What is commonly referred to as a setback?
A setback is a flare in pain or fatigue that significantly disrupts your daily function and/or sleep for a few days or more. Some things commonly go along with a setback including increased self-criticism, frustration, low mood, and loss of tolerance for some activities.
What is a setback plan:
It is a flexible plan of what you can do to self-manage what is happening, to calm things down and build things back up again. You can create a compassionate setback plan as a flexible guide for managing a flare-up and increasing activity gradually again. It draws on previous experience or managing your pain and what is helpful for your wellbeing.
Why is compassion important in a setback plan?
Compassion is important in a setback plan as often people blame themselves, self-criticism and frustration increase, which in turn turns up the pain volume. Having a compassionate focus also encourages kindness, gentleness, courage and strength. It helps you support yourself and do what’s wise for you at that time, like asking for a little more help and support for a few days or weeks (there is a strength in this).
Compassion encourages you to step back rather than pushing on regardless or stopping everything (neither of which are recommended) and ask yourself questions like ‘what can I do for myself out of kindness today’ (this is a question I love that I heard on a course with Dr Mary Welford).
‘Our compassionate self brings wisdom that illuminates the available choices & the possibilities flowing alongside them, along with what could be most helpful right now.’
~ A Parkinson
What causes a setback? There are many reasons and commonly it is a combination of things, including:
- Doing too much (this could be the boom-bust cycle if it happens regularly)
- A virus
- Increased stress
- Decreased sleep
It isn’t always easy to work out what has caused a setback, sometimes it helps to explore what had led up to it and other times it isn’t. If you find you are having repeated flare-ups without any obvious contributors the best thing to do is usually to focus on actioning your compassionate setback plan.
Why do we need a set back plan? Here are a few reasons:
It helps you stay in control and feel confident with self-management.
There are always flare-ups when living with pain and sometimes these are really difficult to deal with. It sometimes feels like a million steps backwards have just happened at speed. A setback plan helps us remember the things that are helpful, what to do to manage things and build tolerance back up (it’s not always easy when pain increases to think clearly).
If we don’t have a plan we can end up losing fitness and more tolerance for the activities we need and want to do, and instead we end up maintaining a new lower level as systems adapt to this and we lose fitness. This also affects confidence for doing daily activities amongst other things.
Flare-ups can make people withdraw further from others, themselves and the world around them. Retreat is a natural protection mechanism, this may be a helpful short-term strategy, however it is not helpful when it is repeated regularly in the long-term. Retreat and disconnection are also things that turn up the pain volume and sensitivity. Having a setback plan that gives some structure to help calm things down and build things up gives some helpful guidance and structure.
It helps you take steps forwards in a meaningful way.
What to put in a setback plan?
This is individual to you and requires some exploration and reflection. Grab a notebook and make some notes, if you are having a setback now use this experience and previous ones as you read to make notes, otherwise remember the last time or times you had a pain or fatigue flare-up that affected your function and sleep for a few days or more.
- Consider what may have contributed to the setback, if this is helpful. Compassionately acknowledge (a gentle tone, a helpful acknowledgement without criticism) this and what could be done differently next time.
- What helped you calm things down and build things up before? What didn’t help before?
- Set yourself some easy short-term goals based on meaningful activities (what’s important to you, what do you most enjoy doing).
- Plan to gradually build things up to rebuild tolerance and fitness. Align this with your goals and allow yourself flexibility to adjust things if needed along the way.
- Moving little ad often is usually helpful. Remember to include movement in your setback plan.
- Prioritise what needs to be done and leave the rest or ask for help (it’s not a weakness to ask for help it’s a strength and being wise to what’s helpful). It can be frustrating leaving things, there are strategies that can help you manage this.
- Remember to change how you usually pace things for a short-time, you will have lower tolerance as the need for protection has be deemed to have increased (things are on high alert), this helps calm things down. It is important to have a flexible plan for building things back up as you will otherwise adapt to the new level.
- Don’t stop everything and rest for more than a few hours at a time, it is usually better to do a small amount regularly with short rests.
- Notice self-criticism with self-compassion and unhook from unhelpful thoughts. One way to do this is to say, for example, ‘I notice that I am thinking the thought that…’ Another is to write a compassionate letter to yourself to acknowledge how things are and that it’s not your fault, it is understandable & part of being human and living with pain. There was a post on this on the Unity Physiotherapy Facebook page in September 2019 as part of Pain Awareness Month. There is also guidance in The Compassionate Mind Workbook & Compassion Focused Therapy for dummies. If you are unsure, or struggle with this, please get help from a suitably trained therapist.
- Practice self-compassion. There is guidance in both books mentioned above, The Compassionate Mind by Professor Paul Gilbert and on Kristien Neffs website https://www.self-compassion.org
- Increase relaxation based activities, for example meditation, gentle stretching or anything you find calming.
- Integrate more things that stimulate the soothing system (this is part of the 3 circles model in compassionate mind training/compassion focused therapy). I go through this in clinic with people, there is also guidance in the above books and this video by Chris Winson https://m.youtube.com/watch?v=peC-bB4DqXQ&fbclid=IwAR3b10RyukjKxkukeByQB4XQVeo0bMkVfjo1uvwggpamb09iTc0r-vpc07M
- Consider if you need medication in a bad flare-up or can you manage things effectively with other strategies. If you need medication discuss this with your Doctor, Pharmacist or Non-Medical Prescriber, such as a Physiotherapist who has done additional training, how to optimize this.
- Focus on the present moment and the small steps rather than the set back and where you were.
Need further help?
Ask your physiotherapist or other healthcare provider for help if you are unsure of how to create your setback plan. This is something I help people to do at Unity Physiotherapy and am happy to help you explore creating a setback plan.
‘A compassionate setback plan helps you keep returning to a life full of meaning & purpose despite pain ‘
~ A Parkinson