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Reducing Both True and False Guilt

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Note: Chronic illness brings physical suffering from symptoms, but it also creates mental suffering, caused by things like worry, uncertainty, regret, guilt and grief. The articles in this series focus on ways to ease the second type of suffering, psychological pain.
Guilt is a frequent companion of people with CFS and FM and one source of mental suffering. We feel guilty about things we’ve done and about things we failed to do. 

If you experience guilt, what can you do to ease the burden it imposes? One potentially helpful approach to reducing this source of mental suffering is to focus on two types of guilt: true guilt and false guilt and to use different strategies for each.
True guilt is the negative feeling we have when we harm others. False guilt, on the other hand, is a negative feeling triggered by not living up to standards that are no longer realistic or because of things outside our control. For example, we may blame ourselves for getting sick or feel guilty because we think we are no longer contributing to our family or to society.

Here are some ideas of how to respond constructively to both types of guilt.
True Guilt
True guilt (guilt that arises when we have harmed others) can cause mental suffering if we feel stuck in thinking about what we have done, condemning ourselves. We can get unstuck by taking action.
One appropriate response to guilt triggered by actions which harm others is to apologize and make amends. For example, one person in our program said that if she does something to hurt her husband or her children, like lashing out at them verbally, she apologizes.
Another response to true guilt is to use it as a motivation for change. For example, some people in our program say that they have used guilt over canceling out on commitments as an impetus to be more consistent in their pacing in order to make themselves more dependable.
In sum, true guilt can be helpful if it motivates you to treat those around you with more consideration or to take better care of yourself in the future.
False Guilt
On the other hand, if you experience guilt triggered by things over which you lack control, you may experience another kind of mental suffering: guilty feelings where they are not appropriate. Here are six strategies you might use in response.

1) Adjust Expectations
One kind of false guilt is triggered by a difference between a person's expectations and their capabilities. For example, some people with CFS and FM may feel guilty because they are no longer the kind of parent they were before becoming ill or are not contributing to the family as they did earlier.
Such guilt can be reduced by adjusting your expectations to match your new level of functioning. As one person said, "I've lowered my standards for myself. This isn't easy, since I'm a recovering perfectionist." When self-condemnation is harsh, some people find it helpful to imagine how they would react if you they observed another person saying such things about herself.

One person in our program wrote that she tells herself, "If I were caring for an injured loved one, in distress, how would I take care of her? I try to treat myself the same way."

Another strategy is to change who you compare yourself to. One person says that comparing herself to her healthy self is “hugely frustrating. So I adjust my expectations by comparing myself to a support group of other folks like me.” (That was a strategy I used, too.)
A final strategy for responding to outdated expectation is to use humor. One person in our program said that he was feeling guilty about how little he got done in comparison to healthy people. Then he read about koala bears and learned that "they spend 16 to 18 hours a day in a motionless stupor." His conclusion: "From now on, I'm going to look to koalas to see how I'm measuring up in the productivity department."

Then there's the article Making a NOT TO DO List,which flips usual expectation on their head. Having such a list gives you permission to eliminate activities without feeling guilty about it.
2) Reframe (Change Self-Talk)
Part of the process of adjustment is changing our internal dialogue or self-talk, so that it supports our efforts to live productively with illness rather than generating guilt.

For example, one person says she has changed how she talks to herself about taking naps. In the past, when she took a rest, she told herself it was because she was lazy, but now 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."
Similarly, another person, when feeling tired, says, "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." Another says, "I didn't cause my FM, so why should I feel shame when it prevents me from doing things?"
And another person says she uses self-talk as a way to combat fatigue: “I have a voice inside that thinks I'm lazy and malingering and I have to keep talking back to that voice with a more healthy, reasonable, reassuring voice. Feeling guilty just makes me more tired.”
Because self-talk is usually deeply-ingrained and habitual, changing it requires effort and takes time. For a detailed description of how to do it, see the last article in this series: Changing Self-Talk: A Cognitive Therapy Primer.

3) Shift Attention
Feeling guilty is common, but we can control how we respond when feelings of guilt arise. One person said that she asks herself "Is this feeling productive?" In some cases, the answer will be "Yes." Guilt can draw our attention to ways in which we have failed to live up to our standards and can motivate us to act differently. (See earlier discussion of true guilt.)
If the feeling is not productive, however, it may be better to respond to guilt by turning your attention elsewhere. As another person wrote, "It's better not to go some places in your head, so I've learned how to control my own thoughts." For a discussion of strategies for doing this, see the next article in this series: Rising Above Rumination.

4) Educate Others
Some guilt may be triggered by how others treat you. Their lack of understanding may lead you to feel guilty about your symptoms or the limitations they impose.

Just as one response to false guilt is to adjust your expectations for yourself, another is to work on changing the expectations others have of you. This involves educating the people in your life, so they understand that CFS and FM are long-term conditions that impose significant limits and require adjustments.
If you think educating others about your condition would make them more understanding and supportive, you might talk with them or give them something to read, such as the materials in the Family & Friends archive.

Educating others about CFS and FM often requires patience (people sometimes tell us it took several years for their families to understand) and is not always successful. Most who try eventually put limits on their efforts to educate others, focusing on the relationships that are most important and recognizing that some people may never understand or be sympathetic.

A woman in our program was successful with a clever approach. She gave copies of a pamphlet on CFS to her husband and adult children, asking that they read it as their birthday present to her. Although the process took a year, one by one her family members came to accept her CFS.

5) Learn Assertiveness
Another strategy for reducing false guilt is to be assertive,speaking up for yourself, setting limits and saying "No" in order to protect yourself and avoid doing things that intensify your symptoms.

For example, you can teach your family and friends to respect your need for regular rest breaks and can make your limits clear by telling others how long you'll talk on the phone, how much time you will spend at a party and so on.
Another part of assertiveness is learning to delegate and ask for help. Others often feel as helpless as you about your illness; asking them to help you in some specific way replaces the sense of helplessness with a feeling of accomplishment while protecting your health.
Here are two examples of assertiveness from people in our program.

One person, wanting to strengthen her resolve to set limits with others, posts notes all over her house saying, "I'd love to but I just can't." The notes remind her what to say when people make requests. She says "seeing the notes so often ensures I remember to use this answer without feelings of guilt." For more, see the article Assertiveness: A Tool for Reducing Symptoms.

A formerly housebound woman in our program provides another example. She reports that for several years she told her family that she had severe limits, but she always said "yes" to their requests, leaving her with high symptoms.

Initially she blamed her family for not allowing her to pace herself, but finally decided that the solution was for her to set limits. By making clear what she would and would not do (for example, setting limits on how often she would babysit her grandchildren), her health improved so much that she was able to return to work.

6) Practice Relationship Triage.
A final strategy is to reevaluate your relationships, practicing relationship triage: making explicit decisions about whom to include in your life, concentrating on the more valuable or necessary relationships and letting others go.

In the words of Dr. David Spiegel of Stanford: “Simplify the relationships that are necessary but unrewarding, and eliminate the ones that are unnecessary and unrewarding.” (For more, see Chapter 20 in our introductory course text.)