> This idea that you can't stay in bed for longer than 20 minutes unless you can sleep is very challenging for someone who is already spending all day in bed because they're sick, and setting up this expectation, I've found, is a recipe for non-acceptance and self judgment.

That sucks, but tbh, it doesn't sound related to CFS (the sleep disturbances certainly do, but not the fugue-state rumination). Certainly sounds like it would exacerbate it though. I was dealing with a similar sounding cycles of 48 hr wakefulness. Awful, awful.

Regardless, may I suggest moving to a chair next to your bed? It's still getting out of bed, but maybe not so debilitating?

> I have had really negative effects from cognitive behavioral therapy in the past. Instead of letting me recognize and eliminate cognitive distortions, the CBT routines seem to add new forms of suffering rumination.

I would hazard that whoever taught them to you was not entirely competent, particularly since it sounds like they should have been known enough not to make you think that noticing one's distortions and dysphoria is all one needs to resolve them would make

If this was significantly in the past, things are quite different now. The last 20 years of mental health treatment are light years more effective than what came before, which was, IMHE mostly useless and often deleterious.

Moreover there are better ways to approach issues like the ones you describe, specifically DBT and its combination of distress tolerance skills, mindfulness and self-compassion. Of the three, it really sounds like what you are going through needs a whole lot of compassion.

https://www.amazon.com/Self-Compassion-Proven-Power-Being-Yo...

Another article in The Atlantic was published recently, mentioning John Vasconcellos. Kristin Neff thinks self-compassion works better.

https://www.theatlantic.com/health/archive/2016/05/why-self-...

Neff also has a book https://www.amazon.com/dp/B004JN1DBO