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By Bruce Campbell
 

Note: Second in a series offering an introduction to pacing via three success stories.

 

When you think of what makes your symptoms worse, things like overdoing, poor sleep and stress may come to mind.

Let me suggest another cause, one that is often overlooked: lack of assertiveness. If we’re not able to stand up for ourselves and our needs, we’re likely to find it difficult to say “no” to demands that take us beyond our limits and produce relapses.

 

Being ill can make it difficult to be assertive. We may feel dependent on others or fear that we will be abandoned. But to protect our health, we need to communicate our limits to others in a way so that the limits are understood and accepted. In other words, to be assertive.

 

 

Not long ago, some of our groups had a discussion about assertiveness. One person described a pattern of passivity and said she wanted to use our discussion as an opportunity to learn about assertiveness and apply it to one relationship in particular.

 

The trigger, she explained, was a visit she had from a friend. He stayed for six hours, way more than her body could tolerate. Because he had driven an hour to get to her house and had fixed lunch for them both, she was reluctant to end the visit when her body starting crying out for rest.

 

An irony in the situation is that he had made equally-long visits every Sunday for more than a decade. She told the group that the visits had been using up all her energy for the day of the visit and also some of the energy required for the following two or three days, meaning that she began each week in an energy hole.

 

She told the group that the visits had been very important to her and she was grateful that the relationship had lasted when many other people had drifted away. But she wanted to find a way to spend time with her friend that “maintains the friendship and respects his needs and feelings, but which doesn't knock me around.”

 

Although initially she was not clear about how to proceed, she knew that she wanted to find a way to explain to her friend that the visits were costing her too much. She also wanted to think about what alternative would work for her. She thought that it would probably involve an earlier start, a shorter visit, and her taking one or two rest breaks during their time together.

 

She asked for suggestions from the group about how to speak to her friend and was particularly grateful for one suggestion that gave her a model of what to say. It stated her views, was factual and respectful, did not blame him for the relapse, and invited him to work with her to find a solution.

 

 

 

A week later, she checked in with the group in an email titled “Assertiveness: I did it!” She reported that she had talked with her friend about their visits. Working together, they came up with a plan to break the visit into two parts with a 1 1/2 hour break in the middle, where she takes a rest. The plan also included her taking two 15 minute breaks as well.

 

She told the group that the experience had been “life changing. I am now fully set up for living within my limits and therefore improving my health, and I have experienced how gentle, caring and cooperative assertiveness can be.”

She reported back to the group a year later that the visits had worked out as planned so that she was able to continue the visits but without the heavy price.

 

 

Pacing means finding the limits imposed by CFS or FM, adapting to them, then extending the limits as allowed by the body. When you think of pacing, the first thing that comes to mind may be avoiding too much physical activity. That’s important, but we think pacing applies to seven more areas as well: 

We refer to a person’s overall limits as her Energy Envelope and the limits in specific areas as the Little Envelopes.

 

Assertiveness is part of the social envelope, which refers to limits on how much time a person can interact safely with others. The limit may depend on the time involved, the specific people and the setting.

Meeting in public or with a large group may be stressful, but meeting privately or with a small group may be less draining. And, as in the story, the amount of time and taking rest breaks are often crucial.

 

By taking note of the effects of different combinations of time, people and setting, you can get an idea of your social activity envelope. That’s part of the first step of pacing: finding limits. The second step is to adapt your life to them and that often involves assertiveness.

 

And the same two-step approach applies to the other envelopes as well: using self-observation to define limits in specific areas, then adjusting your life so it fits within the envelopes.

 

The reward: lower symptoms, less suffering, a more stable and predictable life, and a more productive use of time.

 

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