Ten Keys to Successful Coping
2:
Find Your Limits
By Bruce Campbell
Having a chronic
illness can often feel like living on a roller coaster. You swing
between intense symptoms and rest, in a frustrating cycle of push and
crash. When your symptoms are low,
you push
to get as much done as you can. But doing more than the body can
tolerate, you intensify your
symptoms and crash. You then rest to reduce symptoms, but then,
if you
feel frustrated and try to make up for lost time, you may plunge into another round of
overactivity leading to another crash.
The
Push/Crash Cycle
There is an
alternative to this cycle of push and crash: living within limits. Your
activity level and the way you live your life affect your
symptoms. If you honor your limits, you can gain some control over your
symptoms and bring predictability to your life. This article explains
how to find your limits; the next article shows how to live within them.
The Energy Envelope
One way to explore the idea of limits
is through the concept of the Energy Envelope. You can think of your
situation in terms of three factors: 1) available energy: the energy you
have. It is limited, and is replenished by rest and food; 2) expended energy: the energy you lose through physical, mental
& emotional exertion; and 3) symptoms: fatigue, brain fog, pain, and
so on.
If you expend more energy than you
have available, you will intensify your symptoms. This is called
living outside the Energy Envelope. This approach commonly leads to the
push and crash cycle described above. An alternative is living inside
the Energy Envelope. If you keep your expended energy within the limits
of your available energy, you can gain some control over your symptoms.
If you accept your limits (keeping your activity level within the limit
of your available energy), you can reduce symptoms and the severity of
relapses, and over time may be able to expand your limits. This is
an upward spiral.
The Fifty Percent Solution &
the Bowl of Marbles
Let me suggest a couple of ideas you
might use if you wanted to apply the concept of the Energy Envelope.
The first is called the fifty percent solution. Each day estimate
how much you think you can accomplish. Then divide this in two and
make it your goal to do this lesser amount. The unexpended energy
is a gift of healing you are giving to your body.
The second idea is to imagine your
available energy as a bowl of marbles. You have a limited number
of marbles to use each day. The number may vary from day to day.
Physical activity uses some, but mental and emotional activity do as
well. With every activity, you take one or more marbles out of the bowl,
remembering that stress is a big marble-user and so lessening stress
will preserve your supply of marbles for other uses.
The overall idea in both the fifty
percent solution and the bowl of marbles is that our limits force us to
set priorities in order to control symptoms and bring stability to our
lives. Both techniques are ways you can reframe your situation to give
yourself permission to do less in order to improve quality of life.
Defining Your Limits
Another way to use the idea of the
Energy Envelope is to develop a detailed description of your limits.
This can give you a thorough understanding of what you individually have
to do to minimize symptoms and improve your quality of life. If
you want to do this, I suggest you look at five different aspects of
your life: your illness, activity, rest, emotions, and stress. (For
more, see the discussion on how to complete the Energy
Envelope form in the Energy
Envelope chapter of our course textbook.)
Illness: The severity of your
illness suggests your safe level of activity. To get an initial idea of
a safe activity level, you can rate yourself in comparison to other
patients on the CFS/Fibromyalgia
Rating Scale. Most of the students in our course have rated
themselves between 25 and 45, but we have had people across almost the
full range of the scale.
Activity
: This factor
refers to how much you can do without making yourself more symptomatic.
You can divide this into three areas: physical, mental and social
activity.
Physical activity means any activity involving
physical exertion, including housework, shopping, standing, driving and
exercise. To define your limits in this area, estimate how many hours a
day in total you can spend in physical activity without intensifying
your symptoms. Because the effects of exertion can be cumulative, you
might ask yourself how many hours a day you could sustain over a week
without worsening symptoms. Also, you can note whether some parts of the
day are better than others. Finally, you can estimate how long you can
do various specific activities, such as housework, shopping, driving,
etc.
Mental activity means activities requiring
concentration, like reading, working on the computer or balancing a
checkbook. Three questions to ask in this area are: How many hours per day
can I spend on mental activity? How long can I spend in a single
session? What is my best time of day for mental work? Some people, for example, find they can work at the computer
for 15 minutes or half an hour without problem, but that they experience
symptoms if they work longer. They may be more productive at some times
of the day than at others. They may be able to avoid triggering brain
fog or other symptoms if they have two or more brief sessions a day
rather than one long one.
Social
activity refers to the amount of time you spend interacting
with other people. I suggest you think of social activity in two
forms: in person and other (e.g. phone and email). Questions to ask
yourself about each type include: How much time with people is safe
for me in a day? In a week? Is the amount of time dependent on the
specific people involved and the situation? (You may tolerate only a
short time with some people, but feel relaxed around others.) For
in-person meetings, you might also ask yourself whether the setting
makes a difference. Meeting in a public place or with a large group
may be stressful, but meeting privately or with a small group may be
OK.
Rest: This factor refers to the
quantity and quality of sleep at night and rest during the day.
Questions you might ask about sleep include: how many hours of sleep do
I need? What is the best time to go to bed and to get up? How refreshing
is my sleep? Daytime rest means lying down with eyes closed in a
quiet environment. Questions here might include: how much total daytime
rest do I need? How frequently should I rest?
Emotions: Strong emotions like
fear, anger, grief and depression are normal reactions to having a
chronic illness. This factor refers to the emotions we experience as
part of being ill and also to the sensitivity we have to
emotionally-charged events. Questions in this area include: What
emotions are important in my life now and how intense are they? What is
the effect of emotionally-charged events? (Events with strong emotion
often trigger the release of adrenaline, which can be very taxing.)
Stress: This refers both
to the sources of stress in our lives and to our sensitivity to those
stressors. In terms of sources, three are crucial: finances,
relationships, and things. Finances can impose severe limits and be a
major source of stress. Relationships can be sources of support
and help, sources of strain or both. Physical sensitivities refers
to food, sense data (light and/or sound sensitivity, sensory overload),
seasons and the weather (intensification of symptoms at certain times of
the year or with different weather conditions).
Your Energy Envelope is a list of your
limits. Having an understanding of your envelope can
help you to set priorities. After completing the exercise of defining
your envelope, you might decide that poor sleep was the crucial issue
for you at this time. Or you might find that a stressful relationship
needs attention. In any case, the idea is to understand your limits in
detail, so you can control symptoms and decide where to focus your
efforts for improvement.
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