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Ten Keys to Coping and Recovery2: Find Your Limits Having a chronic illness can often feel like living on a roller coaster. Better days trigger a hope for recovery; days with intense symptoms may bring despair. It’s easy to get caught up in a frustrating cycle of push and crash. You may work to get as much done as you can, but then experience intense symptoms that force you to bed in the hope of reducing discomfort. After a while, you feel better but then try to make up for lost time and experience another period of intense symptoms. In our course, we discuss an alternative to this cycle of push and crash. We believe that having a chronic illness means living within limits, and that by honoring those limits we can gain some control over our illness. The Energy Envelope One way to explore the idea of limits is through the concept of the Energy Envelope. You can think of your situation in terms of three factors: 1) Available energy: the energy you have. It is limited, and is replenished by rest and food; 2) Expended energy: the energy you lose through physical, mental & emotional exertion; and 3) Symptoms: fatigue, brain fog, pain, and so on. If you expend more energy than you have available, you will intensify your symptoms. This is called living outside the Energy Envelope. This approach commonly leads to the push and crash cycle described above. An alternative is living inside the Energy Envelope. If you keep your expended energy within the limits of your available energy, you can gain some control over your symptoms. If you accept your limits (keeping your activity level within the limit of your available energy), you can reduce symptoms and the severity of relapses, and over time may be able to expand your limits. This is an upward spiral. The Fifty Percent Solution & the Bowl of Marbles Let me suggest a couple of ideas you might use if you wanted to apply the concept of the Energy Envelope. The first is called the fifty percent solution. Each day estimate how much you think you can accomplish. Then divide this in two and make it your goal to do this lesser amount. The unexpended energy is a gift of healing you are giving to your body. The second idea is to imagine your available energy as a bowl of marbles. You have a limited number of marbles to use each day. The number may vary from day to day. Physical activity uses some, but mental and emotional activity do as well. With every activity, you take one or more marbles out of the bowl, remembering that stress is a big marble-user and so lessening stress will preserve your supply of marbles for other uses. The overall idea in both the fifty percent solution and the bowl of marbles is that the limits imposed by the disease force us to set priorities in order to control our symptoms and bring some stability to our lives. Both techniques are ways you can reframe your situation to give yourself permission to do less as a way to promote healing. Defining Your Limits Another way to use the idea of the Energy Envelope is to develop a detailed description of your limits. This can give you a thorough understanding of what you individually have to do to minimize symptoms and increase your chances for recovery. If you want to do this, I suggest you look at five different aspects of your life: your illness, activity, rest, emotions, and stress. Illness: The severity of your illness suggests your safe level of activity. To get an initial idea of a safe activity level, you can rate yourself in comparison to other patients on the CFIDS/Fibromyalgia Rating Scale. Most of the students in our course have rated themselves between 20 and 45, with the median being 30. (Median means there are an equal number of people above and below.) Activity: This factor refers to how much you can do without making yourself more symptomatic. You can divide this into physical, mental and social activity. Physical means things like housework (how long and how intense), shopping and errands (how many times a week, for how long), driving (how long, how far), standing (total time per day standing up, maximum time per period), and exercise (how many times per week, how long per session, how intense). Mental refers to activities using concentration, like reading and time on the computer. Social means time with people and the type of contact (for example in person or by phone). To get an idea of activity limits, list each of the factors above (housework, shopping, driving, etc.) and estimate how long you can do each without making your symptoms worse. Rest: This factor refers to the quantity and quality of sleep at night and rest during the day. Questions you might ask about sleep include: how many hours of sleep do I need? What is the best time to go to bed and to get up? How refreshing is my sleep? Daytime rest means lying down with eyes closed in a quiet environment. Questions here might include: how much total daytime rest do I need? How frequently should I rest? Emotions: Strong emotions like fear, anger, grief and depression are normal reactions to having a chronic illness. This factor refers to the emotions we experience as part of being ill and also to the sensitivity we have to emotionally-charged events. Questions in this area include: What emotions are important in my life now and how intense are they? What is the effect of emotionally-charged events? (Events with strong emotion often trigger the release of adrenaline, which can be very taxing.) Stress: This refers both to the sources of stress in our lives and to our sensitivity to those stressors. In terms of sources, three are crucial: finances, relationships, and things. Finances can impose severe limits and be a major source of stress. Relationships can be sources of support and help, sources of strain or both. Physical sensitivities refers to food, sense data (light and/or sound sensitivity, sensory overload), seasons and the weather (intensification of symptoms at certain times of the year or with different weather conditions). Your Energy Envelope is a list of what you uniquely have to do to have a good day. It is your list of things to do to feel better. Also, having an understanding of your envelope can help you to set priorities. After completing the exercise of defining your envelope, you might decide that poor sleep was the crucial issue for you at this time. Or you might find that a stressful relationship needs attention. In any case, the idea is to understand your limits in detail, so you can control symptoms and decide where to focus your energies for improvement. Related Article
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