Stress and fatigue

Stress and fatigue

Many people contact a psychologist because they feel under pressure, drained of energy, or “tired but wired” - often over time. Stress and fatigue can affect sleep, concentration, mood, work functioning, and relationships, and can occur across different life situations as well as psychological and medical conditions.

The aim of therapy is to understand what is driving and maintaining your difficulties, and to identify steps that are realistic, safe, and sustainable.

Important note: Stress and fatigue can also have medical causes. When needed, we are happy to coordinate with your GP.

What do we mean by stress, fatigue, and sleepiness?

These terms are often used interchangeably, but they can mean different things - and that matters for what helps.

• Stress: Demands (external or internal) + how they are appraised + how you cope with them. Over time, prolonged activation can create “wear and tear” on the body (often referred to as allostatic load), and may contribute to increased restlessness, pain, irritability, and sleep problems.
• Fatigue: Can be
  • physical (heavy body, reduced stamina),
  • cognitive (brain fog, reduced concentration), or
  • related to sleep (non-restorative sleep).
• Sleepiness: More of a drive to fall asleep (dozing, unintentional sleep). This may point more toward sleep deprivation or a sleep disorder (e.g., sleep apnea).

Separating these helps us choose the right approach - and avoid explaining everything as “stress.”

Common signs of strain and fatigue

You don’t need to “fit” a diagnosis for your experience to be real. Many people describe, for example:

• persistent tiredness that doesn’t improve with rest
• feeling like your “system is on high gear” even when you are exhausted
• sleep difficulties (trouble falling asleep, awakenings, early waking) and feeling unrefreshed
• concentration problems, slower pace, more mistakes/forgetfulness
• irritability, low mood, anxiety, or rumination
• more tension/pain, headaches, gastrointestinal symptoms
• reduced social capacity and work performance
• “boom-bust”: pushing on good days and feeling worse afterwards

What can be behind it?

Stress and fatigue often arise in combination. Common contributing factors include:

1) Sleep and circadian rhythm

Sleep problems can be both a consequence of stress and a key factor that maintains fatigue. Insomnia often causes daytime difficulties that can resemble depression/fatigue (tiredness, low energy, cognitive slowing).

2) Stressors and “internal demands”

High demands, low control, role pressure, caregiving load, conflict, or difficult life events can lead to prolonged stress. Perfectionism, a strong sense of duty, or difficulties setting boundaries can intensify it.

3) Low mood, anxiety, trauma, and pain

Fatigue often co-occurs with worry, anxiety, PTSD symptoms, depression, or long-term pain. In these cases it’s common to see cycles where sleep, activation, avoidance, and loss of capacity reinforce each other.

4) Work-related fatigue (“burnout”)

In ICD-11, burnout is described as an occupational phenomenon: energy depletion/exhaustion, increased mental distance or cynicism, and reduced perceived effectiveness - specifically related to work. Symptoms can overlap with depression, so we always assess the full picture, not only “work.”

5) Medical and medication-related factors

Anemia, thyroid issues, infections, sleep apnea, inflammatory conditions, medication side effects, and alcohol/substance use can contribute. When there are clear indications of this, a medical assessment is recommended.

How we work with stress and fatigue

We begin by building a simple, concrete understanding of your situation: What does “fatigue” mean for you? When does it get worse? What helps a little - and what helps in the moment but makes things worse over time?

From there, we choose steps that match your pattern.

Assessment and formulation (first 1-2 sessions)

• clarify the type of fatigue (physical/cognitive/sleepiness) and level of functioning
• map sleep and circadian rhythm (often using a simple sleep diary)
• explore stressors, rumination/worry, and coping patterns
• look for signs of depression/anxiety/trauma, pain, and work strain
• consider whether there are indications for medical follow-up

Approaches that are often helpful

Depending on your needs, we may work with:

• CBT-based stress management: identifying “stress drivers,” adjusting standards and demands, addressing worry/rumination, prioritising and problem-solving
• Boundaries and calibrating effort: pace, breaks, expectation-setting, communication, and realistic adjustments (including workplace accommodations)
• Sleep treatment (CBT-I) for insomnia: structure, stimulus control, sleep pressure, and thoughts that keep sleep problems going (CBT-I is always adapted to health and life circumstances; we avoid a “one size fits all” approach.)
• Activity balance: moving out of “all or nothing” patterns and building steadier rhythms and more predictable recovery
• Pacing/energy management when symptoms clearly worsen after activity
• Working with pain and tension: understanding links between stress, sleep, pain, and functioning - and strategies that support daily life
• Values-based direction (ACT-inspired): making room for what matters, without pushing the body too hard

Who might this be a good fit for?

This may fit you if you:

• experience persistent stress/fatigue that affects work, studies, or personal life
• struggle with sleep and feel it is draining your energy
• have been “getting through it” for a long time, but at an increasing cost
• want a clear plan and realistic change - not quick fixes

Other support may be needed first or alongside therapy if:

• there is strong suspicion of an unresolved medical cause
• there is severe depression or another severe condition with marked functional impairment
• there is ongoing substance misuse that requires specialised treatment

In a crisis

Therapy is not an emergency service. In an acute emergency: call 113. If you need urgent medical help that cannot wait: contact the out-of-hours medical service 116 117.