14. Managing Stress
Although it took me quite a while to understand the effects of stress, eventually I came to see that stress was a double challenge for me and everyone with CFS. First, the CFS adds new sources of stress, such as the ongoing discomfort of symptoms, isolation, uncertainty about the future and financial pressure.
Second, there is something special about CFS that makes people much more sensitive to stress than before. It was as if CFS had reset my “stress thermostat,” making me sensitive to more types of stress than before and increasing the effects of a given level of stress. Even modest amounts of stress greatly intensified my symptoms, creating a feedback loop in which my symptoms and my response to them intensified one another.
Once I realized how vulnerable to stress I had become, I decided that dealing with stress had to be a big part of my effort to manage CFS. Over time, I came to believe that controlling stress was second only to pacing as the most powerful tool for coping with CFS. By using stress management techniques such as those described below, I learned how to interrupt the cycle in which symptoms and stress reinforced one another.
Approaches to Managing Stress
Because there were many causes of stress, I decided to use a variety of strategies to manage it. Many of them fit into the category of stress reduction. This set of practices involves retraining yourself to respond differently to stressors so that they do not have the same effect as in the past. For example, if you worry in response to an increase in symptoms, you may tense your muscles. Muscle tension can create pain, draining energy and causing fatigue. By learning to relax, you can lessen muscle tension and ease symptoms. This is one example of how to reduce the impact of stressors by changing your response. In the self-help program, we teach people to use 14 different stress reduction techniques.
The second approach, stress avoidance, is preventive, using self-observation to learn how stress affects you and then taking measures to avoid stressful circumstances. For example, you may notice that when you hit a limit, any further activity will intensify your symptoms. In such circumstances, rest can reduce the stress on your body. Having good relationships are a buffer against stress. People with supportive relationships have lower anxiety and depression. The main ways to prevent stress are by avoiding stress triggers and by using pacing, order and routine.
My first effort at controlling stress was through stress reduction. I used two formal stress reduction practices, the body scan and the relaxation response.
The body scan is a relaxation procedure in which you focus your attention on one part of the body at a time. I had started using doing this practice several years before CFS and found it a helpful way to relax. The relaxation response is a form of meditation that involves repeating a word or sound over and over for fifteen or twenty minutes. When your mind wanders, you return to your chosen word or sound. (For step-by-step instructions for these practices, plus three others, see the article Stress Reduction: Five Practical Techniques.)
I started experimenting with the relaxation response when I noticed that sometimes my daily rests were somewhat stressful because my mind was racing, full of anxious and worried thoughts. I hoped that by quieting my mind, I could achieve a deeper quality of rest than by just lying down and doing the body scan.
I found that meditation put me in a state of deep relaxation, in which I was aware of what was going on around me but detached from it at the same time. Relaxing my mind while relaxing my body had a dramatic effect on my anxiety level, thus reducing my tendency to over-produce adrenaline.
Another traditional stress reduction technique I found helpful was one I mentioned earlier: making mental adjustments or changing my self-talk. Being aware of what I told myself, especially during relapses, helped me to reduce my stress. When I caught myself saying things like “You’ll never get better” or “You’ll be like this the rest of your life,” I countered by telling myself “You’ve bounced back from all your previous setbacks, so just relax” or “Remember how things always look hopeless when you’re at your worst.”
It was important to counter the negative thoughts because, unchecked they created a vicious spiral. Negative thoughts intensified my stress, which made my symptoms worse, which in turn triggered another round of negative thoughts. Challenging the negative thoughts enabled me to interrupt this downward spiral.
It was also helpful to be aware of my expectations for myself. If I told myself something like “It’s Monday, you have to do the laundry,” I sometimes had to remind myself that my health came first and nothing bad would happen if I postponed the laundry.
Lastly, I made good use of exercise as a stress reducer. I took daily walks, as described earlier.
Stress avoidance proved to be just as helpful as stress reduction. By avoiding things that caused stress, I could prevent it.
One cause of stress, I discovered, was novelty. It takes more energy to respond to a new situation than it does to something familiar. My response was to make my life as predictable as I could by using routine, living my life as much as I could according to a plan. Having a daily schedule of activity, rest, exercise and socializing at set times gave structure to my life. With routine I had less pressure, and fewer surprises and emotional shocks. I mentioned routine as a pacing strategy earlier, but I found that it also helped me control stress.
I also learned to identify stress triggers, those situations and even people that set off symptoms. I found, for example, that I was vulnerable to sensory overload, particularly the noise and hustle and bustle associated with restaurants and other public places. My strategy was to avoid the noisiest places, for example by being selective about what restaurants I visited and when.
My vulnerability to sense overload led me to limit my consumption of the media. I learned to look away from the TV if there were rapid scene changes that would otherwise be disorienting. Also, I limited my exposure to tragic events, such as 9/11. I followed the guidelines suggested for the general public: keep up, but don’t immerse yourself for hours on end.
I also experienced a kind of sensory overload around certain people. Some were fidgety, others were animated or highly emotional. Whatever the trigger, I found them hard to be around. My strategies were to limit contact (generally to an hour or less) or, in a few cases, to avoid the person entirely.
In all these different ways, I took action to reduce the stress in my life. I believe that my successes built on themselves, creating a positive feedback loop. As I gained some control, I’m sure that I relaxed and that my growing confidence further reduced my stress. As I improved, my “stress thermostat” returned to normal.