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Energy Envelope Theory
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== The principles of the Energy envelope theory == === Accept the limits the illness imposes === The energy envelope theory is based on acceptance of ME/CFS as a severe chronic condition that deeply impacts the lives of persons that suffer from it. The theory advises working within the limits imposed by the illness rather than fighting against it. Jason et al. have acknowledged the similarities of this approach with [[acceptance and commitment therapy]] (ACT).<ref name=":0" /> === Stay within the envelope === The key advice of the envelope theory is to stay within the envelope, meaning the limits ME/CFS imposes. Under the Energy Envelope Theory, treatment programs that recommend a steady increase in daily activity, such as [[Graded exercise therapy]] (GET), are discouraged because the person with ME/CFS may exceed the amount of energy available for that day, thereby initiating post-exertional malaise or an increase in symptoms. By balancing energy expenditure and availability, patients can diminish the number of setbacks and act at a higher level of functioning. Paradoxically, by doing less, ME/CFS patients might be able to do more. === Avoid underexertion === At the same time the envelope theory also warns about the dangers of too little activity. According to Jason et al. “it is important to avoid under-exertion, which might involve increasing activity for some individuals.”<ref name=":3">{{Cite journal | last = Jason | first = Leonard A. | author-link = Leonard Jason | last2 = Roesner | first2 = Nicole | last3 = Porter | first3 = Nicole | authorlink3 = Nicole Porter | last4 = Parenti | first4 = Brittany | last5 = Mortensen | first5 = Jennifer | last6 = Till | first6 = Lindsay | date = 2009 | title = Provision of social support to individuals with chronic fatigue syndrome | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693568/|journal=Journal of Clinical Psychology|language=en|volume=66|issue=3 | pages = n/a–n/a|doi=10.1002/jclp.20648|issn=0021-9762|pmc=|pmid=19902489|via=}}</ref> This constituted the main criticism of [[Activity Pacing Therapy]] (APT), the form of pacing used in the [[PACE trial]]. APT promoted the use of pre-emptive rest and the 70%-rule. Patients were advised to not exceed 70% of their perceived amount of energy. According to Jason, this advice might have unwanted consequences: <blockquote>“By doing less than what patients have the energy to do, and the resulting pre-emptive rest, this intervention could even have the unwitting effects of increasing social isolation.”</blockquote>The energy envelope theory advises patients to do as much as they can without triggering post-exertional malaise and relapses. The phrase ‘staying within the envelope’ does not simply mean ‘don’t do too much’. Instead it refers to “a comfortable range of energy expenditure, in which an individual avoids both over-exertion and under-exertion, maintaining an optimal level of activity over time.”<ref name=":4">{{Cite journal | last = Jason | first = Leonard | last2 = Benton | first2 = Mary | date = Nov 2009 | title = The Impact of Energy Modulation on Physical Functioning and Fatigue Severity among Patients with ME/CFS| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2767446/|journal=Patient education and counseling|volume=77|issue=2 | pages = 237–241|doi=10.1016/j.pec.2009.02.015|issn=0738-3991|pmc=2767446|pmid=19356884}}</ref> === Not a cure === The envelope theory suggests that, if perceived and expended energy levels are kept at the same level, ME/CFS patients will slowly gain strength and energy.<ref name=":5">{{Cite journal | last = Pesek | first = Julia R. | last2 = Jason | first2 = Leonard A. | last3 = Taylor | first3 = Renee R. | date = Jan 2000 | title = An Empirical Investigation of the Envelope Theory| url = https://www.tandfonline.com/doi/abs/10.1300/J137v03n01_04|journal=Journal of Human Behavior in the Social Environment|language=en|volume=3|issue=1 | pages = 59–77|doi=10.1300/j137v03n01_04|issn=1091-1359}}</ref> By staying in the envelope, patients will experience fewer crashes and symptoms of severe fatigue. This might enlarge the envelope and expand the limits ME/CFS imposes on patients. The envelope theory is however no cure or treatment of ME/CFS, but a strategy that helps patients cope with the illness.<ref name=":4" />
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