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(Note: Last in a five-part series on self-management skills.)

The previous article focused on reframing as a series of mental adjustments. This final article in the series focuses on two other types of mental adjustments: changing self-talk and adjusting expectations.

 

 

The term self-talk means the things we say silently to ourselves about ourselves. Some people call it “the voice in my head.” That voice can sometimes be an inner critic and sometimes an inner cheerleader. In either case, the things we say can have a big effect on our moods, outlook on life and motivation to improve.

 

Self-talk is a habitual way of responding to experience and often takes the form of an internal critic who can be very negative and pessimistic. For example, if you experience a relapse, your inner voice might say something like, "I'll never get any better. Every time I try something, I fail." Unrealistically negative thoughts make you feel anxious, sad and hopeless. These feelings, in turn, make it difficult to act constructively

 

But self-talk can be changed to be both more positive and more realistic. That is the focus of a well-researched approach called Cognitive Therapy.

 

 

Cognitive Therapy helps people to recognize and gradually change unrealistic habitual thought patterns called cognitive distortions. Some of the most common distortions are:

 

Drawing a broad conclusion based on a single incident or insufficient evidence. For example, if exercising results in a relapse, concluding that exercise will always be impossible. An alternative approach is to look at each experience individually. For example, if one exercise program is not successful, a helpful approach is to analyze why and then to experiment to find a type and amount of exercise that does not trigger a relapse.

 

Assuming we know what others are thinking and feeling. For example, if a person doesn’t contact us, we may conclude that they don’t care about us any more. But there are other possibilities. Perhaps the person has not known how to respond or did not want to disturb us with a call. Or maybe they themselves have been ill or out of town. An alternative to mind reading in this situation is to take the initiative and contact the person.

 

Using inflexible rules about how we or others should act and feeling guilty when we violate these rules. For example, we may say “I should be a better parent” or “I should provide for my family.” An alternative is to tell ourselves that we have an illness that imposes significant limits. To be realistic, we can adjust expectations to match current abilities. For example, we may say to ourselves “I can’t do everything I used to do, but I can still find ways to contribute.”

 

 

Cognitive Therapy teaches a three-step process for identifying, refuting and replacing our cognitive distortions. Over time, unrealistic thinking will gives way to more rational, balanced thinking. And, because cognitive distortions often lead to feelings of hopelessness and helplessness, replacing them can lead to a more optimistic and effective approach to life.

 

The three steps are: 

 

The first step to changing your habitual thinking is to recognize it. This is not easy to do because our thoughts are automatic, so deeply ingrained that they seem self-evident. The technique I’ll describe is based on the book Mind Over Mood but can find similar techniques in other books and you can learn them from psychologists who specialize in Cognitive Therapy. 

 

To see how this step works, imagine someone with ME/CFS or FM who took a walk one day and felt very tired when she got home. Feeling depressed and hopeless, she asked herself what thoughts were going through her mind at that point.

They were, "I'll never get better. Every time I try something, it fails." She recorded her experience by writing a brief description of it (“Walked 15 minutes; very tired after”), noting her emotions (depressed, hopeless) and the thoughts she had when the emotions were strongest (“I’ll never get better”).

 

The purpose of this step is to help you gain some distance from your thoughts, to remove their taken-for-granted or self-evident character. Because these thoughts are automatic, they can be hard to recognize and it can take some time to develop this skill.

 

Once you identify your automatic thoughts, you evaluate them to identify distortions and irrationalities. To help you determine to what extent your automatic thoughts are valid, ask yourself what is the evidence for and against your thoughts. Writing down the evidence pro and con helps you gain further distance from your thoughts and makes them less self-evident. 

 

In our example, the person might write under “Pro” that she has frequent setbacks and exercise often makes her symptoms worse. Under “Con,” she might note that many people with ME/CFS and FM improve and that she has made progress in other areas of her life.

 

In the last step, you propose a new understanding of your experience. It should be either an alternative interpretation of your experience (if you refuted the thought) or a balanced thought that summarizes the valid points for and against (if the evidence was mixed).

 

In our example, the person might write, “I have frequent relapses, but I've made progress and that gives me hope. I would still like to develop a safe way to exercise, so I’ll start by asking other people what’s helped them."

 

 

Here are some examples of people changing their self-talk. The first comes from a woman in our program who says she grew up with a message in her head, "I always finish anything I start." Once she had ME/CFS, using that approach caused relapses, so she replaced "work until done" with "I rest when tired."

Another person used to chastise herself for taking a nap, telling herself, "you are weak and lazy for having to rest." Now, when she goes to take a nap she says, "I am helping myself to be healthy. I am saving energy to spend time with my husband or to babysit my grandchildren."

 

A third person gave an example of the process of changing her self-talk. One day when she had a big list of chores in her head, her thought when she finished cleaning the kitchen was "if I don't do (the next thing on my list) now, I'll never get it done." 

Then she thought “‘wow! Good catch!” She said that recognizing thoughts like that helped her to see “how I myself am at the heart of the push-push which leads to the push/crash. [So now I understand] I have to have the inner dialogue of ‘I need to rest now’.”

 

 

The third type of mental adjustment is changing our expectations. ME/CFS and FM impose limits, but we may be slow to adjust our standards to meet our new limits, instead measuring our performance in comparison to healthy people or to the person we used to be.

We may say things like "A good wife prepares dinner for her family" or "a good mother gives her children the best birthday parties possible." You can reduce guilt and the intensification of symptoms by adjusting your expectations so that they match your new level of functioning.

 

Sometimes these standards are called the SMOs: Shoulds, Musts and Oughts. For example, "I should do more," "I must provide for my family," and "People ought to treat me better." The SMOs are rigid and create stress. They make it difficult to think flexibly.

 

One person in our program wrote about the benefits of changing her expectations, “Lowering my expectations so that they fit my new situation has been really helpful. I am not happy about having ME/CFS, but adjusting my expectations for myself has reduced my suffering greatly and taught me truly valuable life lessons about taking my time, living more in the moment and not being so hard on myself.”

 

Another person in our program used humor to change his expectations for himself. He said he was feeling guilty about how little he got done, then he had a realization that he had been comparing himself to healthy active people, when “I should have been comparing myself to koalas, who spend 16 to 18 hours a day in a motionless stupor."

 

It may also help to change your expectations about how others view you. As one person said, "I let go of expecting people to respond to me the way I think they ‘should'. For example, I let go of expecting that people will understand my disease. So with no expectations, I [feel] less resentment, which leads to less stress in life."

 

Changing expectations fits with changing self-talk. One person says, "When I hear myself saying, ‘You're stupid!' I remind myself that I have an illness that affects my thinking."

Another person reports that she used counseling to "stop being so hard on myself and accept that I was not pathetic, useless and weak, but was doing a lot to cope with my illness and actually living a pretty worthwhile life in spite of my difficulties."

 

Another helpful mental adjustment is to have a positive focus, which doesn't mean denying problems or ignoring symptoms, but rather taking heart in progress and successes as signs that improvement is possible. As one person said, "I feel better affirming my strength rather than focusing on how hard it has been. I have survived with several illnesses and that means I am strong."