The CFIDS & Fibromyalgia Self-Help Book

Chapter 3:  Goals and Targets

We all have things we would like to do but have trouble doing. Target setting, the technique you’ll learn in this chapter, will help you translate your good intentions into action. Using this three-step procedure, you can move toward your goals by taking a series of small, realistic steps. Target setting can be a key tool in your self-management program because it enables you to do the things you know will help but which you may have difficulty accomplishing.

Let’s say that you have decided to try to control your fatigue through pacing. You could pursue that goal in a variety of ways. Using the problem-solving approach described in the previous chapter, you might identify several ways to pace yourself, such as resting more, reducing your activity level, going to bed at an earlier hour or keeping records of your activities and symptoms. If you decided to try rest first, how would you go about it? Target setting gives you a step-by-step answer. (Other self-help programs use this technique but may call it by different names, such as contracting or making an action plan.)

Target setting involves three steps: making a realistic short-term plan, carrying it out, and evaluating the results.

Make A Plan

Your plan consists of specific actions that you can realistically expect to accomplish in the next week. Being specific in stating the plan is the key. The target you set for yourself should be concrete and measurable. Rather than something like “I want to get more rest,” you should state specific actions that are under your control. For example, you might plan to rest 15 minutes in the late morning four days in the next week. The plan you create should answer the following questions:

Once you have stated your plan, you need to determine whether it is realistic. To judge whether a target is doable, ask yourself “how confident am I that I can complete this target as stated?” Answer by giving a number between 0 and 10, where 0 means “not confident at all” and 10 means “totally confident.” If the answer is 8 or higher, you have a good chance to succeed. If your confidence level is lower, try stating your goal in less ambitious terms. For example, you might reduce the number of times per week. It usually works better to set a goal of doing something four or five times a week rather than every day. Another way to modify your plan is to reduce the length of time you do something, say from half an hour to 15 minutes.

An alternative response if your confidence is low is to ask what might stop you from achieving your goal. For example, if you want to exercise outside, bad weather might make that difficult. If you can identify potential problems, you may be able to come up with solutions. Alternative ways to exercise in bad weather might be to walk in a mall or use an exercise video at home. Once you have considered alternatives, you can ask yourself if your confidence level has changed.

Your success with targets may be increased if you use the following guidelines. First, start by setting a single target. This gives you a chance to learn how to use targeting. It takes a while to develop a new skill. The purpose of target setting is to help you have an experience of taking an active role in managing your illness.

Second, accept yourself as you are and begin by aiming to make a small change. If you do, you are likely to succeed and your success will build on itself, boosting your self-confidence and encouraging you to work for further improvement.

Third, make your target something that you want to do, not something that others want or something that you think you “should” do. That way, your motivation is likely to be higher and your chances for success better.

Implement

After you have formulated your plan, write it down. In our groups, we use a target form that is divided into three sections. Write your target and confidence level in the section labeled “My Target.” Putting your intention in writing helps strengthen your commitment. Other ways to make it more likely that you will follow through include telling other people about your plan and posting your target in a prominent place, such as on the refrigerator.

As the week unfolds, track your efforts by filling out the second section, “Results.” Use this space to write down what you’ve done and any problems that have arisen. Putting your experience in writing is a good way to hold yourself accountable and thus increase your chances for success.

Evaluate

At the end of a week, evaluate your results by asking how successful you were in meeting your target. The two most common problems people experience in target setting are not being specific and being too ambitious. The solution to the first is to ask whether your target answers the four questions of what, how much, when and how often. The solution to the second is to ask whether your confidence level is at least 8 on a scale of 0 to 10.

Even if your target is well stated and seems realistic, you may still experience problems. Perhaps the unpredictability of your illness will prevent you from completing the target as planned. Or you may decide that your target is not realistic at this time. But whatever the results, you can learn from your efforts. To help you gain something positive regardless of the outcome, fill out the “Lessons” section of the form.

It can be helpful to view your target setting as a series of experiments. If you meet your target, you have a successful experiment and can gain some control over your illness. If the results are different from your expectations, you may learn something useful about your illness and your approach to it.

Sample Targets

The targeting technique is remarkably flexible. You can make a target in practically any area of your life. Here are some samples from people in our classes.

Rest for 20 minutes in the morning and in the afternoon

Taking scheduled rests is one of the most common and successful targets used by people in our groups. Such “pre-emptive rests” can help control symptoms.

The person who set this target wanted to re-establish a more normal routine after staying up later and later. She first stated her target as “get to sleep by 10:30” but then realized that she couldn’t control the time she feel asleep, but she could control her bedtime.

Some people experience brain fog or nausea if they stay on the computer or do other mental work too long. This target involved setting an activity limit. Targets can be used to help you not do something or to limit how much you do.

The mother in this family and her daughter both have CFIDS. The mother thought that by having someone come in several times a week, her daughter would have more companionship and the mother could have some free time.

The man who set this target was worried about the extra responsibilities imposed on his wife by his illness and wondered how they could handle all the uncertainty created by his CFIDS. Making this commitment to his class motivated him to have a long-postponed conversation.

This target was used by a person who thought that the demands of family and illness had squeezed all the pleasure out of her life. It may seem paradoxical to schedule pleasure, but it worked.

One Student’s Experience

To give you a more concrete idea of how targets work, let’s look at the experience one student had with her first target. This person found the idea of scheduled rest periods appealing as a way to reduce her symptoms and bring more stability to her life. (See discussion of rest in Chapter 6.) She accepted the definition of rest we use in the class --lying down with your eyes closed in a quiet place-- and set a target of resting 15 minutes every afternoon during the following week. This target answered the four questions. It defined what she was going to do (rest), how much (15 minutes), when (afternoon), and how often (daily).

Next she asked herself how confident she was that she could complete the target as stated. Her answer was 6, below the minimum level of 8 that we suggest. She realized that she was uncomfortable committing to doing something daily, and decided she would aim for four days rather than every day. With this less ambitious goal, she rated her confidence at 8. Here is what she wrote on her target form.

               What                     Rest

               How much             15 minutes a session

               When                    Mid-afternoon

               How often              Four days in the next week.

               Confidence            8

She began the week successfully by resting for 15 minutes on Monday afternoon. She was surprised at how easy it was to do, and she got up feeling more energetic, which she noted on her log. On Tuesday she lay down as scheduled but got up after a few minutes when the phone rang. She was expecting a call from her doctor’s office about some blood tests. The call was from a friend, and they talked for half an hour. By the time they finished, the person’s daughter was home from school, so she gave up on the idea of rest for that day. On Wednesday she unplugged the phone before lying down. A call came in during her rest, but the answering machine took it. She felt a little guilty not answering the call, but was refreshed by the rest.

On Thursday she did some errands in the mid-afternoon and didn’t attempt a nap. On Friday, she rested but got up feeling worse than when she lay down. She noted that she was very worried about something her husband had said in the morning before he left for work. He told her he wasn’t sure how much longer his job would last. She felt anxious all day and her mind was spinning during her rest. As a result, her time lying down didn’t feel very restful.

The entries she made in the “Results” section of her Target Sheet were as follows:

         Mon      3:00 pm     Rested 15 min    Felt better after
         Tue      2:30 pm      Rested 3 min     Stopped to answer phone
         Wed     2:30 pm     Rested 15 min    Ignored call
         Fri       3:00 pm      Rested 15 min    Felt worse after: worried

Lastly, she asked herself what she had learned from her experience. She congratulated herself on nearly meeting her target. She rested for three days, with some rest on a fourth. She concluded that her experience was enough to show her the value of resting. She had more energy after at least some of the rests, gaining a sense that rest might offer a way to control her illness. In thinking about the worry that had interfered with her rest on Friday, she remembered hearing about relaxation techniques, and asked herself whether she might practice them while resting. She thought that doing so might help her rest her mind as well as her body, giving her a way to reduce her worry. In the “Lessons” section of her Target Sheet she wrote:

Resting can be helpful. Want to try relaxation as part of rest.

Now it’s your turn. Think of a problem that bothers you. Pick just one and commit to making a start today. Then brainstorm several possible solutions, things that might reduce or solve your problem. After reviewing them, pick one to try in the next week and write down a target that answers the four questions what, how much, when and how often. It could be about something you plan to do or about rest or sleep or some other area of your life, whatever you think would be helpful to you at this time. Whatever it is, make your target specific like the examples given earlier.