6. Goals and Targets - Managing Chronic Fatigue Syndrome and Fibromyalgia, 2015 Edition

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(Note: A chapter from the 2015 edition of our book.)

This chapter explains target setting, the skill we teach for reaching goals. The technique involves breaking down a goal into a series of small, realistic steps. Using this skill, you translate your hopes and good intentions into concrete plans and build confidence through success.

For example, let's say that you would like to learn how to control your symptoms through pacing. You could pursue that goal in a variety of ways. You might take regular rest breaks, have short activity periods, go to bed earlier or keep records of your activities and symptoms.

If you decided to start with rest, how would you go about it? Target setting gives you a step-by-step path to follow, involving 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 near future, typically a week. The target you set for yourself should be specific, which means it is concrete and measurable. For example, instead of saying “I want to get more rest,” you say “I will rest 15 minutes in the late morning on four days in the next week.”

A test of whether a target is specific is whether someone else could complete your target if handed a piece of paper that had your description of the target on it.

The plan you create should answer the following questions:

What specifically will you do? For example, will you rest, phone a friend or take a series of walks?

How much? If your target is to rest, will you rest for 15 minutes, an hour or some other length of time?

When? Will you rest in the morning, afternoon, or evening or some combination?

How Often? How many days a week will you do your target? You may want to do something daily, but you’re more likely to succeed if you allow yourself some “breathing room” by aiming to do something several times a week rather than every day.

The second key to success in target setting is to test that your target is realistic or doable. You can test whether your target is realistic by asking yourself how confident you are that you can complete your target as stated. Answer by giving a number between 0 and 10, where 0 means “not confident at all” and 10 means “totally confident.”

Your confidence level is your estimation of how sure you are that you can complete the target in its entirety, not a measure of how much of the target you will complete. A confidence rating of 5 means that you are only somewhat confident of success, not that you think you can complete half the target.

If the answer is 8 or higher, you have a good chance to succeed. If your confidence level is lower than 8, we suggest that you restate your goal in less ambitious terms. For example, you can increase your chances of success if you reduce the number of times per week that you rest from everyday to four or five days. Or, for an exercise target, you might reduce the length of time you exercise from 15 minutes to ten 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. Stop this process once your answer is 8 or higher, meaning that you are quite confident that you can complete the whole target as stated.

You are more likely to succeed if you also keep a few other ideas in mind. First, your target should be something that you want to do, not something that others want or something that you think you “should” do. Second, we suggest that you start by setting a one target per week.

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 a success experience. Third, 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.

Implement

After you have formulated your plan, write it down on the Target form. (You can find a blank target form at on the Logs, Forms & Worksheets page.)

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 place where you are likely to see it frequently, such as on the refrigerator.

As the week unfolds, track your efforts by filling out the Results section of the form. 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 thereby 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 prevents 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 can learn something useful by reflecting on your experience and that process may lead to further experiments.

Sample Targets

You can make a target in practically any area of life. Here are some examples from people in our program.

Rest for 20 minutes twice a day: late morning and mid-afternoon

Taking scheduled rests is one of the most popular first target in our groups.

Go to bed by 10 pm 5 days this week

The person who set this target wanted to re-establish a more normal routine after staying up later and later.

Get off computer after 20 minutes (each session)

You can set a target not to do something or to limit how much you do.

Find a nanny to help with childcare by calling two possible sources, one a day

Both the woman who set this target and her daughter have CFS. 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.

Set up conversation with my wife about our relationship

The man who set this target was worried about the extra responsibilities imposed on his wife by his illness. Making this commitment to his class motivated him to have a long-postponed conversation.

Read a book for pleasure 30 minutes per day after lunch, 4 days this week

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 in this case.

One Person's Experience

Here’s a more detailed example of a target. It was set by a woman who was intrigued by the idea that scheduled rest periods might be a way to reduce her symptoms. Using the definition of rest as lying down with her eyes closed in a quiet place, she set a target of resting 15 minutes every afternoon for a week. This target answered the four questions. It defined what she was going to do (rest lying down with eyes closed), 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. She realized that she wasn’t confident she could do something every day, so she changed her target to aim for four days rather than every day. With this less ambitious goal, she rated her confidence at 8 and wrote her target as:

What Rest lying down, eyes closed

How much 15 minutes

When Mid-afternoon

How often Four days in the next week.

Confidence 8

She began the week successfully, resting for 15 minutes on Monday afternoon. She got up feeling more energetic and less brain fogged. On Tuesday, she lay down as scheduled but got up after a few minutes when the phone rang. The call was from a friend and they talked for half an hour.

When the call ended, 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 she let the answering machine take it. She got up feeling refreshed by the rest.

On Thursday, she did some errands in the mid-afternoon and didn’t attempt a nap. She rested on Friday, but got up feeling worse. She had felt preoccupied during her rest by a worry about her daughter’s progress in school. Her mind was spinning and, as a result, the time lying down didn’t feel very restful.

The entries she made in the Results section of her target form were as follows:

Mon Felt better after

Tue Stopped to answer phone

Wed Ignored call

Fri Felt worse after: worried

Lastly, she evaluated her experience with rest. She congratulated herself on nearly meeting her target. She rested 15 minutes 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. This is something that many people in our program do to quiet the mind during a rest. She thought that doing a relaxation procedure or meditation while resting might reduce her worry. In the Lessons section of her target form, she wrote:

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

Getting Started

Now it’s your turn. Think of a problem that bothers you, then list several possible responses, 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?

Once you’ve stated your target, ask yourself how confident you are that you can complete it successfully. Give your confidence a number between 0 (meaning no confidence) and 10 (totally confident). If your confidence is less than 8, restate your goal in less ambitious terms.

Once you have a target and feel confident about achieving it, you’re ready to go. Give your target a try for a week, and then look at the results. If you meet your target, congratulate yourself. Whether or not you met your target, ask yourself what lessons you can learn from the experience and congratulate yourself for conducting an experiment.