Speaker, Clinician, Researcher, Author, Advocate,
On Board of Directors of IACFS
Elected IACFS/ME President March 2009
Fred Friedberg, PhD
Private Practice (516) 702-4213 in NY,
or in Connecticut, (860) 619-8069..
and in-person (Warren,
counseling sessions for people with fibromyalgia, chronic fatigue
syndrome, multiple chemical sensitivities, and related illnesses.
or in-person consultations.
Each are the same fee of $100 for a 45 minute session.
Clinician at Stony Brook University (631) 632-8252
Professor of Psychiatry
Stony Brook, NY
Stony Brook, NY.
Treatment interests: Chronic fatigue
syndrome, Fibromyalgia, EMDR.
- is an assistant professor
School of Medicine at SUNY, Stony Brook, on Long Island, NY.
- is principal investigator
of a 5-year behavioral
study of CFS funded by the National Institutes of Health (NIH).
published scientific articles in
Psychologist, Journal of Clinical Psychology,
Research and Practice, Clinical Infectious Diseases,
Neuropsychiatry, Archives of Neurology, Journal of Psychosomatic
Cognitive and Behavioral Practice, Journal of Behavior
Therapy and Experimental Psychiatry,
and The Journal of Chronic Fatigue
- has conducted professional workshops for the
American Psychological Association,
the Association for the Advancement
of Behavior Therapy, and the Society of Behavioral Medicine.
Books: see web links section
Fibromyalgia & Chronic
7 Proven Steps for Less Pain & More Energy
The Last Page
[skip ahead if you don't want to know how it ends]
In the process of healing, you develop and value yourself, not only as
an engine of work and sacrifice, but also as a human being with
important personal needs. Curing symptoms without healing means that
you are much more vulnerable to relapses. A cure without healing will
probably be short-lived; your desperation to recapture your pre-illness
lifestyle will just deplete your precious energies all over again.
Healing begins when you listen to your body and respect the signals
that come from it. For too long your history has been to ignore your
body's signals and push onward regardless of the consequences.
Respecting signals of exhaustion, pain, and stress allows you to
recognize your responsibility to yourself to preserve your health.
Healing means that you permit yourself time to preserve your
heath––and recover as much as possible. You cannot directly
control the process of recovery, but you can guide yourself through a
healing process that ultimately leads to improvement and perhaps
near-recovery. There's a bridge between illness and recovery; its
called "healing."Chapter 3: Why Mind-Body Dualism Doesn't Help.
Page 17: The Downside of "Biology is Everything"
If you view treatment of these illnesses as a search for purely
biological causes, then you're ignoring what may be most helpful to
your right now: the control you can exert over your own beliefs,
personal stress levels, and activities.
When I was in that biology-is-everything camp, I sustained myself with
the belief that I would find a practitioner who could cure
me––but after 18 years of slavish adherence to the
biological model, I had little to show for it other than a depleted
bank account. ...
Why I left the Mind-Body
Debate: ... First, finding a cure could occur well after my lifetime,
and I'm not willing to just wait. Second, I can substantially improve
my illness––through lifestyle adjustments and stress
Chapter 18: Medical and Alternative Treatments, Page 150
fatigue and depression are often linked, physicians sometimes prescribe
antidepressants for CFS patients. However, two controlled studies of
Prozac in CFS patients have reported no beneficial effect on CFS or
depression symptoms (Wearden et al. 1998; Vercoulen, Swanink, Zitman,
et al 1996). This doesn't mean that anti-depressants aren't helpful for
some people with CFS. In fact, a survey I did of 285 CFS patients
(Friedberg 1995) revealed that roughly one in four respondents did
indeed report significant benefits from antidepressant medications. On
the other hand, 31 percent of respondents said that antidepressants
made them feel worse.Chapter 10: Identifying and Lessing Anger, Page 102
What are realist expectations? First, I would suggest minimizing
expectations altogether. Expectations are implicit demands that others
behave in a certain way. Of course, everyone develops expectations for
others––there is nothing criminal about them. But if others
don't live up to your expectations, it's better to feel that this is
only unfortunate or inconvenient, not devastating. For instance, a
study of marriages found that partner satisfaction in long-lasting
marriages increased after twenty years––not because
husbands and wives became better husbands and wives, but because old
expectations about how the other spouse should behave were dropped.
Your expectations may extend to doctors who are "supposed to" try to
help you. But as you have discovered, doctors aren't always helpful.
.....Chapter 11: Finding Relief from Worry, Discouragement, Guilt
the losses you experience when you're ill is a healthy and important
process––a process that sets the stage for future healing.
Writing down these losses and how you feel about them is one way to
begin the process. ...
... Yes, you do
have the illness and its limitations, but dwelling on these things
requires thinking. This type of thinking can be changed. .... refocus
on what you can do. Appreciate the rewards and good feelings from
accomplishments, however small compared to you pre-illness activities.
... Worrying isn't equivalent to caring
about yourself of anyone else––it's merely a repetive
thought process without a constructive end. ...
To help lessen these harmful feelings of guilt, I suggest practicing
some personalized variation on the following statements:
• I will do what I can reasonably do, and I will value this achievement
rather than condemning myself for what cannot be done.
• Guilt neither makes me do more, nor changes my behavior–– it only sustains bad feelings.Chapter 6: Can Good Coping and Stress Reduction Improve Illness? Page 43
You may be unaware of the low-level stress that you experience. This is
quite common in people with these illnesses––many have
learned to ignore stress signals from their bodies, simply pushing on
with their daily activities. Also, much of the stress resides just
below consciousness, so you may fail to recognize it or dismiss it
because it's not obvious. However, even persistent, low-level stress
can keep symptom levels higher than they would otherwise be.
Stress reduction techniques, another important tool in this improvement
program, can reduce both stress flare-ups and the general stress that
is always with you.Chapter 9: How to Pace ALL of Your Activity––Its More Than You Think
Fits and starts of activity when symptoms ease may cause you to run out
the clock on your energy while ignoring pain and fatigue. The result:
relapses, collapses, crashes, and setbacks. ... There are always
certain things you must do regardless of their effect on your illness,
but you probably have more flexibility than your realize to rearrange
your schedule or do your activities in a more energy-conserving manner.
... Daily pacing, however, frees you from this frenetic pursuit of
accomplishments, large and small.Chapter 16: How to Make Yourself Miserable
did this make me laugh as I could recognize myself in each of them at
different parts of my journey!! When I read it to others, its usually
to a chorus of laughs where people have made progress, and groans to
the points that are still sore. Its okay to laugh and groan
simultaneously, too, or think these only apply to other people in the
group! Hey, that could be number 10! - Elly]Nine Rules to CFS/FM Misery
Ask yourself "Why Me?" as often as possible. Whenever your feel any
degree of peace, know that this is a false peace––you are
still ill; you must endlessly question why this curse has been visited
upon you.Chapter 17 is called, "Physician Visits: Why They Go Wrong"
- Focus on how sick you are, magnify every ache, pain,
flu-like feeling, or discomfort that you have–– to he
greatest degree possible. Only in this way will you realize the true
impact you your illness.
- As an alternative,
ignore––and deny––all of your symptoms. Consume
as much caffeine as necessary to power through your day. After all,
ignoring your illness is the only way to feel normal and healthy.
View relapses and setbacks as your body betraying you; this illness
obviously has nothing to do with you or your lifestyle. View it as a
foreign invasion––as if aliens have taken over your body.
Look to physicians, medical researchers, and other healers for your
salvation. After all, only they can improve your life, and only they
can possibly have a clue about how to lesson your symptoms. Reject any
personal efforts to change your life as simply cosmetic. Remember: a
complete cure is the only acceptable outcome.
- Be as mad at
yourself as you can for not being able to make yourself well. Also be
mad at anyone and everyone who doesn't understand your
illness––what's there not to understand in an illness
that's invisible, not recognized by doctors, and has no identified
cause or effective treatment?
- Declare yourself inadequate
because you cannot do things or help others in the way that you used
to. After all, if you cannot meet your own high standards now that
you're ill, you must be even more inadequate than when you were well
and doing more.
- View relaxing thoughts as
satanic––banish them immediately from your consciousness.
Replace them with thoughts of all the things that you'd like to do but
know that you can't do. Keep your mind focused firmly on the happy days
of the past, when you were well. Remember, those days as blissful and
carefree yet highly productive. Never question your old
priorities–– they were indisputably the correct ones.
- View guilt, anxiety, and frustration as your dearest friends that prove how intolerable your life is with your illness.
goes on to discuss until a few years ago, he believed points 4 and 5,
viewing setbacks with loathing and intolerance and looked to any number
of medical and alternative treatments to cure him because anything less
than that would have been unacceptable.]
[The sub-headings tell some the story. One excerpt given.]
Physicians and the Psychiatric Model
- What Doctors Recommend to Other Doctors about CFS/FM
- Your Right to be Skeptical
The Role of Doctors in Discouraging Healing Possibilities
The Modern Medical Myth: Most Illnesses have Identified Causes
- The Physician's View
Physician Skepticism: Does the Diagnosis Perpetuate the Condition?
- Arguments For and Against Withholding Diagnosis
- Do Symptoms and Impairments Change After a Diagnosis? Page 145
"One recent Canadian study did explore how symptoms and disabilities
change after a diagnosis of FM is made. In this study, Kevin White and
his colleagues (2002) evaluated fifty-six patients newly diagnosed with
FM. These same patients were then reevaluated eighteen to thirty-six
months later. At these follow-up evaluations, no changes were found in
physical function or health care utilization. In addition, these
patients acutally reported fewer symptoms as well as a significant
improvement in health satisfaction. So these individuals, after
receiving the diagnosis of FM, not only did no worse, they actually
seemed to be do somewhat better! This is the first study (at least,
that I am aware of) that directly tested the hypothesis that a
diagnosis of CFS or FM perpetuates these conditions; its findings
decidedly do not support the anti-diagnosis argument. If this type of
study is replicated––perhaps with a "no diagnosis" control
condition––physicians may, at long last, take notice.
Finally, I have found no study that shows that withholding a diagnosis
and referring patients to mental health professionals actually helps
people with these illnesses; although skeptical physicians may refuse
to diagnose CFS and FM, many of them do not offer any alternatives for
dealing with these illnesses."
How Doctors can Help
Combining Medical and Behavioral Approaches
Fibromyalgia & Chronic
presentation by Fred Friedberg, PhD, to the
A Lifestyle Balance Program for Less Pain & More Energy
CFS/FMS Support Group and the
Pain Connection® Montgomery County
Chronic Pain Support Group
5, 2007; 1:30 - 3 pm
Elly's first impressions (April 17, 2007):
of the studies that Fred quoted, the techical stuff, his story can be
found in his new book, FM & CFS, Seven Proven Steps for Less Pain
and More Energy.
What was special to me was that he
showed up, he shared his experience, he made a real effort to help
people understand that he used to think it wasn't worth it to make
changes in how he behaved or thought and now he does. He didn't spend
too much time talking about the seven steps because there was so much
to set up and because he enjoyed being with the people who took the
time to show up. He wanted to hear their questions and honor their
presence. When he got to the specifics of the steps, it was surprising
and I'm sure a bit frustrating for some that Fred said it didn't matter
which technique within each step people chose, only that they picked
something and worked with it often and consistently. Darn! Its still
He also let us know that even with his more energy
and less pain, even though he can do these steps after giving up the
denial that they can help, he still must schedule around his CFS, he
still has it. He wasn't offering the steps to no pain and optimal
energy. He was offering very commonly know techniques for coping,
throwing in research evidence for how they work in medically
unexplained conditions, especially CFS and FM.
Fred can now
play volleyball for two hours, but only if he has the freedom to drop
by and his buddies are glad to see him. If he was being counted on,
required to be there, it wouldn't necessarily work out and the added
stress would diminish his enjoyment and capability for playing.
had a great question from the audience about how to you cope with not
being able to sign up for things in advance. Fred and I pointed out
there are ways such as finding things that you can do last minute,
buying the dvd of an event afterward, just not doing them. We said this
was very important because signing up in advance is stressful not just
on the day of the event when you are deciding whether you can attend,
but everyday in between as you wonder if you'll disappoint others or
yourself once again. Cutting out as much of that stress is worth it.
Finding places that accept you when you can make it last minute is
Chapter 15 - Test Yourself: The Improvement Checklist
of FM & CFS: 7 Proven Steps to Less Pain and More Energy
copies of the presentation slides, all 89 of them, 6 per page.
Thank You Letter
Fred Friedberg, PhD
Associate Professor of Psychiatry
Putnam Hall/South Campus
Stony Brook University
Stony Brook, NY 11794-8790
Tuesday, April 10, 2007
Dear Dr. Friedberg,
you for taking the time, traveling to be with us Thursday afternoon,
April 5, 2007, to share your knowledge and experience of working with
fibromyalgia, chronic fatigue syndrome, chronic pain, and medically
unexplained syndromes at a first ever joint session of The Northern
Virginia CFS/FMS Support Group and Pain Connection® at the Davis
Library in Bethesda, MD. Fifty attendees was an amazing turn out for a
weekday, Spring break, Easter and Passover week event! Many more
people expressed desire they could have attended. A few have asked for
transcripts or tapes, things beyond our means, but a good sign of even
Co-leader Toni Marshall and I felt it
particularly inspiring and useful to attendees your validation of the
difficult experiences common to a high percentage of people with these
conditions, how you shared changes in your own thinking over time about
how to live and cope with them, how your own investment in new ways of
behaving has given you more energy and strength to do more of what you
find fulfilling and fun. We also want to reiterate that you connected
so well with the audience just by talking from the copies of the
slides; you didn't need the power point projector we couldn't provide.
You did a great job handling the input and questions from the audience.
We also appreciate how often and how powerfully you validated doing
what we can without crashing is more important than doing a lot and
crashing. The implication is living less is as valid as living
large, a message much appreciated.
As you so courageously talk
about in your book and in person, it isn't so much knowing the steps or
the specific ways an individual implements them that help us find more
energy for living. There is a long set-up phase that involves shifting
from wanting someone else to fix it to wanting to do all one can for
oneself even without expectation of a full cure, then doing and living
all those little ways that save us energy––and living them
again and again. There were several in the audience who have not
shifted, who do not want validation. They still want the cure around
the corner. They want the answer to be in the 7 Steps and they wanted
you to hurry up, tell us all about only those, right now! They had the
urgency of wanting it all to be fixed by something they heard in a
lecture, not the hard work of applying simple ideas to one's life with
repeated practice. Ironically, Step 1 is the one about relaxation!
and I learned more than usual from observing people's
all-over-the-place reactions to this talk in particular. Your material
and your story shine the light on uncomfortable subjects such as
denial, looking for the answers from experts or things, having to do
some work one's self, and having to change one's mind and behavior. The
title of the talk attracted people in many stages of acceptance and
readiness, and with a wide variety of, and, investment in expectations.
Our conversations with each other have addressed the role of
expectations in draining energy. Your book and talk give us examples
and motivation to talk more at future meetings about the consequences
of having expectations, even realistic ones.
Thank you again for
sharing your caring with us last Thursday. As we found out in
discussion at the post-event dinner and analysis with some long term
members more familiar with you and your books, there is much more to
discuss and share in a group setting. If you find yourself in the
Northern Virginia area on the 3rd Saturday of the month sometime in
2008, we'd love to have you back.
Elly Brosius, MS, (703) 968-9818
Toni Marshall, (410) 647-7578
The Northern VA CFS/FMS Support Group
14404 Brookmere Drive
Centreville, VA 20120
for Psychologist Fred Friedberg, PhD
On this site / CFSupport:
Research by Dr. Friedberg
- Pub Med Search for F Friedberg
(note - there is more than one - look for CFS/FM articles)
Support Groups Help People with CFS and FM? A Comparison of Active
and Inactive Members
J Rheumatol. 2005 Dec; 32 (12) : 2416-20
- Alexithymia in chronic fatigue
syndrome: associations with momentary,
recall, and retrospective measures of somatic complaints and emotions.
Psychosom Med. 2007 Jan-Feb;69(1):54-60.
- Eye movement desensitization in
fibromyalgia: a pilot study.
Complement Ther Nurs Midwifery. 2004 Nov;10(4):245-9.
- Selecting a Fatigue Rating Scale
By Fred Friedberg, PhD and Leonard A. Jason, PhD in CFS Research
- Does graded activity increase activity? A
case study of chronic fatigue syndrome.
J Behav Ther Exp Psychiatry. 2002 Sep-Dec;33(3-4):203-15.
- Chronic fatigue syndrome and fibromyalgia:
clinical assessment and treatment.
J Clin Psychol 2001; 57: 433-55. Friedberg
F, Jason LA
Chronic fatigue syndrome (CFS)
and fibromyalgia (FM) are closely related illnesses of uncertain
etiology. This article reviews the research literature on these
biobehavioral conditions, with an emphasis on explanatory models,
clinical evaluation of comorbid psychiatric disorders, assessment of
stress factors, pharmacologic and alternative therapies, and
cognitive-behavioral treatment studies. Furthermore, clinical protocols
suitable for professional practice are presented based on an
integration of the authors' clinical observations with published data.
The article concludes with the recognition that mental health
professionals can offer substantial help to these patients.
John Wiley & Sons, Inc.
- Journal of Chronic
Fatigue Syndrome, Haworth Medical Press, Vol. 5, No. 3/4, 1999.
- An Overview of
- A Subgroup Analysis of Cognitive-Behavioral
“Several studies of graded
activity-oriented cognitive behavioural treatment for (ME) CFS, all
conducted in England, have reported dramatic improvements in
functioning and substantial reductions in symptomatology”
“On the other hand, cognitive behavioural intervention
studies conducted in Australia and the United States have not found
signficiant improvements in functioning or (ME) CFS symptoms”
“Furthermore, descriptive studies of (ME) CFS patients in
England, the US and Australia suggest that the (ME) CFS patient
population studied in England shows substantial similarities to
depression, somatisation or phobia patients, while the US and
Australian research samples have been clearly distinguished from
primary depression patients and more closely resemble fatiguing
“The differentiation of (ME) CFS subgroups by symptoms and
disability may plausibly suggets protocols that are specific to these
widely divergent clinical presentations”.
Science, and the Emergence of a New Disease: The Case of Chronic
L Jason, DePaul Univ; JRichman, University of IL at Chicago; Friedberg,
SUNY Stony Brook; Wagner, Taylor, Jordan,
DePaul Univ. Sept 1997, American Psychologist, Vol. 52, No. 9, 973-983
of Chronic Fatigue Syndrome, Haworth Medical Press, Vol
1 No. 3/4. 12/29/1995
Innovations in Research, Theory, and Clinical Practice.
- Coping Skills - Treatment of
Situational Vomiting: A Case Study
Journal of Cognitive Psychotherapy: An International Quarterly, Volume
1, Number 3, 1987
10-14, 2007 - 8th International IACFS Conference
Lectures in patient and professional conference.
- April 5,
2007 - Thursday, 1 to 3 p.m.
A Lifestyle Balance Program for Less Pain and More Energy
with Pain-Connection.org -
The Montgomery County MD Chronic Pain Support Group
Davis Library - Basement Meeting Room
6400 Democracy Blvd,
Mapquest for Davis Library