-minute shower. We slowly increased the time I sat up. When I was ready, I started getting up for short periods and pottering around the flat. We then added a 5-minute walk outside the flat which we gradually increased every week. 

Throughout this period the symptoms continued to be very strong, but Bev advised that the body was capable of a 20% increase every 2 weeks and that the key was to stick to the programme even when the symptoms flare up. The theory being that they will settle down after a few days and the body will acclimatise to the new norm. It certainly wasn't always easy or pleasant, but I found that this was the case. 

Dealing with setbacks

However, I did suffer one major setback. It came not long after Bev and I had discussed how to deal with relapses. I had a session with Bev, and we agreed to scale back for a week or so to let the symptoms settle. I then built back up again but more quickly this time.

During this period Andy and I had worked on ways to tackle my anxiety. I was becoming much more aware when I was feeling anxious which was a great start, but we also looked at thinking patterns. The ones most relevant to me were: catastrophising is when you assume the worst case scenario is going to be realised, applying a negative mental filter to only see things that worry you; black and white thinking (a person or event is either simply good or bad); making predictions about the future; emotional reasoning (I feel bad so it must be bad). Andy encouraged me to take a step back and consider as though a friend was reporting these thoughts and feelings to me, how would I objectively analyse them.

Learning other strategies to cope

One thing that made a big difference with the anxiety was practising mindfulness using the Headspace app. Meditation is learning to exist in the moment and be cognisant of what you are directly experiencing physically and emotionally without any additional layer of analysis or judgement. Mindfulness is trying to take that approach to everyday life. I found that although it's a very difficult skill, when I was doing it well, it gave me a break from worrying about being ill and helped calm me. My symptoms always abated after a session.

Back to walking and jogging and work

My capacity gradually increased and by November I was managing a 45-minute walk in the morning including 15 minutes of jogging. I would also go out on one 'expedition' a day (usually a trip on the bus to have lunch in Ealing, a drive in the car or having an orange juice or two in the pub). I started to contemplate a return to work.

At my request Bev spoke to my manager who was fortunately very supportive of a graded return to work, initially working from home. Together we worked out a sensible plan which started on 2 hours for 3 days a week. I started this in January and am now (April) working full time, 4 days a week in the office and 1 day at home.

During these months I have continued with the exercise but put other activities on the back burner. It’s now time to gradually increase my social life and move back into my own flat.

My physical symptoms are now markedly less. I've barely had a headache, no nausea at all, no dizziness and considerably less fatigue and tiredness. In fact, now that I'm starting to do some real exercise my body is really feeling the positive effects and rather than feeling awful post-run, I do feel the usual physical tiredness after exercise but benefit from the endorphin hit exercise gives the body.

I'm not 100% there but I'm feeling better than I have done in a year, much more relaxed and optimistic and I'm really looking forward to getting back to life. Really. 

Nick 2019