Baseline and emotional exertion in ME/CFS

When you look for your baseline with ME/CFS, you usually count steps, minutes and breaks. One part of your load appears in none of those numbers: what you feel. Strictly speaking this type of exertion is socio-emotional, because loneliness, being misunderstood and withdrawal belong to it as well. It is the part of your baseline that is hardest to measure, and for many people the part that most often leads into a crash.

What emotional exertion means in ME/CFS

Every emotion affects your energy. Stress, grief, fear, loneliness, anger. And just as much joy, anticipation and excitement. Your nervous system processes both, and both cost strength.

This is not a side note. The German ME/CFS Association explicitly names emotionally demanding situations alongside physical and mental effort as triggers for PEM, and lists “positive or negative emotions”.

For everyday life this means: a conversation that moves you belongs in your calculation just as much as the walk to the front door.

One baseline, three parts

Your baseline is the space in which you can move without a worsening or PEM following. It is made up of three types of exertion:

• Cognitive: everything that demands your brain. Thinking, making decisions, processing stimuli such as light, noise or touch.
• Physical: every form of movement, from sitting and digesting to walking.
• Emotional: every emotion, the pleasant ones as well as the heavy ones.

These three parts are rarely the same size. They differ from person to person, from day to day, and they shift over the course of a day. They are also connected: when one part grows, another can become smaller.

That is why the baseline is not a line but a space that carries fluctuation.

Why emotional exertion cannot be measured

With movement it is about the 1500 steps you take today. With reading it is about the 20 minutes you manage. Both are countable, and both belong to today.

With pain and grief it is different. There it is about all the pain of the past years, about the feeling of being misunderstood or alone, about no longer recognising yourself in the illness, and about bumping into limits again and again.

Physical and cognitive exertion usually counts from today and yesterday. Feelings often carry your whole life. That is why this part can hardly be put into a number.

What triggers emotional exertion

• A sentence that hurts
• An appointment that is still ahead
• Old things coming back up
• A conflict that stays unresolved
• A lovely visit you are looking forward to

One sentence weighs particularly heavily: “it is not that bad, surely”. It is rarely meant unkindly, and sometimes it is even true. That is exactly what makes it so hard. Instead of help, what arrives is an assessment.

Coping strategies: why the old ways no longer carry you

Coping means dealing with something. It covers all the conscious and unconscious strategies a person uses to meet stress, exertion, loss of control, fear or pain. These strategies are not wrong. They once had an important function.

A distinction is made between adaptive strategies, which carry you in the long term and build self-efficacy, and maladaptive ones, which relieve you briefly and lead to suppression, exhaustion or standstill. Three maladaptive ones appear particularly often in ME/CFS:

• Enduring and submitting: “it will not change anything anyway”. You see the illness as unchangeable and stop standing up for your needs.
• Avoiding: you steer clear of certain feelings and thoughts, withdraw or distract yourself in order not to feel.
• Overcompensating: you keep functioning, make plans and appear strong although the ground is giving way inside.

With ME/CFS it is above all avoiding that falls away. Distraction and suppression need energy, and in bed, without reserves, neither is available. What carried you for years suddenly does not work any more.

This is not about avoiding these strategies altogether. They can protect you too. What matters is whether you choose consciously or stay on autopilot.

Feeling instead of avoiding: three steps in the morning

When avoiding no longer works, the other way remains: give your emotions a fixed place instead of pushing them aside. Not without limits, but for a defined period of time. That makes this part plannable too.

The defined period of time is the most important part of it. Especially at the beginning it is about not getting lost in any of the phases.

What this means for your pacing

Emotional exertion belongs in your planning just like the physical kind. Four starting points:

• On days with conversations, appointments or conflicts, plan less physically.
• Count the lovely events too. Visitors, anticipation and a good phone call also cost strength.
• In your symptom diary, note not only activities but also what was going on emotionally.
• After emotionally hard days, expect the same recovery as after physically hard ones.

If you keep landing in a crash despite careful pacing, it is worth looking at this third part. That is often where the gap in the calculation is.

📖 More in my book

In Beyond Survival you will find the three types of exertion explained in detail, along with a chapter on coping strategies and the way from autopilot to conscious choice.