The Concept of Active and Protective Coping for Individual Psychotherapy in Chronic Fatigue : an Example from Post COVID

Abstract

Individuals affected by chronic fatigue often experience unpredictable fluctuations in their symptoms and activity levels, often leading to a perceived loss of control. This paper presents an explanatory model for understanding coping behaviors in chronic fatigue from the perspective of Cognitive Behavioral Therapy. As a comprehensive framework for patients and therapists, we introduce the Model of Active and Protective Coping for Chronic Fatigue (APC-Model), integrating clinical observations, existing knowledge, and the principles of behavioral analysis. The model identifies two dysfunctional behavioral patterns: Active Coping, by which individuals overexert themselves, and Protective Coping, by which activity levels become too low. Patients may alternate between these patterns, thereby exacerbating symptoms. The APC-Model suggests stabilizing activity levels within the individual’s area of endurable load as a major goal to enhance symptom management and control. Applying behavioral analysis separately to each dysfunctional coping pattern can help patients detect and disentangle the underlying and the maintaining factors, as well as those contributing to the shift between coping patterns. We illustrate with a case study suffering from chronic fatigue as part of post COVID, how this approach provides a valuable tool for deriving points of intervention and treatment strategies for individuals affected by chronic fatigue. We provide therapeutic material to support its practical application in English and German.