In my quest to live the best life that I can, I have begun reading more books about fibromyalgia. Most of the information I have so far acquired about fibromyalgia has come from reading various websites around the internet and discussions with my doctor. Of course, in the nebulous darkness of the internet, what counts as credible information isn’t always immediately beyond perusing the main medical sites. I want to improve my quality of life, so, like any bookworm, I decided it was time to get serious about reading books on my condition.
My goal in reading and reporting on these books is to relate information I found interesting that I learned from the book, to identify strategies that I could use to improve my quality of life, and to outline the contents of the book for others with fibromyalgia. This way, I can improve my quality of life and allow someone else to decide if a particular book will be useful for their needs.
Friedberg, Fred. Fibromyalgia & Chronic Fatigue Syndrome: 7 Proven Steps to Less Pain & More Energy. Oakland: New Harbinger Publications, Inc., 2006. Print.
Friedberg is a clinical psychologist who has lived with chronic fatigue syndrome for 25 years. He is an assistant professor at Stony Brook University.
Critique of Contents
Friedberg proffers seven steps to improving your life with Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM). Many of the steps offer concrete suggestions that are accompanied by scientific research and personal case studies to show how these strategies improve quality of life (e.g., sleeping better and anger). Some of the strategies, however, are brief descriptions with overly general advice that seems a waste of a step (e.g., getting support from others).
I enjoyed the inclusion of case studies to show how some individuals improved their life, but I also felt that many of them were too short to provide the depth and analysis that I would have preferred from a case study. Instead, their brevity sometimes implies that these lifestyle changes were so simple that no genuine effort was involved. Lifestyle changes, however, are essentially habits that we have fallen into, and changing (and maintaining!) these habits are incredibly difficult. A more thorough analysis of some case study may have permitted better understanding how to implement and maintain these lifestyle changes.
Friedberg makes many suggestions throughout the book, and the one I had the hardest time swallowing was to spend two hours a day using extended-relaxation techniques. Who has the time to devote two hours toward meditation each day? I certainly don’t, though I will concede that I also don’t have time to be sick. Other suggestions, like pacing, seem hard to implement, but I absolutely understand the benefit. In some ways, I can force myself to pace better with activities like housework by structuring breaks between various chores. Though this seems simple to adopt, I will have to fight against my personality because I have always preferred to clean until everything was done because I enjoyed relaxing in a clean house with nothing left on my to-do list. I can make this adjustment because, after all, it’s particularly difficult to enjoy a clean house when I’ve crashed. I’m less certain how I could successfully apply pacing to my work day, but I will reflect on ways I can better utilize this strategy.
What I gleaned most from this book was my need to reduce stress and improve my quality of sleep. I’ve decided to try guided meditation (a practice that I find, in theory, absolutely ridiculous) for 20 minutes before bed as a combined effort to reduce my stress level, try out one of the recommended relaxation techniques, and improve my sleep through a more structured and calming approach to get ready for bed. Friedberg suggests that I need to try out any new practice for at least three weeks before deciding whether I am benefiting from it. I sure hope these three weeks won’t be long.
Summary of Book’s Contents
Part 1: Definitions, Possible Causes, and Lifestyle Factors
Friedberg defines CFS and FM and explains some of the history of both of these conditions, including the search for underlying physical ailments to pinpoint a biological reason for them. He argues that CFS and FM “have both physical and psychological causes” (16). He suggests that focusing on lifestyle changes can improve quality of life.
Friedberg explains how personality types may also affect the onset and severity of CFS and FM symptoms. Individuals with overextended lifestyles who prioritize helping others can drive themselves so hard that their bodies essentially crash. He cites several studies ranging from 1993 to 2001 that generally support his supposition that individuals with CFS and FM had personalities that were more passionate, strong-willed, energetic, and driven (25-26). These personality traits can result in high levels of stress, which aggravates symptoms of CFS and FM, especially for individuals who value their abilities to be productive and help others.
Friedberg shares his own battle with CFS. He suggests that his CFS were affected by his relative social isolation and working too much. In his quest to improve his quality of life, he moved several times to get away from toxic chemicals (e.g., from New York to Long Island to Connecticut), but his symptoms followed him each time. He eventually made lifestyle changes that substantively improved his life.
Friedberg discusses the difference between the effect of control and coping strategies on illness outcomes. He notes that the sense of illness control will be different for different people, as each individual will need to identify activities that improve or worsen their symptoms. Further, individuals with negative or pessimistic outlooks on their futures tend to have worse outcomes.
Part II: The Seven Steps to Improvement
- Use deep relaxation techniques, such as meditation, guided imagery, and progressive muscular relaxation. Using these techniques can reduce stress, muscular tension, anxiety, and pain. These techniques can also increase your sense of well-being. One study showed that an hour of meditation a day resulted in significant changes to individuals with FM through the reduction of depression, sleep deprivation, and overall negative impact on the illness on quality of life (53). Friedberg further suggests setting up smaller chunks of time devoted to these strategies by starting with 10 to 20 minutes of relaxation twice a day and slowly add time until you’ve reached an hour. He further strongly urges that you increase the time to two hours devoted to relaxation techniques, if you have the time.
- Improve quality of sleep by practicing what amounts to good sleep hygiene alongside relaxation techniques. Good sleep hygiene includes: using your bed to sleep (e.g., no reading or watching TV in bed), going to sleep at the same time, and no longer napping during the day. If you cannot fall asleep within 30 minutes (or if you wake up in the middle of the night and cannot return to sleep within 30 minutes), he suggests getting up and practicing extended relaxation techniques.
- Pace your activities, especially on days that you feel more like your old self. Friedberg encourages you to collect activity data on yourself to help identify your levels of energy and pain in relation to the activities that you do. This daily log will help you identify how you may be aggravating your symptoms. Both physical and mental activities can increase your level of fatigue and pain. Pacing can be applied to many types of activities, from eating to housecleaning to socializing. Each type of activity can be draining to different individuals in unique ways, so the key is to identify how these activities drain you and how to better pace yourself to avoid a crash. Start small and gradually increase your level of activity. Even on days you feel good, you absolutely have to not go beyond whatever “level” you’re at, no matter how good you’re feeling.
- Identify and lessen your anger. Although anger is certainly natural for people with CFS or FM, Friedberg says that anger—especially anger at yourself—is counterproductive. Hidden anger is linked to worse pain and disability outcomes, and individuals with chronic pain often have less awareness of their anger than other patients with medical conditions (94). People with FM or CFS may suppress negative emotions because they want to be viewed as good, believe they have no right to complain, fear being selfish, or believe that only the weak complain. Friedberg suggests that much of the hidden anger is rooted in the expectations that we have for ourselves and for others. He suggests ways to better express your feelings, stop criticizing yourself, and develop more realistic expectations.
- Find relief from worry, discouragement, and guilt. This step is much akin to the fifth step in dealing with anger as a negative emotion. Friedberg mostly suggests acknowledging the feeling and then trying to modify your thoughts by replacing negative ones with positive or more accepting statements about your illnesses (e.g., I’m so worried about being disabled in the future vs. Worrying will not allow me to control my symptoms).
- Find pleasant events and pleasurable experiences to increase your quality of life. Friedberg recommends writing a list of ten pleasant activities that require minimum effort and begin by scheduling five of those activities for your next week. Activities could be as simple as taking a bath or reading a good book. He cautions against using vacations as a Band-Aid for pleasurable events, however, because many individuals bring their stress with them on vacation or overdo the scheduled activities on vacation.
- Get realistic support from others. Friedberg notes that support can be physical or emotional. Many individuals look to their significant others for this kind of support, but not every spouse is equipped to be a supportive partner. To shed insight on the topic, he includes two brief case studies where one partner left a spouse and one didn’t.
Part III: Physicians, Treatments, and “Cures”
Friedberg discusses the difficulties in finding a doctor who is knowledgeable about CFS and FM who will not treat it with skepticism. Much of this skepticism is rooted in the traditional medical approach that diseases are either related to the mind or body whereas CFS and FM require an integrated approach to better treat the conditions, which is outside the domain of many traditional doctors. Some doctors even believe that diagnosing CFS or FM perpetuates the condition, though Friedberg provides several case studies that rebut such a belief.
Friedberg briefly reviews some medical and alternative treatments for CFS and FM, but since the book is 10 years old, I’m not sure how current some of this information is. For example, he does not mention Lyrica, Savella, or Cymbalta in treating FM, all of which my doctor described as drugs that are specifically used for individuals with FM. Friedberg does encourage people to be skeptical about alternative treatments that lack scientific research; the placebo effect is a real response. For example, one study found that people with FM benefited just as much from acupuncture as from a sham acupuncture procedure (153).
Graded Activity is a cognitive behavioral therapy whose goal is to help individuals with FM and CFS become more active through the slow increase of physical activity. For example, one patient began with a five-minute walk every other day, culminating in a thirty-minute walk every day over a year-long period. The approach has some controversy because activists view it as suggesting that people with FM and CFS do have a psychological illness. Friedberg believes that graded activity can be used alongside pacing to improve quality of life. Graded activity is not a cure, Friedberg cautions, but it can lead to reductions in symptoms and impairments.
In his final chapter, Friedberg confronts the myth of uninterrupted good health by pointing out that a third of Americans have some kind of chronic condition. He encourages you to adopt healthy perspectives on illness outcomes by focusing on realistic expectations (or, as he says, the absence of expectations). Don’t set timelines for improvements or benchmarks for when you’d like to return to which activity. And, as he notes, you can have “healing” without being “cured.”