Pacing: What It Is and How to Do It

Achieving Consistency in Pacing

By Bruce Campbell

While most people understand that staying within their limits 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.

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. Here’s what one person in our program wrote about how she got to the point of using many different strategies to control her CFS.

Some people have told me that they felt tired and discouraged when they read the long list of illness management strategies that I use. All I can say is that I didn't start doing them all at once! The transformation into a more disciplined person was a long-term process. The changes have been introduced gradually over time, maybe one a week at best. And I make sure I find the right one before I move on to adding the next.

Use Routine

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.” (For more on schedules, including sample worksheets, see the previous article in this series.) Another wrote,

Developing a routine and sticking to it have been helpful because the familiarity reduces the number of surprises and lowers the attention that I have to spend on unexpected happenings. If I always wash my face after brushing my teeth, then, when I’m done brushing my teeth, I don’t have to think about what I’m going to do next.

A related idea is the development of new habits. 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. (See her 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. She gradually altered her life to fit within the limits she had discovered.

Visualize Consequences

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 and visualize how you would feel if you go outside your envelope. One person said, “Imagining the fatigue and brain fog provides a counterweight to the immediate pleasure I anticipate from doing something that takes me beyond my limit.” Another person said that before she acts she reminds herself that all her actions have consequences and asks herself, “Can I live with the payoff…is this activity worth the payoff?”

Adjust Your Expectations

Many strategies for succeeding at pacing require the development of new habits and routines. The foundation for these may lie in developing new expectations of yourself. Here’s what two people in our program said.

It has been important for me to accept my new life with CFS, move on, and realize I will not return to my former self. I've needed to redefine expectations of myself based on the new me.

I have accepted that I will probably never fully recover and in acknowledging that I am discovering better ways to co-habitat with the illnesses.

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.” Acceptance is the last stage working through the losses brought by illness. For more, see the article Move Beyond Loss to Build a New Life.

Develop Personal Rules

Living by a set of personal rules means not having to think and also reduces the power of spontaneity to overwhelm good judgment. Some people have had success using very detailed and individualized rules to protect them from doing too much.

One person with a severe case of CFS developed 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. Having these rules helped her keep a focus on long-term goals when she was tempted to act in the moment. If you are bothered by brain fog, you might consider taping rules in some prominent place, like the refrigerator.

Some people create a series of rules for specific circumstances. For example, some people set a limit on how long they talk on the phone, how long they stay on the computer and how long they spend with relatives. Another example: One person noticed that he often returns to a normal activity level too soon after a cold or flu. He made a rule to take extra rest every day for at least a week after symptoms from the secondary illness had ended. 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?

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 the effects of your actions. With records of your activity level and your symptoms, 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. 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 also be an important source of motivation and inspiration. Seeing written proof that activity level affects symptoms can provide a stimulus to stick with pacing. Records of progress can provide hope. For more on record keeping, see Learn to Predict the "Unpredictable” or the chapter titled Records and Worksheets in our course textbook.

Heed the Body’s Messages

Learn to listen to your body and the messages it sends. According to author Anabel Hobbs, the first time it whispers the message. The second time it speaks in a normal voice. And the third time it yells.

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. For more, see the next article in this series.

Practice Forgiveness

Forgive yourself. No one stays in her envelope all of the time. Also, 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 more on how to change your “self-talk” (thoughts about yourself) to be more supportive, see the article Taming Stressful Thoughts. The article describes a three-step process for changing your thinking, based on the principles of Cognitive Therapy.

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.”

Other people have a habit of putting others’ needs ahead of their own. Sometimes called “people pleasers,” these patients 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.