What I understand by "baseline"

Dr Martina Melzer, published: 07/08/24

In my view, the most important goal of the baseline is to stop being stuck in the "push-crash cycle" all the time and to get a condition deterioration less often, i.e. the "Post Exertional Malaise", or PEM for short. The baseline is therefore about stabilizing the condition.

Most people with ME/CFS or Long Covid are certainly familiar with the word pacing. It is now also the established conventional medical method for minimizing PEM.

Pacing is basically about identifying the things that consume the most energy. Physically, emotionally, mentally and from the environment. And then to dose these things well - with a cycle of pause and activity. Planning, prioritizing and accepting help are often essential too.

You can also approach the topic of baseline from the perspective of a dysregulated nervous system. In my view, the focus here is on recognizing what puts you into survival mode. You could also call it stress mode.

The autonomic nervous system, consisting of the sympathetic and parasympathetic nervous system (vagus), can be in a healthy state and in an unhealthy state. I refer to the latter as survival mode. Whenever you notice that something is triggering stress in your system and putting you in survival mode, you calm down and slow down a little, stop being active, rest, etc. This also stabilizes your condition in the long term.

In my view, the problem with pacing is that it can really help to stabilize the condition. But it's easy to avoid more and more things - for fear that they could cause symptoms again and trigger the next crash. In the long run, this only increases your anxiety, causes a lot of stress and self-blaming, and restricts your life more and more - sometimes more than necessary. And it can keep you where you are. And prevent you from slowly and carefully daring to do more again.

But the same thing can also happen if you pay attention to when you go into survival mode, i.e. which things trigger this. Avoidance strategies can creep in very quickly and you become anxious about anything that could stress you out and cause another PEM.

So my conclusion: with both approaches, it's all about the "how". It is an important first step on your recovery journey to establish a kind of baseline, i.e. to make your condition a little more stable. Then you will have more strength and energy to deal with other things that contribute to your recovery.

Ideally, you combine the pacing and nervous system approach - with the right mental approach. Be aware of what takes up the most energy and quickly puts you under stress. Then dose these things by planning, prioritizing, supporting, a cycle of pause and activity. Also, always calm down when something is stressing you out. And: don't stress too much about it! Don't panic about the next crash! Don't let fear rule! And don't criticize yourself if you do get another PEM. Instead, accept it, take good care of yourself and learn something from it.

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Important: The statements in this text are the result of my research from scientific studies, professional articles, books, courses, education and training as well as my own recovery process. I have done the best possible research, but nevertheless make no claim to accuracy. In science, something is considered a hypothesis until it is clearly proven (or disproven). That is then evidence, a fact. The statements in this text are a combination of hypotheses and facts.

Also, the content on this page is for informational purposes only and is not a substitute for talking to your doctor or other therapist. Please talk to your doctor or therapist before making any decisions about your physical or mental health. Every way into a mind-body syndrome is something individual, and every way out.