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While most people with CFS and FM understand that staying within their energy envelope would bring a higher quality of life, many find it difficult to do. If you are in that situation, what can you do to increase your consistency in living within your limits? Here are nine strategies to consider.
 

Use Routine and Reminders

Having a regular daily schedule eliminates a lot of decision-making. One person in our program said, "Instead of having to ask whether something is or is not within my envelope, I have tried to stick to a schedule I know is safe." Another says, "Except in special circumstances, I do roughly the same stuff at roughly the same time of day....[I've done it for so long that] it's not a mental battle to do it - it's just the way my day is."

While pacing may seem daunting at first, it can become second nature over time as one's daily habits are altered. Bobbie Brown was able to do this, as she describes in the article 25 Reasons Why I've Improved. She first learned her limits for activities such as driving, time on the computer and phone, and socializing.

Then she gradually altered her life to fit within the limits she had discovered. Habit change can be facilitated by using reminders. For example, you can use a timer to limit the length of computer sessions or post reminder notes on the refrigerator or bathroom mirror. For more on this topic, see Chapter 31.
 

Develop Personal Rules

Some people with CFS and FM have had success using very detailed and individualized rules to protect them from doing too much. Living by a set of personal rules means not having to think and also reduces the power of spontaneity to overwhelm good judgment. If you are bothered by brain fog, you might consider taping rules in some prominent place, like the refrigerator, the bathroom mirror or your computer.

These may be general rules. For example, one person with a severe case of CFS 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.

In addition, some people develop rules for specific circumstances. For example, they might set a limit on how long they stay on the computer, how long they spend with people in social situations and how long they will stand before taking a rest. If you develop specific rules for yourself, you can simplify your illness management program into asking yourself two questions: What situation am I in right now? What is my rule for this situation?

A related approach is, quoting the title of an article on our website, to develop a set of overall "Personal Guidelines for Managing Chronic Illness." The idea here is to have a few rules to guide your life with chronic illness, something you can turn to in times of confusion to guide you to a healthy decision.

Stop & Choose

One way that people get pulled outside their limits is by giving in to the temptation of doing something that seems appealing at the moment. A way to avoid such lapses is to stop before you act and realize you have a choice.

One person in our program carries a card in her purse to remind her of the consequences of overactivity. On one side, it says "What's the Trade-Off?" The other side reads "Just Say No." (An alternative to the second part is to ask: "Am I willing to accept the consequences?")

Another person visualizes how she would feel if she went outside her envelope. She says, "Imagining the fatigue and brain fog provides a counterweight to the immediate pleasure I anticipate from doing something that takes me beyond my limit." A third person has sayings she uses to remind her of alternatives. One is "I can finish this task and crash or listen to my body and stop."

Alternatively, you can focus on the positive and give yourself reminders of what you gain through pacing. For example, you might post notes to yourself in prominent places in your house, saying things such as "Staying within limits gives me control," "Pacing reduces my symptoms," and "Pacing makes my life more stable."

Keep Records

Keeping a health log, which should take no more than a few minutes a day, can help you gain consistency in pacing in at least three ways.

First, records can help you get a clearer picture of your limits and reveal the connections between what you do and your symptoms. Using records, you can see how much activity you can do safely in a day and a week, and whether there are delayed effects. Also, a log can show the effects of mental and emotional events, as well as physical activity.

Second, a log can help you hold yourself accountable for your actions by documenting the effects of your actions. Reviewing your records can be like looking at yourself in a mirror.

As one person in our program said, "Logging brings home to me the reality of my illness. Before logging, I didn't realize that most of my time is spent on or below about 35% functionality. This false perception that I was better than I am led me to overdo things, but now I am less ambitious."

Third, records can motivate you by showing you that staying inside your limits pays off in lower symptoms and a more stable life. Records of progress can provide hope. For more on record keeping, see Chapter 30.

Adjust Your Expectations

Many strategies for succeeding at pacing require the development of new habits and routines, which in turn are based on reduced expectations. The ability to develop new expectations is based on adopting a different attitude, a particular kind of acceptance.

As explained by recovered CFS patient Dean Anderson, this acceptance is not resignation, but rather "an acceptance of the reality of the illness and of the need to lead a different kind of life, perhaps for the rest of my life."

Some people find it helpful to compare themselves to other people with CFS and FM rather than to healthy people. Coming to acceptance is a process that often takes several years, but it has significant benefits.

In the words of one person, "I've discovered that I can now be perfectly at peace with lowering my expectations as I know too well what happens when I try to push the envelope and then relapse!!" For more on acceptance, see chapter 26.

Heed Your Body's Messages

You can gradually retrain yourself to respond differently to the signals sent by your body. Instead of ignoring your body, you can learn to hear and respond to the body's warning signs.

In the words of one person, "Getting well requires a shift from trying to override your body's signals (in order to continue what you were doing) to paying attention when your body tells you to stop or slow down." Another person said, "I've had to learn to replace ‘work until done' with ‘stop when tired.'"

Make Changes Gradually

You may feel overwhelmed at times when you think of all the adjustments you have to make to live well with CFS or FM. The solution: focus on one thing at a time. One person described how she changed by saying, "The transformation into a more disciplined person was a long-term process. The changes have been introduced gradually over time. And I make sure I find the right one before I move on to adding the next."

Forgive Yourself

No one stays in their envelope all of the time. Life has its ups and downs; some times are more stressful than others. Instead of beating yourself up when you slip or circumstances overwhelm you, it's better just to ask, "What can I learn from this experience?" and move on. For step-by-step instructions for changing your "self-talk" (internal monologue of thoughts about yourself), see Chapter 31.

Value Yourself

Some people with CFS and FM have difficulty acting in their own interest. In some cases, the answer is to learn assertiveness. Assertiveness means finding your limits and then communicating them to others. One person in our program reported that she was able to avoid setbacks when she learned to speak up for herself.

She wrote, "Communicating clearly when I need medicine, rest or quiet time and taking time for these things when I need them all help me to prevent a relapse." Asking for help rather than trying to do it all yourself is part of taking care of yourself.

Other people have a habit of putting others' needs ahead of their own. Sometimes called "people pleasers," these individuals with CFS and FM have difficulty setting limits or saying "no" to others. Because of this view, people pleasers may not take care of themselves. This trait can be deeply ingrained and may require counseling to change.