Habit Changes & Rules: Two Keys to Improvement

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By Bruce Campbell

A woman in our program says that she has switched her idea about jobs around the house from "work until done" to "stop when tired."

She made the switch when she realized that continuing to do things as she had in the past was making her symptoms worse. Making a change from ignoring her body to listening to it has made a big difference to her symptoms and quality of life.

The change she describes is a good illustration of one of the challenges of having ME/CFS or fibromyalgia. Habitual ways of living no longer serve us and in fact may make our symptoms worse, but replacing them with new habits can make a big difference.

The Four Steps of Habit Change

Habit change has four parts. It begins with awareness. For the woman above, awareness meant the recognition that her old attitude toward household tasks led not to a sense of accomplishment, but rather to intensified symptoms and a sense of helplessness.

At this stage, the goal is not habit change, but rather awareness of the consequences of continuing old habits.

The second step is the creation of alternative behavior. In our example, it meant responding to fatigue by stopping work rather than ignoring the warning sign sent by the body.

Key to success in this step is to plan a response ahead of time, so that when the situation intensifying symptoms begins, you can do something different than in the past.

You might say to yourself something like, "No, I don't have to continue; I have an alternative" or "I'm going to be good to myself and take a break."

The third aspect focuses on thoughts and involves rewriting our mental scripts. Continuing with the same example, the thought "I've got to finish this job" would be replaced by thoughts such as "If I continue, I'll be forced to spend an hour in bed" or "My new way of living is to listen to my body and to be good to myself, so I'm going to take a break now."

The thoughts you create to counteract the old habit remind you of the consequences of continuing the old ways (increased symptoms) or reinforce the alternative (control).

Part of changing scripts is reframing our view of ourselves to support positive behaviors. For example, one person in our program has changed her view of taking rest breaks.

She used to tell herself she was weak for lying down during the day. Now, when she rests she tells herself, "I am helping myself to be healthy. I am saving energy to spend time with my husband or to baby sit my grandchildren."

The fourth part of habit change is support: having people around us who understand our situations and will support our efforts to change. Support reinforces our motivation to change. We make use of this principle in our groups in several ways.

First, our program focuses on creating an environment supportive of pacing, stress management and other practices that have been found helpful for people with ME/CFS and FM.

Second, our groups include training and practice in setting short-term goals and other skills. The groups encourage positive behaviors. People often tell us that the prospect of disappointing the group by not completing their goal helps keep them on track.

Personal Rules

One aid to habit change is personal rules.

People in our program use rules in two ways. First, some people state a few rules crucial to controlling their symptoms.

One person, for example, has three rules for herself: no more than three trips outside the house per week, no driving beyond 12 miles from home, and no phone conversations longer than 20 minutes.

Second, people create rules covering different circumstances. Rules are planned responses, which you use as a substitute for old habitual behaviors. Over time, the new behavior becomes a habit.

After you find your limits in various areas, you can establish a rule for each area.

For example, you might set rules for how long to stay on the computer, when and how much exercise to do, how far to drive, when to go to bed at night, when and how long to rest during the day, how much media exposure to have, and how long to spend in social situations.

These rules have an If/Then structure. Here are examples:

If I've been on the computer for 20 minutes, then it's time to take a break.
If it's 11 o'clock, then it's time for my morning rest.
If it's 9 o'clock, then it's time to start getting ready for bed.

For some situations, it may make sense to use a timer. For example, you could use a timer to remind you of your limit for writing emails, talking on the phone or chopping vegetables.

The 1% Solution

Living with ME/CFS and/or fibromyalgia can feel overwhelming. Most experts agree that, in the absence of a cure, the most powerful treatment for both conditions is lifestyle change, which means adapting how we live our daily lives.

You can do this by taking a series of small, realistic steps to improve your quality of life, an approach we call the 1% solution. Rather than aiming for a quick cure, you focus on improving a bit at a time. Habit change and personal rules can play a role.