High stress / burnout
Sustained stress dysregulating the stress axis — a predisposing and perpetuating contributor to fatigue.
Sustained psychological stress can dysregulate the stress (HPA) axis and contribute to fatigue, poor sleep, and burnout, often acting as a predisposing and perpetuating factor that makes recovery harder. It is assessed by history, with cortisol and heart-rate-variability as adjuncts, and addressed with stress-reduction approaches — CBT, mindfulness, and meditation — which are low-risk and benefit the mood-and-stress cluster broadly.
How it's tested
Stress / HRV assessment
Structured history of life stressors, optionally with cortisol and heart-rate-variability measures.
Treatment options & their evidence
Graded honestly — including treatments that failed in good trials, which is worth knowing.
Cognitive behavioral therapy (CBT)
Strong evidencepromise 3 · 2 RCTsThe best-evidenced behavioral option for fatigue/coping (e.g. the ReCOVer 'Fit after COVID' RCT). It targets perpetuating factors and does NOT assume a psychological cause; note it improves subjective fatigue more than objective activity or cognition.
Caution: Must not include graded-activity escalation where PEM is present, and must avoid 'dysfunctional beliefs' framing.
Mindfulness / meditation
Mixed evidencepromise 1.22 · 1 RCTAn MBSR RCT improved anxiety, depression, and stress (weaker effect on core fatigue/cognition). A useful low-risk adjunct for the mood/stress cluster.