Ten Keys to Coping and Recovery

6: Make Progress through Small Changes 

By Bruce Campbell

The subject of this article is a practical technique for implementing the old phrase “the journey of a thousand miles begins with a single step.”   By using the tool we call target setting, you can move toward your goals by making a series of small changes. This process has four steps.

1) Identify a Goal and Possible Steps to It

Begin by identifying a goal you want to work toward.  It might be something like improving sleep, getting off the push and crash roller coaster or improving a strained relationship. Then, brainstorm several possible steps that might help you move there. For example, if your goal is to reduce your symptoms, you might consider resting regularly every day, setting activity limits, getting to bed by certain hour or keeping records of your symptoms and activities.

2) Make a Short-Term Plan

The second step is to create a short-term plan or target. The plan consists of specific actions you can realistically expect to accomplish in a short time, typically one week. Being specific is the key. The target should be concrete and measurable. For example if you want to rest, you might say you will rest 15 minutes in the late morning four days in the next week.

The plan you create should answer the following questions:

1. What will you do?  You might aim to do something, like phoning a friend or walking several times a week.  Or you could set activity limits for yourself, like getting off the computer after 20 minutes.  (For other examples, see box below.) 

2. How much will you do?  If your target is to rest, will you rest for 15 minutes, an hour or some other length of time?

3. When will you do it? Will you rest in the morning, afternoon, evening or some combination? 

4. How often will you do it?  How many days a week will you do your target.  It’s good to allow yourself some “breathing room,” both in the way you phrase your commitment and in your attitude about it.  We all have good and bad days.  You can build recognition of this fact into your target by aiming to do something several times a week rather than every day.  

I recommend you write down your target. Committing your target to paper helps you to think through your plan in detail and makes your commitment explicit.  For a sample, see the Weekly Target form.

Even though you can set targets in more than one area at a time, we recommend you start with a single target.  Target setting is a skill and takes time to learn .  The purpose of target setting is to help you have an experience of taking an active role in your recovery. So I suggest you begin by aiming to make a small change.  If you do, you are likely to succeed and your success will build on itself, boosting your self-confidence and encouraging you to work for further improvement.

3) Check If Realistic and Implement  

Third, check if your target is realistic or doable.  To judge whether a target is doable, ask yourself “how confident am I that I can complete this target as stated?”  If the answer is 75% or more, you are likely to succeed.  If your confidence level is lower, try stating your goal in less ambitious terms.  You might reduce the number of times per week.  For example, set a goal of doing something 4 or 5 times a week rather than every day.  Or you might reduce the length of time you do something, say from half an hour to 15 minutes. Then you implement your plan, filling out your Weekly Target sheet. The written record shows you how you are doing and helps you hold yourself accountable.

4) Ask: What Did I Learn? 

At the end of the week, you evaluate your results. It can be helpful to view your target setting as a series of experiments.  Each experiment will produce information from which you can learn.  If you meet your target, you have a successful experiment and can gain some control over your illness.  If the results are different from your expectations, you may learn something useful about your illness and your approach to it. 

The most common problems people experience in target setting are not being specific in stating their targets and being too ambitious.  The solution to the first is to ask whether your target answers the four questions of what, how much, when and how often?  The solution to the second is to ask whether your confidence level is at least 75%

Even if your target is well stated and seems realistic, you may still experience problems.  By reflecting on your apparent failure, however, you may learn something important about yourself. A student in one of our early classes did this with an exercise target. On some days, she felt good after exercising, but on other days she felt worse. In analyzing her experience, she remembered that on one of the days she felt bad she had exercised in the morning. All the other days she had walked in the afternoon. Thinking about this led her to realize that mornings often were difficult for her. This discovery led to her to schedule not only her walking but also shopping and appointments during her “good hours.” So you can succeed with targets even if you don’t meet your goal.

An Example of Target Setting

To give you an idea of how targets can work, here’s an example from a student in one of our groups. Mary found the idea of daily, scheduled rest periods appealing as one way to reduce her symptoms and bring more stability to her life. So she set a target of resting 15 minutes in the afternoon on four days during one week. 

Her target answered the four questions involved in making a plan. Mary said what she would do (rest), how much (15 minutes), when (mid-afternoon), and how often (four times).  She was uncertain about whether she could succeed, remembering that she has found it difficult to meet goals since she became ill.  She rated her confidence level at 75%. 

As shown on her Progress Record, Mary began the week well.  She rested for 15 minutes on Monday.  She was surprised at how easy it was to do, and she got up feeling more energetic, which she noted on her log.  On Tuesday she lay down as scheduled but got up after a few minutes when the phone rang. It was a friend and they talked for half an hour. When they were done, she gave up on the idea of rest for that day.  On Wednesday she unplugged the phone before lying down. A call came in during her rest, but the answering machine took it. Mary felt a little guilty not answering the call, but was refreshed by the rest.

On Thursday Mary did some errands in the mid-afternoon and didn't attempt a nap.  On Friday, she rested but got up feeling worse than when she lay down.  She noted that she was anxious that day and spent her rest time worrying. As a result, her time lying down wasn't very restful. She thought she might do better in the future if she practiced out relaxation techniques during her rest.  

Mary was successful with her target in two different ways. First, she nearly fulfilled her plan by resting for 15 minutes on three days with some rest on a fourth. The experience was enough to show her the value of resting. Second, she generated an idea about further experiments she might try. Her rests helped her recognize that she was worrying a lot and gave her the motivation to try relaxation procedures during her rests to help quiet her mind as well as her body.

Ten Keys Series