Eight Steps to a  Better Life

Step 6: Reduce Stress

By Bruce Campbell

Stress is a doubly difficult challenge for people with Chronic Fatigue Syndrome and fibromyalgia. First, sickness adds new stresses to those you had before becoming ill. They include the discomfort of symptoms, isolation, financial pressure, strains on relationships and uncertainty about the future. Second, CFS and fibromyalgia seem to make people much more sensitive to stress than they were before becoming ill. It is as if CFS and FM reset a “stress thermostat,” making patients sensitive to more types of stress than before and increasing the effects of a given level of stress. For both these reasons, addressing stress is an important part of self-management for people with CFS and fibromyalgia.

Two Approaches

In thinking about how to manage stress, I suggest you consider two approaches: stress reduction and stress avoidance. The first involves learning how to respond differently to stressors. Examples include having a regular relaxation practice and programming pleasurable activities into your day. The second approach is preventive, taking measures to avoid stressful people, substances and circumstances. Because stress is so pervasive in long-term illness, I recommend you use several strategies to combat it, identifying sources of stress in your life and selecting those techniques that apply to you. I also suggest that you define stress broadly. For example, many people in our program have identified work as a major stressor in their lives. Responses have included using flextime, changing to a less demanding job, switching to part-time, starting a home-based business, going on disability and taking early retirement.

Stress Reduction

Often, how we react to a stressor determines how much stress we experience. Stress reduction involves learning how to respond differently to stressors so that they do not have the same effect as in the past. Here are seven ways to reduce stress.

1) Relaxation: Uncertainty, worry and pain often create muscle tension, which, in turn, creates fatigue and intensifies pain. Relaxation is a powerful antidote. Through relaxation, you reduce muscle tension and anxiety, thereby reducing pain. You might consider having a daily relaxation practice, such as those described in the articles in the stress management archive, but other, less formal approaches can help, too. These include exercise, attentiveness to breathing, baths and hot tubs, massage and acupuncture, rest and listening to relaxation tapes.

2) Problem Solving: Taking action to solve a problem has a double payoff. You address an issue that requires attention and eliminate a source of stress at the same time. For step-by-step instructions in problem solving, with examples, see the article “Experiment,” Key 3 in the series Ten Keys to Successful Coping.

3) Positive Experiences: Immersing yourself in activities you enjoy is a great stress reducer. Positive experiences include pleasurable activities such as seeing a movie, listening to music, reading or spending time with a friend; exercise and movement; writing in a journal, either for release of emotions or to gain insight; talking and being listened to; becoming absorbed in music or artistic activity; laughter and humor; and spending time alone.

4) Mental Adjustments: Our thoughts can be a source of stress, so changing them can reduce stress. For example, if we have unrealistic expectations about our how much we can do, changing our standards reduces stress and helps us avoid overdoing. Thoughts may also create stress if we are overly harsh in what we say to ourselves when bad things happen. The article “Taming Stressful Thoughts” gives step-by-step instructions for recognizing and changing habitually negative thoughts.

5) Assertiveness: Speaking up for yourself is a powerful stress reducer. One part of assertiveness is setting limits with others. By saying “No,” you avoid doing things that would intensify your symptoms. Delegating tasks to others and asking for help are other ways in which you can reduce the stress of overactivity.

6) Support: Being listened to and feeling connected to others is healing. Support also means practical assistance, which might include such things as shopping, cooking, bill paying or housecleaning. Sources of support include family members, friends, fellow patients or therapists.

7) Medications: Prescription medications to treat anxiety or depression can be a part of a stress management program.

Stress Avoidance

Stress avoidance is preventive, using self-observation to learn how stress affects you and then taking measures to avoid stressful circumstances. The main ways that people in our groups prevent stress are by avoiding stress triggers and by using routine or scheduling.

1) Avoiding Stress Triggers: We may have particular circumstances in our lives that predictably intensify our symptoms. If we can identify these stress triggers, we may be able to avoid them or reduce their impact. I suggest you think of triggers in three categories: people, substances and situations.

Some patients find interactions with particular people are the cause of disabling stress. Responses they have made include talking with the person, limiting contact, getting professional help, and ending the relation. Food, chemicals and other substances can trigger symptoms. By identifying and avoiding specific foods or other substances you may be able to avoid relapses. In terms of situations, if you are particularly sensitive to light, noise or crowds, or experience sensory overload in other ways, avoiding those situations can help you control symptoms. Many patients are selective about their exposure to television and movies, avoiding material that is emotionally arousing and shows with rapid scene changes.

2) Scheduling: Novelty is another source of stress. It takes more energy to respond to a new situation than it does to something familiar. Given our limited energy, saving it for healing is desirable. One way to do that is through making your life predictable. Some patients have done that through routine: living their lives according to a schedule. They have been able to reduce the surprises and emotional shocks in their lives, and thereby reduce their stress. By knowing what to expect, they have reduced pressures on themselves. Any steps that increase predictability are likely to lower stress.

Pacing strategies, which may be adopted to control symptoms, are also effective stress reducers. Scheduling activity based on priorities, taking regular rests, timing activity for the best hours of the day, and staying within known limits all help control stress.

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