Q: It makes me feel so alive when I have energy, that if I’ve got it and can get things done, I use it. But then WHAM, I’m down for the count. I’m always swinging between overdoing and flat in bed. What can I do to pace myself & even things out?
A: Yours is a very common problem, but there is a solution. By using a mixture of the approaches described below, you can get off the roller coaster of boom and bust, and gain a sense of control and predictability.
First Find Your Limits
Pacing means living within the limits imposed by illness, so a starting point is to define your limits. Limits include the total amount of activity you can do in a day without intensifying your symptoms; limits on individual physical activities such as housework, driving, and exercise; limits on mental and social activities; and awareness of the effects of stress and emotions.
One way to define limits is described in “Find Your Limits”
Learn Pacing Strategies
Pacing is not a single technique but rather many. Experiment to find which ones work for you:
• Reducing your overall activity level,
• Taking scheduled rest breaks,
• Using short activity periods,
• Switching among types of activity,
• Setting limits on the time spent in individual activities,
• Doing the hardest tasks during your best hours of the day,
• Limiting sensory input,
• And keeping pleasure in your life.
Make Changes Gradually
You may feel overwhelmed at times when you think of all the adjustments you have to make to pace yourself successfully. The solution: Introduce changes into your life gradually. Focus on one or two things at a time and make sure the changes are working well before trying something new.
Use Routine and Reminders
Pacing involves adapting your daily habits, so that your routines are consistent with your limits. Habit change can be facilitated by using reminders. For example, you can:
• Use a timer to limit the length of computer sessions,
• Or post notes on the refrigerator or bathroom mirror.
Develop Personal Rules
Some people with CFS and FM pace themselves using individualized rules. Living by a set of personal rules reduces the power of spontaneity to overwhelm good judgment. These rules may be general. For example, if your limits are fairly severe, you might have three overall pacing rules, such as:
• No more than three trips outside the house per week,
• No driving beyond 5 miles from home,
• And no phone conversations longer than 20 minutes.
Alternatively, you can develop a set of rules for specific circumstances. For example, you might have limits on:
• How long you stay on the computer,
• How long you spend with people in social situations
• And how long you will stand before taking a rest.
Stop and 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. One way to avoid such lapses, in addition to routine and personal rules, is to stop before you act, and realize you have a choice.
You might ask yourself: "What will be the consequences, and am I willing to accept them?" Alternatively, you might visualize how you would feel if you go outside your envelope: You see yourself lying in bed and feel the pain that results from overdoing.
Another approach is to focus on the positive and give yourself reminders of what you gain through pacing. For example, you might post notes to yourself, saying things like “Staying within my limits gives me a sense of control,” “Pacing reduces my symptoms,” or “Pacing makes my life more stable.”
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.
• Third, records can motivate you by showing you that staying inside your limits pays off in lower symptoms and a more stable life.
Make Mental Adjustments
Pacing means adopting new habits, but it also requires making mental adjustments leading to acceptance of having to live differently. This acknowledgment leads to a different relationship to your body.
Instead of ignoring your body’s signals, as you might have in the past, you can learn to listen to them, for example by replacing the thought “I always work until done” with “I stop when tired.”
Use Assertiveness and Seek Support
Some people with CFS and FM have a habit of putting others’ needs ahead of their own. Sometimes called “people pleasers,” these individuals have difficulty setting limits or saying No to others. If that describes you, you can benefit by learning assertiveness, which you can do through books or with the help of a counselor.
It’s difficult to pace if those around you are not understanding and supportive.
• Educating family and friends is often helpful,
• But sometimes people either reduce contact with those who are not understanding or even end some relationships.
No one stays in their envelope all of the time. Life has its ups and downs; some times are more stressful than others. Instead of berating yourself when you slip up or when circumstances overwhelm you, it’s better just to ask, “What can I learn from this experience?” and move on.
To Learn More:
The website of the self-help program that I direct (www.cfidsselfhelp.org) contains an archive of more than two dozen articles on pacing, including the eight-part series “Pacing: What It Is and How To Do It.”
– Bruce Campbell, PhD