Mental Obstacles to Pacing

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By Bruce Campbell

Pacing means changing what we do, but it also involves changing how we think. We looked at one way in which thoughts affect action in the last article, which discussed pessimism. But there are others; we'll look at several in this article.

Changing Expectations: Modifying the SMOs

Rather than adjusting our standards to meet our new limits, we may measure our performance against either the person we used to be or the healthy people. 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."

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 make it difficult to think flexibly or realistically.

One person in our program had a humorous way to prod himself into changing his expectations for himself. He said that he used to feel guilty about how little he got done.

Then he had a realization: "I was comparing myself to healthy active people when really I should have been comparing myself to koala bears, who spend 16 to 18 hours a day in a motionless stupor." He concluded "from now on, I'm going to look to koalas to see how I'm measuring up in the productivity department."

His comments raise a serious issue: we can reduce our guilt and the pressure to overdo by having an appropriate standard of comparison. For many, that might be not healthy people, but rather others with CFS and FM who are at a similar functional level.

Reframing

Another mental obstacle may be our self-talk or inner dialogue. Self-talk can be inaccurate, negative and pessimistic. The solution: change it to be more realistic. This is often called reframing.

For example, one person in our program used to chastise herself for taking a nap, telling herself, "you are weak and lazy for having to rest." But after learning to reframe her view of rests, she now tells herself before taking a nap, "I am helping myself to be healthy. I am saving energy to spend time with my husband or to baby sit my grandchildren."

Similarly, when feeling tired, you can say "This fatigue is not my fault; it came with CFS. So I don't need to feel guilty about not being able to do everything I used to." Or: "I didn't ask for FM, so why should I feel shame when it prevents me from doing things."

Another example of reframing was provided by a person who recognized that she was resisting pacing and other strategies because of her self-talk. Examples of her old self-talk included:

I should work because I am nobody without a job.
I shouldn't ask for help no matter how bad I feel.
I should always finish what I start, regardless of the cost.
As soon as I feel even a little better, I must go back to all of my old ways.
I can't lie down because it is wrong to rest when there is so much to be do.
I must find a cure.
I should push through the pain.
She has replaced sayings like those above with self-talk such as:
I accept that I am chronically ill and that I will only improve if I listen to my body and take tiny steps forward.
Resting is wonderful because it allows my body to heal.

I listen to my pain.

Pacing is wonderful because it allows me to do more and protects me from relapse.
Asking for help allows other people to feel valued and to overcome some the helplessness they feel in the face of this illness.
Asking for help helps me to pace and rest and give myself space for healing.
I can have a meaningful, worthwhile life no matter what state of health I am in.

Waiting for the Cure

Another mental obstacle to pacing is the hope of a cure. Recovery is rare for people with CFS and FM, yet many people say to themselves "I'm going to be the exception." Thinking you are going to recover can lead to a lack of acceptance of the chronic nature of CFS and FM, which may result in a postponement of taking actions that have a high probability of helping.

One person wrote that she had found four benefits from accepting that she might not recover:

Gives me more control since I'm no longer looking for a doctor to cure me.
Restores energy that I was expending in frustration and anger at doctors who didn't cure me.
Saves money, as I'm not actively looking for the elusive fix.
Gives me the opportunity to focus more on what I CAN do.

Not Seeing How We Effect Our Symptoms

Do you ever feel like you're living on a roller coaster, swinging between times of intense symptoms and periods of rest? When your symptoms increase, you go to bed. When symptoms subside, you resume a higher activity level, but that leads to increased symptoms and the cycle starts all over again.

If that describes you, you may be applying to CFS or FM an approach appropriate to previous illnesses. The difference with CFS and FM is that how you lead your life has a big effect on your symptoms.

In our classes, we ask people what makes their symptoms worse and what helps them control their symptoms. For the former, people often say things like doing too much, poor sleep, travel and other special events, stress, and sensitivity to light, sound and/or food and chemicals.

For giving a sense of control, people often respond with answers like:

Accepting my limits, pacing myself
Taking regular rests each day
Using medications to control symptoms
Changing my diet
Asking others for help
Avoiding people and situations that trigger symptoms
Laughter and other pleasurable activities
Practicing relaxation and stress reduction

In either case, your actions have a big effect on your symptoms and suggest a motto: Less of what hurts and more of what helps.