Self-Observation and Goal-Setting

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By Bruce Campbell

(Note: First in a five-part series on self-managment skills.)

Living well with ME/CFS or fibromyalgia involves learning and using a set of skills. This series describes five skills you can use to improve your ability to manage either or both conditions, beginning with self-observation and goal setting.

Self-Observation

One skill of the self-manager is self-observation. Through becoming more aware of the effects of your thoughts, feelings and actions, you can learn a lot about what intensifies your symptoms and what helps you to feel better. Then, by changing how you live, you can do less of those things that make you worse and more of those that help.

Spotting What Hurts & What Helps

You have probably already identified a number of things that intensify your symptoms. Three mentioned frequently by people in our program are stress, overdoing and sleep problems (SOS). Other factors include travel, stressful relationships, sensory overload (vulnerability to light, sound, touch and/or weather), and food or chemical allergies.

You may also have ideas about what helps you to feel better and gives you some control. Factors mentioned often in our classes include pacing, getting good sleep, taking rests each day, using medications, practicing relaxation and other techniques to reduce stress, and getting support.

Keeping Records

Your ability to learn from self-observation can be enhanced greatly by keeping records. Keeping a health diary or log can reveal patterns and show you the links between your actions and your symptoms. I made use of several simple logs that aided my recovery. The payoff for an investment of a few minutes a day was great.

First, my records showed me the links between factors in my life and my symptoms. The logs showed me that my CFS was worse in the morning and better in the evening. They also revealed that the effects of activity were often delayed and that the effects were cumulative during a week.

Also, logging demonstrated the connection between standing and symptoms, documented how much exercise was safe, and showed me my vulnerability to stress.

Second, in addition to being a record of behavior, logging shaped it. When I wanted to think that increased symptoms were just part of the illness, my records showed that I had been more active than usual. Seeing the evidence in black and white helped me to stick to my pacing routines. Logging was also a way to hold myself accountable.

Third, my records were a source of motivation. When I saw that some days were better than others, I was motivated to search for what was different about those days so that I could increase their frequency. I also used my records to chart my progress over time. Seeing the number of good days increase gave me hope.

Two Keys to Logging

Simplicity was one of the main criteria I used to choose a log. The other idea I kept in mind was that logging was a three-step process:

Record
Review
Apply

That meant: write notes daily; study the logs every two weeks or so to find patterns; then translate insights into different behavior.

For more on logging, including sample logs, see Logs, Worksheets and Rules in the 2010 edition of the online book used in our introductory course. Blank forms are available for download and printing in the Logs, Forms and Worksheets archive.

Goal Setting

Another skill is the ability to set goals and to achieve them. One effective way to do that is to translate a big goal into a series of small, realistic steps or targets.

The key is to make each step both specific and realistic. Specific means that each step 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 five days in the next week."

Realistic means doable. To test whether your step is realistic, ask yourself how confident you are, on a scale of 0 to 10, that you can complete it as stated. If your answer is less than 8, restate your target in less ambitious terms until your confidence level is at least 8.

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

Rest for 20 minutes each: late morning and mid-afternoon
Go to bed by 10 pm
Get off computer after 30 minutes
Find a nanny to help with childcare
Talk to my wife about our relationship
Read a book for pleasure

We suggest you put your intention in writing. (You can use the Target form you'll find on our Logs, Forms and Worksheets page.) Writing helps to strengthen your commitment. Other ways to make it more likely that you will follow through including telling others about your plan and posting your goal in a place you are likely to see it frequently, such as on your refrigerator or bathroom mirror.

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 your plan as you hoped. Or, you may decide that your target is not realistic at this time. But, whatever the results, you can learn from your efforts.

It can be helpful to view your goal-setting as a series of experiments. If you achieve 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 about your illness by reflecting on your experience.

For more on goal-setting, see the chapter Goals and Targets in the book for our introductory self-help course.