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By Bruce Campbell

(Note: This article is the second of a two-part series on planning worksheets. Part 1 describes daily and weekly schedule sheets.)

Periods of intense symptoms, often called relapses, setbacks or flares, are a common and often demoralizing experience for people with Chronic Fatigue Syndrome and fibromyalgia. One technique for reducing the frequency and severity of setbacks is by analyzing them using a Relapse Worksheet, which is described in the first section of this article. One common occasion for relapses is a special event like a vacation or holiday celebration. The second section describes a planning technique called the Special Event Worksheet.

Relapse Worksheet

Relapse Triggers

The first section of the form asks you to think about the causes of your relapses. While flare-ups of symptoms are sometimes due to the waxing and waning of the illness, other setbacks are caused by factors over which you have some control. These factors could be actions you take or events that happen to you. In any case, they are things that consistently intensify your symptoms. Completing the relapse triggers form provides you with a list of your vulnerabilities. The example below, which consists of items often mentioned by people in our groups, is offered as a starting point.

Relapse Warning Signs

The second section asks you to think about the signals your body sends that indicate you are heading toward a relapse. If you respond by taking corrective actions (see the next section), you may be able to avoid or reduce the severity of a relapse. It is easy to miss or ignore the warning signs. Having a list can help you retrain yourself to respond differently when a downturn begins. By filling out the form, you are expressing a commitment to heed rather than ignore signs of impending trouble. The form below contains signals people in our program often list.

Responding to Warning Signs

The next section of the form is the place for you to set down how you will respond to warning signs. Because it is easy to ignore signs of trouble, it helps to have a plan in place telling you what to do when warning signs appear. Having such a plan can help you to retrain yourself away from ignoring the signals of your body and in the direction of being responsive to its needs. Here's a list of possibilities.

Preventing Relapses

The last section of the worksheet gives you room to answer the question: what do I need to do to avoid relapses? The list below contains ideas used by people in our program. For a discussion of how to prevent and limits the severity of relapses, see the article Minimize Relapses.

Special Event Worksheet

Because of a combination of two factors, special events like vacations and holiday celebrations, can trigger intense symptoms. As non-routine events, they require more energy than everyday life, shrinking your "energy envelope." If you don't decrease your activity level to match your temporarily smaller envelope, the event will intensify your symptoms. At the same time, you may want to be more active than usual or feel pressured by others to be more active, a second potential cause for relapse. In sum, a special event shrinks your envelope at a time you are tempted to do more than usual. How can you respond to this dilemma in a way that allows you to enjoy the event without paying too heavy a price?

One way is to plan for it. In the time leading up to the event, you can determine the actions you will take to avoid or minimize a flare-up of symptoms. The Special Event Worksheet gives you a way to plan for the event by writing out what you will do to protect yourself before, during and after the event. The example below shows how the worksheet might be filled out for a vacation.

Scheduling extra rest and reducing activity before, during and after the vacation are the cornerstone of this person's plan. Doubling rest time before the trip stores up extra energy. Extra rest while on the trip helps to limit symptoms while away. Planning to double rest time after returning home acknowledges that some recovery time is likely to be needed. Similarly, activity level is reduced during all three periods. The form provides a way to translate the need for lowered expectations into specific actions.

After deciding on her activity limits, the person using this form will discuss her activity limits with her family. If you discuss your limits with others ahead of time, you and they can plan to share some activities, while allowing others to do others while you rest. (For more ideas on how to deal successfully with special events, see the section titled "Vacations, Holidays and Other Special Events" in the pacing chapter of our course textbook.)

Resources

For printable versions of the Relapse Worksheet and the Special Events Worksheet, and all the logs, forms and worksheets discussed on this site, go to the Logs, Forms & Worksheets page.

Copeland, Mary Ellen. Winning Against Relapse. Oakland: New Harbinger, 1999.