By Bruce Campbell
Many people with CFS and FM can pace themselves at times, but find it difficult to pace consistently. If that's true for you, here are seven strategies to consider.
Pacing consistently involves replacing one set of habits and routines with a new set. Pacing consistently takes patience, discipline and effort, but you can make it doable if you focus on one thing at a time from the strategies and techniques described below.
Listen to Your Body
Instead of ignoring or trying to override your body's signals, you can retrain yourself to pay attention when your body tells you to stop or slow down. A starting point is to ask yourself, "What does my body need right now?"
Here's an example. A person in our program became very weak and tired while cooking. His first thought was "Finish the job; it will only take another 10 minutes." Remembering previous similar episodes that led to needing two or three hours rest, he asked "What does my body need right now?" The answer was "rest." He turned off the heat and lay down for 15 minutes. When he got up, he felt fine. Fifteen minutes of rest enabled him to avoid two or three hours of rest later.
Use Rules, Routine & Reminders
Some people have success using detailed rules to protect them from doing too much. Living by personal rules means not having to think and reduces the power of spontaneity to overwhelm good judgment. Rules are planned responses to various situations. They show you how to substitute new ways of doing things for old habitual behaviors. Over time, the new behavior becomes a habit.
You may begin by stating a few rules crucial to controlling symptoms. For example, a person with moderate to severe FM or CFS might have three rules: no more than two trips outside the house per week, no driving beyond 12 miles from home, and no phone conversations longer than 20 minutes.
Later you might create a set of rules covering specific circumstances. For example, you might establish rules for how long you stay on the computer, how long you talk on the phone, how much exercise you do, how far you drive, when you go to bed at night and get up in the morning, when and how long you rest during the day, how long you spend in social situations and so on.
Having a regular daily schedule eliminates a lot of decision making. One person in our program said, "Instead of having to ask whether something is or is not within my envelope, I have tried to stick to a schedule I know is safe."
While pacing may seem daunting at first, it can become second nature over time as one's daily habits are altered. Habit change can be facilitated by using reminders. For example, you can use a timer to limit the length of computer sessions or post reminder notes on the refrigerator or bathroom mirror.
Daily & Weekly Plans
Pacing involves having a similar amount of activity each day. Planning is a tool for moving toward that goal. A beginning point for planning is something like setting aside several times each day for rest breaks or having a wind down time before going to bed.
Next you can go on to planning a day at a time. In the morning or the night before, list possible activities for the day. Then evaluate your list, asking whether you will be able to do everything on it without intensifying your symptoms. If not, identify items that can be postponed, delegated or eliminated.
When you feel comfortable planning one day at a time, try moving on to planning longer periods, such as a week. The challenge here is to determine what level of activity you can sustain over a period of time without worsening symptoms. One way to get an initial sense for your limit is to keep an activity diary for a week or two, as described in another article.
Eventually, planning leads to a new way of life based on a new set of habits and routines. For a success story describing the use of routines, see the article Getting the Most from Limited Energy.
Stop & Choose
One way that people get pulled outside their limits is by giving in to the temptation of doing something that seems appealing at the moment. A way to avoid such lapses is to stop before you act and realize you have a choice. One person in our program carries a card in her pursue that says "What's the Trade-Off" (the price she will pay for doing some activity). Some people visualize how they would feel if they went outside their envelope, while others have sayings they repeat to themselves such as "I can finish this task and crash or listen to my body and stop."
Adjust Your Expectations
Pacing involves changing our expectations for ourselves, matching them with our new abilities. The new expectations are rooted in adopting a different attitude, a particular kind of acceptance. As explained by recovered CFS patient Dean Anderson, this acceptance is not resignation, but rather "an acceptance of the reality of the illness and of the need to lead a different kind of life, perhaps for the rest of my life."
Some people find it helpful to compare themselves to other people with CFS and FM rather than to healthy people. Coming to acceptance is a process that often takes several years, but it has significant benefits. In the words of one person, "I've discovered that I can now be perfectly at peace with lowering my expectations as I know too well what happens when I try to push the envelope and then relapse!!"
Keeping a health log, which should take no more than a few minutes a day, can help you gain consistency in pacing in at least three ways. First, records can help you get a clearer picture of your limits and reveal the connections between what you do and your symptoms.
Second, a log can help you hold yourself accountable for your actions by documenting the effects of your actions. As one person said, "Before logging, I didn't realize that most of my time is spent on or below about 35% functionality. This false perception that I was better than I am led me to overdo things, but now I am less ambitious."
Third, records can motivate you by showing you that staying inside your limits pays off in lower symptoms and a more stable life. Records of progress can provide hope. For more on record keeping, see Logs, Worksheets and Rules in our introductory course textbook.
No one stays in their envelope all of the time. Instead of beating yourself up when you slip or circumstances overwhelm you, it's better just to ask, "What can I learn from this experience?" and move on.
You may feel overwhelmed when you think of all the adjustments you have to make to live well with CFS or FM, focus on one thing at a time. If that happens, try focusing on one thing at a time. In the words of one person, "The transformation into a more disciplined person was a long-term process. The changes have been introduced gradually over time. And I make sure I find the right one before I move on to adding the next."