Brain Retraining treatment for ME/CFS and Long COVID - discussion thread

[Utsikt]

I am repeating myself but not currently. No. And that is a problem, but I don't personally believe a brain retraining study would be allowed to go ahead on M.E. as things stand. I said that in an earlier post and someone responded saying they would be ok with that, which is great. But I don't think most people would be ok with thousands to millions being spent on it instead of biomedical research. There would be uproar. The MEA would speak out against it. Patients would say they feel it would do them harm because it's just like CBT and GET (it isn't). There would be huge pressure on the research team to stop.

First of all: the lack of scientific studies means that you can’t claim that their interventions are effective for pwME/CFS in general. I’m no saying you do that (I honestly can’t remember), but they certainly do.

Secondly (and related to you point below), these theories have been around for ages. Somatic tracking was created by Levine, but is heavily based on Reich and Gindler which again are inspired by Freud, etc. If the entirety of the community hasn’t been able to produce a single study that can prove their theories in over a century - what makes you believe that future studies will? (Hint: they won’t because their theories can’t be falsified so they can’t be proven)

I would like to think in 20 years we will have a large number of studies scrutinising it properly. Until then, what we have is a very comprehensive break down of the theory behind why Schubiner and Gordon's ideas are likely helping people (Lekander's book) and thousands of testimonials from patients documenting how and why it helped them and the objective changes they've seen in their recovery. For me, I was unable to work at all and I now work full time (I had to build up to that by volunteering and then working part time), I couldn't walk far and now I can hike, including in hilly areas. I couldn't cycle at all and now I can, etc etc. I couldn't get out the house more than once or twice a week (and sometimes not at all) and I struggled to talk for long, now I have no limitations on those things. I struggled to concentrate on reading/watching films and again now I have no limitations.

What do you do with the thousands or even houndreds of thousands of lived anecdotes of harm or no effect from mind body approaches? Do you not have to put at least equal weight on those? Which way does the scale tip?

To be clear: I say houndreds of thousands because somatic tracking has been around for ages and the biopsychosocial approach to ME/CFS has dominated the public health sector for decades. Pretty much everyone has tried some version of it.

 

[Trish]

You are taking 'fear' literally, as in you're saying you weren't scared of exercise. This is not how the brain retraining world looks at it. You have to visualise it almost as if there is a primitive brain, stuck in a skull in the dark. It relies on messages it gets through your senses and acts accordingly to protect you,

Surely fear is an emotion that is experienced as fear that the person is consciously aware of. If someone has a fear that stops them doing an activity, that is medically called a phobia. You can't be unaware of your own phobia.

If it's buried in a primitive part of the brain and we aren't aware of it, then it is not fear. I think you are describing something else.

 

[Utsikt]

I think this is a really fair point.

My answer would be that when you go through brain retraining, you start to spot certain signs in things people say that indicate it might work for them. So when people are adamant they've tried it and it hasn't helped them, the point about nudging them to look at bits they might have misunderstood is only to try to help them. That is all. I've seen it time and time again that people get stuck, get help to approach things from a slightly different direction and then they manage to start recovering. That makes it worth talking it through. People all learn in different ways. My friend gave up six months in to trying this work as she was getting nowhere. She came back to it 6 months later, tried using a different book and everything fell into place and she is now getting fully better. I have never turned around to her and gone 'SEE!' because actually, I think she's so brave to have come back to the work at all.

What this should never be is a process of shaming anyone or continually moving the goalposts as you describe. For some people, the timing is wrong to do this work or it simply isn't the right approach for them. That is completely fine. I always try to communicate that. You are, I'm sure, an intelligent adult who has given something your best shot and you have every right to then leave it there. Respect to you for even trying.

Why do I tell people 'I thought the same thing before it worked for me' when that might feel gaslighty. Because I need to circle back to the whole reason I am posting here. People get so stuck on the stupid PACE trial, on CBT, on how they have tried 'thinking positively' and none of that relates to what got me better. Many do genuinely not get brain retraining. If you do, great and I'm so sorry it didn't work for you. I really hope you find the answers you're looking for. I feel no desire to push you to keep trying something you don't want to. Really.

When do you stop nudging someone to get them to see if they missed something?

When do you know that it didn’t work for them?

 

[Utsikt]

You are taking 'fear' literally, as in you're saying you weren't scared of exercise. This is not how the brain retraining world looks at it. You have to visualise it almost as if there is a primitive brain, stuck in a skull in the dark. It relies on messages it gets through your senses and acts accordingly to protect you, even if there is a more sophisticated part of you that has no fear of exercise and wants to be out skiing. The primitive brain wins out in this case by ramping up the symptoms. And then there is more fear and more symptoms.

See, this is where you’ve lost me.

What is the scientific causal evidence for this description of how the brain works?

What about the underlying assumptions - can they be proven?

 

[Theresa]

In the world of brain retraining, this makes sense though.

You had some symptoms. The brain gets the message it isn't safe (because symptoms normally mean the body is ill, aka there is a threat and you actually need to rest). You pushed through them. The brain is then actually getting another message it isn't safe (because if you are ill, intense exercise can be dangerous. Plus you aren't listening to your body so there is another layer of danger). So it generates even more symptoms to try to get you to look after yourself.

Based on that theory ( which I do not think is correct) if you pushed through the symptoms initially you should see that there was no need to rest after all and the symptoms would just disappear. This is what Paul Garner says and what most of the brain retraining work entails.

 

[forestglip]

If you reread my post, you'll hopefully see me say you can get your head around the basics in a few days. It's just that that's the basics and also some people do this, dismiss it and miss out on the chance of ever deepening their knowledge to give it the best chance of working. For some people, they do the work over 1-2 years and find they are still learning, partly because they are learning about their own past and what might have caused their brain to be scared, partly because you can keep building on your knowledge. This work is a collaborative and experiential process and you do need to do the work and monitor how your understanding feels and changes over time.

Repetition is key to see what is truly working for you. As an example, one tool is somatic tracking. You can look it up on YouTube to see in action. It would be really easy to read about it, decide it's not for you and leave it at that (and fair enough if you want to do that). But it is only by trying it out a few times a week over a period of weeks, taking time to reflect on your insights, maybe tweaking how you do it by talking with other recovered people who have done the same and learning other bits of info about the theory behind it all that you will get the full experience. 4-8 weeks of work is actually nothing when you are in the middle of it and seeing improvements as the weeks go by, what you tend to see is people find it so helpful that they hungry to immerse themselves in it and learn as much as they can. 4-8 weeks is definitely nothing when you have lost years to being ill and this starts to change that.

Can I say anything about the process? The first part of the process is simply learning how neuroscience has managed to understand how the brain can respond to fear. It is like being given a handbook on what your own brain is doing and you start to go 'oh, I see how this works here, here and here in my own life.' I am such a fan of Lekander's book as he breaks this down so well, giving many people the ability to understand how he is describing it. Not all authors have that knack. Not every book is readable. Can I summarise his book here? I don't feel very skilled at attempting that and it is stuffed with so much interesting stuff that I'd be missing too many key things in it. I'm not an immunologist or a neuroscientist (I wish I was!)

With the above theoretical knowledge, you are then encouraged to do things that will calm your nervous system down. So that might be meditation, it might be journalling (there is so much evidence about journalling helping the brain process emotion including fear, even if we don't understand how that works yet), it might be getting regular time in nature or adding in very small things on a daily basis that make you feel joy. Now believe me, I had tried journalling and meditation whilst ill and they didn't get me better and I hear that a lot from others but this is where the routine of trying these things is important as well as understanding the neuroscience mentioned above to help you understand the role they are playing in calming your nervous system. For some reason, framing it in this theory makes all the difference.

Somatic tracking is then arguably key. This gets you to focus on a particular symptom with a watchful curiousity (that comes from mindfulness) while trying to reeducate your brain to feel safe. It's the weirdest, coolest exercise because you can watch demonstrations of it and symptoms disappear or start to jump around the body in real time. Someone can start with neck pain or ringing in their ears and then move to getting knee pain then nausea and then they all vanish. It's kind of like watching a religious healing except we can explain *why* the brain does this (see Lekander's book again which breaks it down, sorry!). I now know multiple people who had severe M.E who have tried somatic tracking repeatedly over months and recover. Some of them are detailed testimonials in FB groups, some are people I knew for years when they were ill so I know how incredibly unwell and restricted they are. I've watched them go from not believing it will work to trying it, thinking it's not going to help them and then it starts to and then they make huge strides forward. And the symptoms keep coming back and they go over and over these steps and the symptoms go away again. It's so weird to watch but there's no denying it's real when you see it play out.

I hope this helps a bit. No need to force yourself into exercise or to say 'stop' at your symptoms or anything.

Thank you. I think it's useful to at least get an idea of what we're actually talking about instead of using the ambiguous name (at least to me) brain retraining. So here's an attempt to summarize the specifics based on what you've said:

Brain retraining includes learning about the effect of fear on the brain. It also includes doing activities that promote relaxation/calmness, such as journaling or being in nature, which are most helpful when one has the above understanding of neuroscience. Thirdly, it includes meditatively focusing on one's symptoms with a mindset of curiosity.

I assume it includes other aspects and is hard to relate in full in a short post, but would you say that's a fairly accurate description of brain retraining in a few sentences, or would you change/add anything?

Interestingly, I instinctively often do something along the lines of the "somatic tracking" you describe. I have anxiety that runs away with any minor worry, so I sometimes try to focus on something else to not catastrophize. The easiest thing to focus on is the constant anxious feeling in my chest, since it's so prominent. Much easier than trying to focus "past" that big glaring sensation at something like my breath. And I have noticed the focus sometimes naturally "jumping around" to other symptoms or body parts that want attention.

While it's useful for keeping my thoughts calm in the moment, I haven't noticed any long term benefit in any area. I do have some hope that it's a valuable long term practice, based on some vague idea about how maybe constantly focusing on that visceral feeling of anxiety will help me to understand it. See more clearly every nook and cranny and the exact shape of that feeling, and maybe catch the exact moment it arises and eases away. It's mostly hopeful thinking, but might be useful after a long long time for my mental health.

But after doing this for a while, I can safely say I don't think it has or expect it to cause any substantial improvement in my ME/CFS. Still feels like I get hit by a train if I just go to the grocery store. Still feel the consequences of the activities I am too bored not to do. I suppose it's possible it could help if I also do the other activities you mentioned (though I think I already do calming activities like journaling, sitting outside looking at nature), but it feels very unlikely that something like learning what happens in the brain from fear would help (although I'm already reading a neuroscience textbook, so maybe I'll hit the trifecta by accident).

 

[forestglip]

But I don't think most people would be ok with thousands to millions being spent on it instead of biomedical research. There would be uproar. The MEA would speak out against it. Patients would say they feel it would do them harm because it's just like CBT and GET (it isn't). There would be huge pressure on the research team to stop.

But we've got plenty of CBT trials being done for ME/CFS. So why would there be an uproar that prevents even a single brain retraining study but not CBT?

 

[Holinger]

Are you aware they have helped literally thousands of people to recover? I simply wouldn't have recovered if it wasn't for them. That doesn't mean I think they are perfect humans but I have seen so many testimonials from people they have helped and the PRT/EAET training means they will reach many thousands more over the course of their lifetimes. The simple fact is these two men are responsible for huge numbers of people with multiple chronic symptoms recover to the point of having really good health again. There are very few people who have had the positive impact they've had between them. And I've actually met Schubiner in person. He was the most gentle, compassionate man who talked to me about my past with lots of kindness and sensitivity (unlike many of the horrible doctors I met when I was ill). I was very impressed by him and I really don't like male doctors in general.

Then put the evidence forward. If Alan Gordon said he had Me/cfs then that is a flat out lie. His description of it from a video I saw was of ‘back pain with fatigue’. I mean if that is having what most of us have on this forum call me/cfs then a solution will never be found.

 

[Utsikt]

But we've got plenty of CBT trials being done for ME/CFS. So why would there be an uproar that prevents even a single brain retraining study but not CBT?

Not to mention for long covid!

 

[Kitty]

It also includes doing activities that promote relaxation/calmness, such as journaling or being in nature, which are most helpful when one has the above understanding of neuroscience.

I've been getting out in nature regularly and observing and surveying wildlife for the entire 49 years I've been ill, and can report that it doesn't help. Not unpredictably, being out in nature gives you PEM, so not unpredictably, you feel considerably worse afterwards.

Never having suffered from generalised anxiety—doesn't help.

Never being phobic about activity, to a point approaching self-destructiveness—doesn't help.

If what @forestglip outlines really is the approach, all it tells me that people propagating it haven't understood the first sentence of the book when it comes to ME/CFS. I'm not convinced some of them* have even thought about borrowing it from the library yet, let alone actually opening it.


* I'm not referring to anyone who's posted here, of course. They didn't think this nonsense up and it isn't their fault.

 

[bobbler]

CBT and brain retraining have some key differences. In fact, brain retraining incorporates some CBT in it but there is lots to it beyond that. I did an NHS CBT course when I was ill. It made zero difference to me, I felt like I learnt nothing useful in it. It was only when I learnt about brain retraining that I was able to recover.


You know, I would say the same when I was ill. I'd had that professional input and assessment and was being told I had no 'psychological issues.' The problem is the vast majority of psychologists do not understand brain retraining. Some are starting to, including Jake Hollis who was ill when he was training to be a psychologist (so you'd think he'd have known if there was something he needed to work on related to his mental health) but he only started recovering when he learnt the theory behind brain retraining.



Same here. I tried pushing through a lot in the first year because I loved exercise and thought it would help. It didn't fix me, it was making me worse. I would have said the same about fear avoidance not being part of my illness. Except I was wrong because I simply didn't understand how fear worked with my symptoms and how they can involve an underlying fear that I wasn't consciously aware I was experiencing. This is where I'm trying to push people into taking another look at things, by reading Lekander's book. I was browsing it today. It is so good and such an accessible read. I'm really frustrated people here are refusing to read it. I think you'd learn something.



See, this to me reads like an ad hominem, despite the insistence that they're not allowed on this forum. Is it necessary to write this?

I see where we might be finding confusion / cross purposes ...

can I ask do you have ME/CFS

or/and do/did you have another condition that is fear of exercise?

And when you are talking are you talking about ME/CFS or the opposite condition, that is fear of exercise despite it [exertion] actually improving and not harming health long-term, and/or supposed imagined symptoms that improved long-term by pretending they are not there?

 

[bobbler]

Then put the evidence forward. If Alan Gordon said he had Me/cfs then that is a flat out lie. His description of it from a video I saw was of ‘back pain with fatigue’. I mean if that is having what most of us have on this forum call me/cfs then a solution will never be found. He is a charlatan that will sell what he can to his brethren.

indeed. Claim it is thousands recovered but at best a few actual 'testimonials' (in commas as many - of the ones posted, because there aren't many anyway - don't follow the normal etiquette regarding these)

 

[bobbler]

Surely fear is an emotion that is experienced as fear that the person is consciously aware of. If someone has a fear that stops them doing an activity, that is medically called a phobia. You can't be unaware of your own phobia.

If it's buried in a primitive part of the brain and we aren't aware of it, then it is not fear. I think you are describing something else.

And fear and the idea of 'subconscious fear' nonsense (I say this as someone from a psychology background offended by someone trashing the subject by suggesting that BS that has always been an area scientific psychology has pointed out isn't proven ... to put the whole really it is just the irresponsible weaponising terms only meant for the responsible side of the subject given how much harm they can used for by those without good intentions and follow-through in mind)


Well it doesn't matter which one it is because it would in either case be this theoretical 'mediating factor' in their theory.... which is that it causes deconditioning. or causes exhaustion. And deconditioning 'treatment' and 'fear-avoidance CBT' have both been proven not to be helpful, nor either the cause or what is behind ME/CFS.

Plus of course most ME/CFS people do more than most people who are from bps - both before they get ill, and after, due to bps deliberately having constructed a dystopian bullying situation for pwme 'as treatment' for the last 2 decades (and before that) whilst they didn't have to live in that.

Basically for what they claim to be true it is actually incumbent on them to prove pwme all did significantly less than themselves, and indeed less than healthy but lazy people who stay without ME/CFS, nevermind the often much higher levels they are forced to damage themselves with.

But they don't like proof so just go around name-calling and pretending suggesting it's fear and they are so stupid (women) if they claim they aren't then they just 'don't realise they are fearful' misogyny nonsense instead, because actually the stats prove otherwise.

PACE forced people, literally forced it, and tanked people's health. SO what the heck does this crud - other than as slander , and silencing - have to do with the price of eggs for anything related to a serious illness other than an attempt to spread bigotry and waste the energy of those with an energy-limiting condition.



I'm not seeing, after plentiful polite requests, any papers that actually relate to any claims made actually ever listed (just 'see these show x' then 3 links to papers where there is nothing of the sort that I could find) from these individuals. Just rhetoric/sophism. It isn't acceptable to make so many unpleasant unreasonable claims and then still many pages on think you are above citing anything other than your own mindset and quoting a few mates and one-liners to justify it, by that point they are unjustified assertions.

 

[Trish]

Sorry if I misremembered your comment, and I can't find it now. Stress is not simply about trauma, it's about combined load. Exercise, infections, work, lack of sleep, etc. all add to that load.

Then why aren't all the stressed people in the world, which is probably practically everybody at some stage in their lives, suffering from ME/CFS?

A walking test is objective, but is not an objective measure of ME/CFS. Mild patients aren't likely to have much if any difference in walking after recovering.

What do you base that assumption on?

Do you have examples where patients that are at least 50 % physically impaired with an illness that do not show any clinically significant improvements in e.g. 6MWT or ISWT when their illness improves or resolves?

The participants in the PACE trial who managed to do the end of trial 6 minute walk test were on average only able to walk a little further, many walked shorter distances, and a significant number didn't manage to to the test at all, even though the managed to fill in the questionnaires. The distances walked were still at the level of sick people, nothing like the distances a healthy person can walk or the improvements shown by people with other conditions after 12 months of rehab.

I think that shows very clearly that people with mild to moderate CFS as defined at the time were not objectively helped to improve their physical health after 12 months, added to the fact that there was no improvement in the step test and in employment. I think you are wrong. A mild patient who has recovered should have been able to walk much further, done significantly better on the step test and been able to return to work and stop claiming sickness benefits.

 

[Kitty]

We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation.Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities.

I'd be very interested in their theory to explain what happens to your brain if you never stop those normal activities. If you're in full time work and not only do you not know you have ME/CFS, you've never heard of it. If you don't consider yourself suffering from the symptoms you supposedly need to adopt a less threatening understanding of, because you assume it's part of normal adult life.

What's ME/CFS then?

That was my life for 23 years. I went through the same experiences as my classmates: excited by live music, plodding along in a dull office job, going out on protests, feeling happy and content, being really unwell, falling hopelessly in love, trying to help my collier relatives through the miners' strike, feeling incredibly bored, being over the moon at getting a new job.

It never once occurred to me I had a long term illness. ME/CFS fluctuations were linked to my menstrual cycle, and in a family with crippling endometriosis, none of it looked very unusual. I waved away the rest of it as picking up a lot viruses from working in open plan offices. The people around me were forever complaining about being knackered and everything hurting; that's how I felt, so as far as I was concerned I was living the experience of normal women. It somehow escaped me that I was between two and four decades younger than most of them.

I've no doubt all of that can be explained away—the rule seems to be that there are no rules. Theories can be stretched in any direction to explain every situation, and there's no need for them to be falsifiable or even rational.

 

[Trish]

No. And that is a problem, but I don't personally believe a brain retraining study would be allowed to go ahead on M.E. as things stand. I said that in an earlier post and someone responded saying they would be ok with that, which is great. But I don't think most people would be ok with thousands to millions being spent on it instead of biomedical research. There would be uproar. The MEA would speak out against it. Patients would say they feel it would do them harm because it's just like CBT and GET (it isn't). There would be huge pressure on the research team to stop.

I think you are wrong. Objections to PACE and to a Norwegian study of LP have been objected to before starting on grounds of bad trial design, financial and other conflicts of interest of the trial principal researchers, lack of objective primary outcome measures, and lack of equipoise in control groups.

A properly set up study of brain retraining for ME/CFS would have to inform patients fully in advance that the methods being studied have no validated scientific basis for ME/CFS and may not work, and if they don't it's not a sign of failure on their part.

They would need to provide properly informed consent on that basis, and be selected for the treatment and control groups at random from patients who had no prior experience of or beliefs about the therapy. There would also have to be a debrief afterwards for those for whom the treatment failed, to overcome any sense of personal failure and to provide good management advice and support.

And a control group with equipoise, ie being given the same number of sessions of a supportive and positive sounding therapy, perhaps a combination of mindfulness and help with practical home support to reduce stressors and enable better pacing.

The therapists for both groups would need to be open minded about whether the treatment would work, and have no financial or other conflict of interest in the therapy. I think it would be important that the therapists had not gone through the therapy themselves and been convinced it worked, as they need truly open minds.

For outcome measures, if the participants were provided with wearable activity monitors and a symptom recording app, and did an exercise challenge and a battery of cognitive tests before and after the trial, and a year later, then I think many pwME would accept it as a valid study. I would even consider participating myself, if I were younger.

 

[Jonathan Edwards]

So it seems that the up to date Brain Retraining theories derive from 'Schubiner and Gordon's ideas'.

I looked up PubMed for Shubiner and Gordon and found 3 entries. One is the back pain trial we have analysed. Another is about patient experiences from the same trial and the third seems to be a response to a letter pointing out problems with the trial.

So it seems that the trial might be taken as an indicator of these authors' ideas?

The ideas seem to centre around theories of psychological contributions to pain. But the trial shows clearly that its designers have no understanding of the way psychological factors are likely to contribute to the reporting of pain in trials. As a result the data from the trial isn't any use as a test of a theory of psychological contributions to pain itself.

As someone who saw patients with back pain every week for thirty odd years I find it very difficult to believe that psychology has much to do with it. Non-progressive back pain (the common sort studied in the trial) is nearly always located between L4 and S1 levels. Nearly everyone develops structural deterioration of intervertebral discs and their attachments at precisely this level - which is why sciatica nearly always affects roots L4, L5 or S1. I have no doubt that psychological factors will affect the way people with back pain describe it and respond to it in social situations but for the reasons given above the trial tells us nothing about whether psychological factors actually affect the pain. They might do, but that needs to be tested in a competent fashion.

 

[Utsikt]

The ideas seem to centre around theories of psychological contributions to pain. But the trial shows clearly that its designers have no understanding of the way psychological factors are likely to contribute to the reporting of pain in trials. As a result the data from the trial isn't any use as a test of a theory of psychological contributions to pain itself.

Could it be that they authors hold the philosophical view that pain only exists if you report that it exists?

 

[Andy]

The PACE trial has been referenced here a number of times, so I thought it might be worth pointing out that we have a PACE briefing document designed for those who are not fully aware of the issues with it, Science for ME PACE Briefing document

 

[JemPD]

I think you are wrong. Objections to PACE and to a Norwegian study of LP have been objected to before starting on grounds of bad trial design, financial and other conflicts of interest of the trial principal researchers, lack of objective primary outcome measures, and lack of equipoise in control groups.

A properly set up study of brain retraining for ME/CFS would have to inform patients fully in advance that the methods being studied have no validated scientific basis for ME/CFS and may not work, and if they don't it's not a sign of failure on their part.

They would need to provide properly informed consent on that basis, and be selected for the treatment and control groups at random from patients who had no prior experience of or beliefs about the therapy. There would also have to be a debrief afterwards for those for whom the treatment failed, to overcome any sense of personal failure and to provide good management advice and support.

And a control group with equipoise, ie being given the same number of sessions of a supportive and positive sounding therapy, perhaps a combination of mindfulness and help with practical home support to reduce stressors and enable better pacing.

The therapists for both groups would need to be open minded about whether the treatment would work, and have no financial or other conflict of interest in the therapy. I think it would be important that the therapists had not gone through the therapy themselves and been convinced it worked, as they need truly open minds.

For outcome measures, if the participants were provided with wearable activity monitors and a symptom recording app, and did an exercise challenge and a battery of cognitive tests before and after the trial, and a year later, then I think many pwME would accept it as a valid study. I would even consider participating myself, if I were younger.

Wow i'd be really thrilled if a study like this could be done. Then we'd know once and for all!
For those it helped we might be able to elucidate why it helped them and not others and if no benefit was shown we could all stop wasting our energy debating it.

Incidentally, @Friendswithme ... Hi, I wonder if you would mind/are able to please break up your paragraphs into smaller ones when you comment. I want to read what you're saying but I just cant read long paragraphs because the lines all merge together & it becomes impossible, so I cant read it.

I know many other people with ME/CFS also struggle with it so guessing they'd find it useful too

Edited: to remove a suggestion for number of lines (since people are using different device screen widths)