Treatment Fatigue and What to Do About It

Posted by on Jul 7, 2014

If you’ve ever felt that you’ve given every ounce of energy to treatment and can’t muster up any more, you’re not alone. It turns out that there’s such a thing as treatment fatigue, and it can become a sizable barrier to the recovery process.

treatment fatigue

“Journey to the Center of the Earth” by Édouard Riou

About five months into treatment, I began to feel weary. The feeling went deeper than merely being tired after months of effort. It was a soul-smothering kind of weariness that stopped me dead in my tracks and made both recovery and relapse seem impossibly far in either direction.

Even more frustrating, this feeling took hold just when I thought I was improving. I had descended the levels of care in my treatment program and finally made it to the final step, intensive outpatient, which met three evenings per week. I expected to take up my newfound freedom like a champ. So I was rather disheartened when on Day 1 of the new program I felt utterly unmotivated to participate in the groups or make an effort at the meal. Day 2 was the same. So was Day 3.

At first I chalked up my reaction to transitioning to the new level. But weeks crawled by and nothing seemed to improve. Even worse, ED thoughts and symptoms came creeping back, and I was too burnt-out to fight them off.

Frustrated and on the brink of quitting, I contacted a former therapist and asked her, in so many words, “What the hell is going on here??”

She assured me that I was not the utter failure I assumed I was. In fact, she said, I’d been giving treatment my all. I’d worked to identify buried feelings; I’d sat with discomfort and anxiety without reacting destructively; and, meal after meal, I’d challenged the ED voice. I’d done this every day for months, even when I didn’t feel like heeding each and every shift in my psyche.

The problem was actually quite simple, she said—I was fatigued.

Treatment Fatigue

Treatment fatigue can be a consequence of enduring intensive, long-term care—not just for eating disorders, but for any illness that requires a grueling treatment regimen. The reasons for fatigue vary, but it manifests in similar ways—for instance, having difficulty concentrating, feeling anxious, and having a gradual decrease in stamina (which differentiates it from being tired).

For me, it was born of feeling momentarily optimistic about my new recovery behaviors, followed by a few (normal) slips. Not only did I feel that such slips “shouldn’t” be happening after months of intensive treatment, but I also feared that all my work had been for nothing.

Even these feelings are normal, I learned. The early stages of eating disorder recovery are taxing, and often include a lot of physical discomfort as your body readjusts to normalized food intake. And yet, there can also be a sense of relief. Despite years of clinging to my disorder, it was actually freeing to eat without my self-imposed restrictions. Plus, I began to feel better: I regained energy; a cold day did not cause me agony; my swells of anger ebbed; friends’ company became enjoyable again.

Unfortunately, this honeymoon phase of recovery eventually waned. But I’ve since learned that just because recovery loses its early allure does not mean it has moved beyond reach. Hopeful, relieving moments of recovery are real—but so is the disorder. It’s normal to find that certain ED thoughts and behaviors shoot up again like weeds. Deeply ingrained habits take time to uproot.

So how do you battle that frustration when the honeymoon is over?

Kartini Clinic founder Dr. Julie O’Toole writes about treatment fatigue in parents of children with eating disorders. It’s difficult enough to walk with your child through recovery, she says—it feels damn near impossible to stay the course through repeated relapses. She writes:

“Do you remember the myth of Sisyphus from school? The Greek myth where King Sisyphus was condemned repeatedly to roll a boulder up hill with great effort only to have it roll back as he nearly reached the top? This must be what it feels like to have one’s child briefly returned to health only to have the illness come tiptoeing back, seducing the child into first one small eating disorder behavior and then another until the sum total adds up to weight loss and relapse.”

She tells weary parents to do something that to them might seem counterintuitive—take care of themselves. Ask a friend for help with errands, get time alone to go for a walk, vent to a loved one. Self-care is critical to maintain your energy and keep yourself healthy so that you can continue battling.

My therapist advised me similarly. “Be gentle with yourself,” she always said, meaning that I needed to cut myself some slack. I needed to remind myself that I’m not superhuman. Once in a while I need a break. On days when the hard work of recovery feels impossible, it’s okay to cry, hug my cat, and tell myself I will try again tomorrow.

But what if self-care isn’t enough to beat the fatigue? Then what do you do?

After five weeks of dragging myself through the final step of treatment, my team determined the program was doing more harm than good for me. It was time to try a new approach with an outpatient team that could focus on my individual needs.

At first I was angry with myself, because I felt as though I had failed to suck it up and run that final mile. Then I became angry with my team, because I felt as though they’d abandoned me after months of effort.

I panicked, protested, brooded, and then finally surrendered. And lo and behold, they were right. Shifting my recovery work to a new setting helped re-energize my efforts. It reminds me of the way it feels to be in an old room with a fresh paint color—even though you’re in the same space with the same furniture, it suddenly feels new.

Recovery is an arduous journey. It’s normal to find yourself wondering how much more of it you can take. But all journeys have ups and downs. In down moments, cut yourself some slack. Remind yourself that you are not superhuman and that it’s okay to take a break. Do something that soothes you. Remain open to trying new approaches that might revive your spirit.

And be gentle with yourself.

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