Brain Fog Makes Pacing Hard. Fighting Executive Dysfunction
Executive Dysfunction
One of the main symptoms of brain fog is executive dysfunction. The executive functioning of your brain is responsible for:
-Working memory
-Task switching
-Task initiation
-Planning/prioritization
-Self-monitoring (time awareness)
-Inhibitory control
So executive dysfunction makes causes difficulty with all of these cognitive functions.
-----
Pacing = Self Control
Executive dysfunction is often considered simply a lack of self-control. While this can lead to sigma against neurodivergent people as "lazy" which is quite false, it is true that the cognitive functions disrupted by executive dysfunction make it much harder to self-motivate and to control our impulses.
Unfortunately, pacing is for most people with MECFS the greatest act of self-control we will ever attempt. Yet we must do so at a time when our cognitive abilities to self-incentivize have been completely shattered by the executive dysfunction of brain fog.
What is even worse is that it is a feedback loop. If you fail to pace you will quickly get worsened brain fog due to PEM which in turn makes pacing even harder. Thus knowing how to get yourself out of an executive functioning crisis due to PEM is essential.
This post will focus on key problems for pacing caused by executive dysfunction as well as ways strategies for addressing and solving these problems.
-----
Mental & Physical Pacing
Pacing is not just a physical activity. In fact, one of the hardest parts of pacing is not physically adapting your tasks but mentally choosing over and over to stay within your limits.
As patients become more severe, their physical activities often become completely limited to the necessities. Making mental pacing the primary form of self-control required.
While other posts on this page can help guide you in physical pacing specifically, this post will focus on the mental challenge of pacing. The universal struggle that executive dysfunction poses to our self-control regardless of what type of pacing is required by our level of severity.
-----
Problem: Losing Track of Time
Executive dysfunction causes something called time blindness. This means you are bad at estimating how long something will take or how long you have been working on something.
Solution: Enforced Rest & Timers
To counteract time blindness, you need to provide interruptions that will allow you to note how long you have been working and whether you need to rest. This can be done using things like heart rate pacing* which will alert you to physical exhaustion or using timers, either physical or on your phone and taking a brief break to rest, restock and meditate at given times throughout the day.
*see my past post on hr pacing for more!
-----
Problem: Boredom & Dopamine Chasing
Boredom is a truly underestimated foe. This is especially true because brain fog often comes with low dopamine in the brain. This means we are constantly seeking that positive chemical feedback that activities and engagement bring. But how can we reconcile that need for dopamine with our need for rest?
Solution: Positive Reinforcement
One helpful solution is positive reinforcement. Using a meditation app like Breathe, a game like Oasis, or a timer like Forest you can receive positive reinforcement in the form of advancement in the game (or gamified app) when you rest. Likewise, the Stay Focused app will tell you when you have decreased your screen time, or reward you for using meditation apps with time for games or social media.
For those with severe ME it can be helpful to focus on the positive of how much meditation or active rest you have accomplished each day, instead of the negative of how much you exerted. This reframing can help both motivation and mental health more generally.
----
Problem: Needed Tasks + Prioritization
Despite our need to pace, we also have many needed tasks we must do each day as well as priorities in our life. Because executive dysfunction affects our ability to prioritize and initialize tasks you can often find these needed tasks being pushed to the end of the day by procrastination when you least have the energy to deal with them.
Solution: To-do Lists & ADHD toolkit
The most basic initial solution to this problem is a to-do list. I use the app HabitNow to prioritize tasks for my next day at the end of the last. But the reality is that a to-do list simply is not enough to overcome the massive hurdles of executive dysfunction.
Because people with ADHD struggle with executive functioning as well, I have found that advice and life hacks by ADHD creators are often extremely helpful for dealing with brain fog. These accounts have hundreds of tips for how to trick your brain into focusing on needed tasks.
@howtoadhd is a great account to start with!
-----
Problem: Adrenaline Surges
While not directly related to executive dysfunction, adrenaline surges can be a massive hurdle to pacing. This is because adrenaline further increases brain fog and executive dysfunction. This makes it harder to resist dopamine chasing. When combined with increased subjective energy it can be a dangerous combination.
Solution: Aggressive Resting & Medication
The key to managing adrenaline surges is first recognizing them. Key indicators include:
-Sudden burst of energy
-Insomnia
-Feeling wired but tired
-Anxiety
-Hot or cold flashes
-Increased heart rate
-High energy and low HRV
If you are in an adrenaline surge you need to force yourself to rest or else you will trigger more adrenaline. This can be done with forced rest, timers, positive reinforcement and so on. However, it may also be necessary to take a sleeping medication or anti-anxiety supplement like GABA to break the cycle.
-----
The Importance of Self-Compassion
It is essential to remember that just how your fatigue, brain fog, post-exertional malaise and need to pace are not your fault but simply the consequences of your illness, so is your executive dysfunction.
Executive dysfunction is not an excuse for failing to pace, it is a valid reason why pacing is extraordinarily difficult. This doesn't mean you shouldn't try, but it does mean you need to have self-compassion for failure.
Try to hold onto a growth mindset. Do not see a failure to pace as a personal failing but rather a failing of your current setup and circumstances. Try to identify what exactly caused the failure and strengthen your supports around that weak point.
The goal is not to be a perfect person. None of us are. The goal is to create a sustainable system of incentives, reminders, and personal objectives that helps you live the best life possible with your illness.
-----
Recommended Applications for Phone Control During Rest
The following are applications I use to help prevent me from overexerting mentally on my phone. These apps may be helpful to very severe patients whose pacing is primarily about mental stimulation, or for less severe patients who want to increase the amount of time they spend on complete rest or meditation.
Built-In:
Digital Wellbeing
Clock
Free:
Breathe
MyOasis
Reminder
Notification Notes
DreamHopper
Pay To Fully Unlock (free to ty and use indefinitely with restrictions or ads)
Minimalist Phone $35
Stay Focused $15
Sleep By Android $10
HabitNow $8.50
Monthly Subscription:
Calm $10.49
Streaming Services $Variable
---
Pacing is the only evidence-based "treatment" for Myalgic Encephalomyelitis. It is also the hardest thing any person with MECFS will likely do in their life.
Pacing is rationing our lives. To Stop Rest Pace we give up everything for a chance to save any little bit of our health. It is necessary to save our lives, to prevent the Post Exertional Malaise and Post Exertional Neuroimmune Exhaustion that serve as our bodies survival reflexes to force us into rest if we try to defy pacing.
But PEM and PENE also exacerbate the severe brain fog Cognitive Dysfunction neuro fatigue and executive Dysfunction caused by ME / CFS.
In turn, executive dysfunction makes the immense self-control necessary for pacing even more difficult. As with many parts of severe ME, the more severe your chronic Illness becomes the more difficult it becomes to stop its progression.
This post aims to provide some practical tips for pacing with executive dysfunction. While heart Rate Pacing and guides for physical pacing are common, mental Fatigue and mental Crashes are much less discussed. Yet for severe and very Severe ME patients, even too much thinking can cause severe symptoms.
While most ADHD and neurodiversity accounts which offer advice on executive dysfunction are focused on productivity, the same advice can easily be applied to rest. Simply look at resting as the "work" that you are trying to motivate yourself to do. @howtoadhd has some great tips to start with and I welcome suggestions of other accounts in the comments!
Remember, it is not your fault for failing to pace because of executive dysfunction. Do not blame yourself for being addicted to life. All we can do is our best.
