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The Cycle of change. Friday April 8, 2016

Five years ago, in my early fifties, I went from being a fit and very active healthy woman, to struggling to get through the day doing even the simplest of tasks. I ached all over. It hurt to turn over in bed. I could no longer run up the stairs. I had to rest for a good two hours every day.

So I adapted, as you do; I had no choice... I found out, the hard way, that I could do one, just one thing each day: e.g. a wash-load or a trip to the corner shop, not both. I learnt to pace myself.

Two years in, I was referred to a lovely physiotherapist. He encouraged me to persevere with gentle exercise (my weekly yoga class, a Sunday stroll, a gentle aqua-fit class). And we talked; we talked about my relationship with my condition. He taught me about the Cycle of Change. I stress the following is my interpretation of the different stages:

Denial (This isn't happening to me)
Ambivalence (Maybe there's a problem/no there isn't/yes there is)
Planning for change (What am I going to do about this? Anything?)
Implementation of change
Maintenance of changed behaviour/thought patterns
Lasting change

I confidently assured him that I was at "Maintenance"; I knew I had the condition; I had learnt the hard way not to overdo things; I was maintaining a sensibly paced approach with plenty of rest. My life was so very different from before the diagnosis that obviously I was at "Maintenance" ... or was I?

Gently, he questioned this and eventually helped me to see that I was not at "Maintenance" – oh no! I was right back at "Ambivalence"; I tolerated my condition, I had to, otherwise I was wiped out for several days. But I hadn't accepted it. I was grieving for the woman I had been and I was impatient to return to being her – I was looking backwards.

I found this SO hard to accept. I didn't want to look at myself as I had become. I was impatient to return to my former self. Yet I knew in my heart of hearts that he was right. I also knew that there IS no "going back"; which meant that I HAD to accept myself as I was, which I absolutely did NOT want to do – after all, if I accepted the condition, then IT had won and I would never change...

Now the thing about the Cycle of Change is that you can make progress, then suffer a lapse – and find yourself right back at Denial. This was one of the hardest parts of the whole process for me; recognising I was back at the beginning and having to work through all the stages again, and again...

I now use the Cycle of Change in other situations and it has become an invaluable tool for me. Challenging, definitely, but invaluable. Maybe it can help you too?

A Moodscope member.

Thoughts on the above? Please feel free to post a comment below.

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Margaret Fri, Apr 8th 2016 @ 6:59am

Well done for articulating the continual process that has become a way of life for me too. I find difficulty in not transferring my expectations of myself on to others who appear to accept my condition better than me & yet I assume that they expect more from me. This week I am reaping the harvest of carrying on the week before as if I was my former self - I am not a silly woman and yet I spend a lot of time in the denial stage despite having a condition that has been diagnosed for over ten years. My mantra is it is a condition, I am blessed as I am not sick, learn to manage it! ..... & yet I clearly don't.

Frankie Fri, Apr 8th 2016 @ 9:01am

Hello Margaret; thank-you! Yes, I can relate to this "... others who appear to accept my condition better than me and yet I assume that they expect more from me." For me, a key part was accepting the condition - I learnt to manage it ok on a daily basis, but I hadn't accepted it. This puts our bodies and minds in conflict which I believe hinders the healing process. It can certainly be tough. Learning to enjoy new simple, "do-able" pleasures which I previously never had time for was another key step for me. Good luck! Frankie

Adrian Fri, Apr 8th 2016 @ 7:24am

Very helpful Frankie - applies to so many life situations.
A x

Frankie Fri, Apr 8th 2016 @ 9:02am

Thank-you Adrian; yes, it certainly does! Frankie x

LillyPet Fri, Apr 8th 2016 @ 7:42am

Hi Frankie, it's so useful to look at the stages in the cycle of change. It reminds me of the serenity prayer about accepting the things we cannot change.
Your determination to get better rang so true for me in my belief that I can change a situation that everyone else seems to think I should accept.
It's not surprising after a lifetime of messages about getting more excersise, that you'd naturally feel that you can recover your fitness level.
I see it as you having a positive approach. The medical advice only means that an adjustment needs to be made, but I believe in the power of positive thinking in keeping you fit and healthy all the same. I admire your drive Frankie, thanks for an inspirational blog. Hugs to all, LP xx

Frankie Fri, Apr 8th 2016 @ 9:07am

Thanks LillyPet; yes, the Serenity prayer was and still is very useful for me. I really had to recognise when to accept the things I couldn't change and ensure my determination was determination, and not stubbornness; I also had to set myself realistic goals which seemed so small ... and learn not to fret about the things I could no longer do ... Frankie

Lou Fri, Apr 8th 2016 @ 7:48am


A great blog and good food for thought. I am in a similar place and find myself spending a lot of time in denial - an unhelpful place! Seeing this cycle laid out might help me move to and stay in a more useful stage.

Good luck to us both and thanks!


Frankie Fri, Apr 8th 2016 @ 9:08am

Hello Lou - it is a daily choice; the trick is not to beat yourself up for finding yourself back in denial; I have written a follow-up blog about how I reached Lasting Change which may help. Thank-you! Frankie

Di Fri, Apr 8th 2016 @ 7:48am

I embrace you for writing about your experience. I too experience a similar declination in health & energy at the same age. Struggling with stairs, walking with difficulty, etc. The end result was I lost my job. At the same time I was diagnosed with Anxiety depression . I now know that STRESS was the biggest contributory factor and not ageing. Part of my attempt to recover was to join the gym to boost the chemicals, I also had regular massage to ease the pain in my joints (I was in so much pain I woke at night when I turned over). It is now six years since I went off sick & five years since I lost my job. I am now fitter than I was in my twenties. I am also planning to row the Atlantic. So whilst I empathise massively with those that experience a body change I also want to open the idea that for some it is possible to change again. I had felt a total failure prior to this experience but I now have a big hope of achieving in my daily mantra.

Di Fri, Apr 8th 2016 @ 7:48am

I embrace you for writing about your experience. I too experience a similar declination in health & energy at the same age. Struggling with stairs, walking with difficulty, etc. The end result was I lost my job. At the same time I was diagnosed with Anxiety depression . I now know that STRESS was the biggest contributory factor and not ageing. Part of my attempt to recover was to join the gym to boost the chemicals, I also had regular massage to ease the pain in my joints (I was in so much pain I woke at night when I turned over). It is now six years since I went off sick & five years since I lost my job. I am now fitter than I was in my twenties. I am also planning to row the Atlantic. So whilst I empathise massively with those that experience a body change I also want to open the idea that for some it is possible to change again. I had felt a total failure prior to this experience but I now have a big hope of achieving in my daily mantra.

Frankie Fri, Apr 8th 2016 @ 9:11am

Thank-you Di for sharing. And WOW! - row the Atlantic! Rather you than me ... although I do have a dream to walk the Compestela di Santiago Way one day ... Yes, daily affirmations were key for me too. Frankie

Lesley Fri, Apr 15th 2016 @ 5:30pm

Love your ambition, Di. STRESS has impacted greatly on my health since my teens ( I am now 53). I only read the work of a Dr Sarno a few years ago and realised it was all so applicable to me. I am studying now to be a Naturopathic Nutritionist and from my studies STRESS is the number one cause of ill health. Having peace and fun is the antidote.

Hopeful One Fri, Apr 8th 2016 @ 8:25am

Hi Frankie- Thanks for high lighting the 'cycle for change' process. I am training to work with alcoholics and drug addicts to try and get then off their destructive behaviour patterns and the cycle of change concept is applied there as well. In fact it was originally developed in 1986 by two American psychologists called James Prochaska and Carlo Di Clemente to get people to stop smoking. As you discovered it works just as well in other situations. I have found that the most difficult stage for many is to ACCEPT their situation/ dysfunction despite as you say'I found this SO hard to accept@ . This step opens up whole possibilities of change.It should not be seen as the situation 'winning' in anyway but more that you are positioning yourself to deal with it.

Today's laugh.

A man went to Harley Street having seen an advert for a Gynaecologist's Assistant.Knowing that nowadays, job advertisers aren't able to discriminate against the applicant's gender, he was very interested.So he went in and asked the secretary for details.
She retrieved the file and read to him: "This job entails preparing lady patients for examination.You will be responsible for helping them out of their underwear, laying them down on the couch ,putting drapes on and positioning them close to the stirrups.
Then she told him “The annual salary is £20,000 and if you're interested, you'll have to go to Aberdeen "."My goodness!", he exclaimed "Is that where the job is?". She answered, "No , that's where the end of the queue is..."

Thanks everyone for your comments on my post yesterday.

Frankie Fri, Apr 8th 2016 @ 9:16am

Morning Hopeful One: thank-you. Yes, it took me a long time to change my perception that the condition was winning and I kept falling back into "battle" mode, (too easily done, given my competitive nature!) which is never helpful. And thank-you for the on-going laughs which always go down well here! Frankie

Oli Fri, Apr 8th 2016 @ 9:15am

Useful post. And that was a good physio.

Frankie Fri, Apr 8th 2016 @ 9:18am

Oh Oli, he is SO lovely! It has been a fascinating journey of discovery. He is very good at listening and hearing what I am saying - rather like Les was referring to in yesterday's blog. Glad the post is useful for you - thank-you. Frankie

Leah Fri, Apr 8th 2016 @ 9:38am

Your blogs always make me think. Taking advice from Le's b;log yesterday, I will pause take a deep breath and read others comments. It has given me lot to ponder. Thanks

Frankie Fri, Apr 8th 2016 @ 9:57am

Morning Leah - thank-you; hope it helps! Frankie

Susan Fri, Apr 8th 2016 @ 9:50am

Hi Frankie. I read your post with interest.

Two years ago, in order to keep hold of my community teaching job, I began a part time PGCE. The perimenopause hit at the same time (my own diagnosis). These two additions to my life quickly began to floor me. I changed overnight. By the October I had joined Moodscope.

I will be 50 next year and already have similar symptoms to the ones you describe. I am waiting until my course finishes at the end of May, to see if I feel the pressure lift and the symptoms ease. My fear is that little will change and that I will have to live with acceptance - and take a serious look at how to manage things.

I know before I morphed into being constantly tired, flat and slow, (well over a year ago) I was feeling overwhelmed, reacting with rage and anxiety. I still over react and the slightest problem brings me to my knees. I am avoiding going to the doctor because I don't want meds.

I am trying to weather it and keep thinking that I can start swimming or join a gym. I seem to be my own worst enemy and owing to tiredness during the week, my weekends are used up to plan lessons and catch up on coursework. I spent the Easter hols getting up to speed with the PGCE, which has cleared some space in my head, but have just been told an Ofsted is imminent both in my workplace and at uni. I am not panicking yet, and my attitude is, it will have to be 'good enough' - just like my current housework attempts and culinary efforts - I will do the best I can but not kill myself trying.

I find meeting with my good friend (also perimenopausal and a teacher) every Friday for a stroll and a moan, allows me to rise above the water and gulp some air. We manage to laugh a lot too before returning wearily, but temporarily revived, to our separate lives.

I will re-read your post and the inspiring comments from the others again tonight and form a plan of action.

Thank you. Now I need to get dressed and find my walking boots.


Frankie Fri, Apr 8th 2016 @ 10:17am

Morning Susan; wow - I salute your determination with the PGCE; I teach in a comprehensive school part-time so can relate to an imminent Ofsted (we expect ours next term ...) Being "good enough" is a really good starting point. Also, it helps avoid falling into the trap of over-thinking ... And your weekly walk is a "MUST" !!! Re; weekends - I have always tried to have one complete day off at the weekend; unfortunately, the recent increase in data monitoring has prevented me from doing that - and I am part-time! How full-timers manage ... well, increasingly at the expense of their own health, well-being and family/social life, I fear, which is not good for anyone, least of all the students. RE: seeing the doctor; in my experience if you chose your doctor carefully, a simple chat can be useful. Also, I wonder whether you need to explore your feelings of rage, anxiety and feeling overwhelmed? Probably not before finishing your course ... I found annotating my Moodscope graph a huge help in distancing myself from such feelings and in recognising them for what they were - expressions of fatigue,aching and stress primarily. I also tried to note down what had gone well that day, to highlight the positive amidst the negative. Seeing my friend regularly to "sound off" is key for me too. And when I was really low, writing about it helped me to "let it go". Tiny steps can have a big impact; above all, celebrating those tiny steps ... RE: joining a gym or swimming - do you actually enjoy those? Or do you feel you "ought" to do them? Walking more often could be enough if you enjoy it more than the others ... If you would like to have an email dialogue, feel free to email Caroline ( for her to forward to me. Good luck with it all! Frankie

Susan Fri, Apr 8th 2016 @ 4:27pm

Hello Frankie I am back from my walk around, ironically enough, Eyam, Derbyshire otherwise known as 'the plague village.' The village was quarantined and food left at the boundary to prevent the plague spreading to the north. Your thoughtful and concerned response (thank you!) has helped me think more clearly about how I can implement change. Your suspicions are right, I don't enjoy the gym and will not commit to swimming for long. I'll stick with walking and escaping the city for countryside hits. This will help stop my own 'black death' from spreading northwards! In the hols, I discovered that a local animal sanctuary needs people to walk the dogs housed there. I wonder if any Moodscopers might fancy investigating the possibility in their area. It made me feel vital and got me out in the fresh air. I've done this twice, first with an adorable puppy and the last time with a crotchety Jack Russell who wore a muzzle. The latter and I definitely had something in common! I took her muzzle off as soon as we broke free from livestock and her bad mood improved, not entirely, but she was all bark and no bite. When I finish the PGCE, I'll go to a safe place and remove my muzzle too :) I realise that this is my second lengthy post of the day - it must have been a long time coming. Hurrah for Moodscope and Moodscopers - and thank you Frankie for your extended offer of support. I will keep it in mind. Best wishes everyone S xxx

Frankie Fri, Apr 8th 2016 @ 5:30pm

What a brilliant idea - thank-you! And how lovely that you have a form of exercise which you enjoy with the added bonus of animal friends. Frankie

Zareen Fri, Apr 8th 2016 @ 10:28am

This is brilliant Frankie. I found it very helpful & thought-provoking. Thanks for sharing this with us.
Best wishes

Frankie Fri, Apr 8th 2016 @ 5:30pm

You are most welcome Zareen; good luck to you. Frankie

Sheena Fri, Apr 8th 2016 @ 11:25am

Hi Frankie This is so challenging and is real food for thought. I noticed the first 'wall' I ran into when I was still a young teenager. Going from competent all round to being treated as 'damaged'/'different'/'inadequate' was a challenge. However, with the benefit of many decades of hindsight I think that every experience is an opportunity to learn. I'll never know what my life would have been but I know what it is - and I like it! Fast track, fast lane, pressurised living can be soul destroying. Acceptance of now doesn't preclude good things ahead. Every best wish Sheena

Frankie Fri, Apr 8th 2016 @ 5:32pm

This is brilliant Sheena: "Every experience is an opportunity to learn." Thank-you. Frankie

Skyblue Fri, Apr 8th 2016 @ 11:42am

Hi Frankie, I'm with you on all this. My battle has gone on for 9 years now and I've reached the 'lasting change' phase several times! Then after a while I've fallen back into the 'denial' and 'ambivalence' phase which really scares me and causes depression. However, I've learned to take that as a cue to search further for more help and guidance...and it has always come. So each 'lasting change' phase is on a higher level. The search for wholeness goes on, and that definitely involves acceptance. But I find that with each 'lasting change' phase, acceptance is also greater. I believe our bodies are always trying to heal and we can't presume to know what they're ultimately capable of. Thanks for this. xx

Frankie Fri, Apr 8th 2016 @ 5:45pm

Hello Skyblue: this is really useful "I've learned to take that as a cue to search further for more help and guidance ... and it has always come" - thank-you! I agree, our bodies are always trying to heal and when I trust my inner self I find it easier to reach "lasting change". Good luck! Frankie

Niamh Fri, Apr 8th 2016 @ 12:16pm

This was just what I needed dropping into my inbox, to read and ponder this morning Frankie. A heartfelt thank you xx

Frankie Fri, Apr 8th 2016 @ 5:33pm

You are most welcome Niamh. Good luck! Frankie

The Gardener Fri, Apr 8th 2016 @ 5:15pm

The plague village. I have the history of our church, from 1150, in two rooms of our house. Lepers were given extreme unction and driven out of town. their families had to get food to them. Many farms in France have fields labelled 'leproserie' or 'maladrerie'. When the protestants were driven out of here and to a village 'in the next diocese they had their own burial field, still called 'cimitiere

Susan Fri, Apr 8th 2016 @ 9:33pm

That's both sad and interesting. What an isolating time that must have been. You sound a little isolated too. I'm sorry you dread the evenings at the moment. I hope as the evenings become lighter, you feel more uplifted.

The Gardener Fri, Apr 8th 2016 @ 5:19pm

For once I cannot 'relate' to the blog. I can change nothing - try to accept and get what joy I can out of friends, communication and gardening. What I would like to change is my current temperament - I now dread evenings - the boredom is getting to me, and the obsession with hot/cold. During what passes for dinner Mr G will remove/put on his sweater AND fleece several time - instead of ignoring the whole pantomime I find myself counting the changes and grumbling - I can do NOTHING, and only upset myself

Frankie Fri, Apr 8th 2016 @ 5:42pm

Evening dear Gardener: your circumstances are tough and yes, acceptance must seem impossible - and yet you say "try to accept and get what joy I can out of friends, communication and gardening". It sounds as if you are doing the best you can with a horrible situation - once again I salute you. As I watch my frail mother deteriorate and diminish, I too struggle with accepting her inevitable decline ... For me, it is a question of saying good-bye to my mother, and caring tenderly for the woman she has become ... yes, it is really tough for me, so I can only begin to imagine how much tougher it is for you ... I will light a candle for you and Mr. G. this evening. Frankie

Carol Fri, Apr 8th 2016 @ 6:01pm

Thank you frankie, can relate to this condition too, although i dont yet know what label mine has and im too scared to find out tbh. im still coming to terms with long term mental health and physical health challenges, loss of career, identity, income, friends, etc...i thank you for your wisdom, resilience and courage in sharing so eloquently and generously, bless you x

Frankie Fri, Apr 8th 2016 @ 10:38pm

Evening Carol; thank-you for your kind words. Having been through low-grade breast cancer just prior to receiving this diagnosis, I can well relate to your feelings of fear about finding out ... However, in my experience, strength always comes with the knowledge - and blessings - often in the form of the lovely people whom I meet and have met. It sounds to me as if you have been through so much already that your body needs plenty of time to recover ... maybe being able to name your condition will be the starting point of recovery ... and these days the internet can offer so much information and advice about all these conditions. I hope you find the strength to find out what it is ... Wishing you peace of mind and heart, Carol. Frankie

Mary Fri, Apr 8th 2016 @ 8:21pm

Hello Frankie. I am still in denial because I hate getting old. I HATE it. I am having a middle-aged crisis and bitterly resent being asked if I have "grandchildren". "My oldest is only 14!" I want to yell at them. "Do I look old enough to have grandchildren?" But yes - a number of my friends do have grandchildren. I cannot tell you how bitterly I resent this aging process. And - I never thought I would. I loved turning 50 and finally becoming grown up. But I don't want to be a grandmotherly type. Maybe I should start running around with younger men - because I can now totally see why older men start running around with younger women!

Frankie Fri, Apr 8th 2016 @ 10:50pm

Hello Mary - yes, I hated my condition and the person I became as a result, resentful, bitter, frustrated ... I found that my negative feelings were not helping at all and I eventually realised that I didn't want to be bitter, so I had to take action to deal with the denial. It wasn't easy, but it has certainly been worth it. Wishing you peace of mind and heart. Frankie

The Gardener Fri, Apr 8th 2016 @ 10:00pm

Hey Mary, c'mon, this won't do. At 40 I had my first article published, at 50 I went to university - at 60 I was in France as a fully-fledged historian - at 70 I was dancing in Paris fountains and being kissed by loads of young men - at 80, life got seriously difficult, but it was great in between - buy a new dress which is far too young for you, and then act up to it. Just watched the Charlie Chaplin semi-biography - tears of a clown, indeed. Good luck, god bless.

Anonymous Fri, Apr 8th 2016 @ 10:30pm

Hello Frankie. Is your condition physical? Which makes you depressed because you are no longer the fit person you used to be? My problem is that I cannot accept I am clinically depressed. No medic has actually told me I am depressed. The diagnosis has always been mine. Depression brought about by insomnia. I wish there was a medical way of diagnosing depression like there is a physical condition. A Dr did once say to me that the spectrum of depression is very long and that in his view I was at one end ie the least depressed (if you see the spectrum as a line)
I wish I really knew my condition as I am in denial about it and keep hoping that one day I will feel different. Jul x x

Frankie Fri, Apr 8th 2016 @ 10:46pm

Hello Jul; yes my current condition is physical, but I have suffered from depression in the past too. I think there are questionnaires on-line which you can answer to assess (in broad terms only) whether or not you are depressed. I can well recognise the feelings of hoping to feel differently one day ... but when we do this, I think it means that we are living in the future and not seeing today's blessings - however small they are. There is a second part to this blog which focuses on the strategies which helped me. Maybe they will help you too ... Frankie xx

Hopeful One Fri, Apr 8th 2016 @ 11:02pm

Hi Anonynous- if you are thinking of physical tests like blood tests or brain scans then no there are no tests for depression. As depression is a mood disorder it can really only be diagnosed by asking the patient how they feel and what physical symptoms they have for example sleep patterns or loss of appetite, drive , motivation etc . The test that I am familiar with is called the Burn's questionnaire. I can give you the details if you are interested. It is pretty accurate. The Moodscope test is also helpful - any score in the blue zone requires investigation..

Anonymous Sat, Apr 9th 2016 @ 4:34pm

I have filled in a questionnaire at my Drs surgery HopefulOne which I answered in a fairly exaggerated way in order to get some anti depressants. The antidepressants worked for 6 months and I felt great so maybe they were what was needed. Eventually however they stopped which told me that my body and brain had driven through the medication and my true self had emerged again.. I did feel let down and sad afterwards and tried them again sometime later and they didn't work work. I wasn't expecting them too so it must have been a case of mind over matter. I've not tried them since. The ones I tried were Citalopram. For me they worked by taking the edge off my anxiety about not sleeping so i didn't care if I slept or not. Anyway Frankie, I look forward to your next blog on this subject. Julxx PS Hopeful..would you send Caroline the Burns Questionnaire for her to send on to me please?. When you have time. Am very grateful.

Hopeful One Sun, Apr 10th 2016 @ 5:21pm

Hi Anonymous- message received. I will give you the details of where you can find the questionnaire rather than involving Caroline who probably has a lot on her plate running Moodscope don't you think? The questionnaire is on page 20 -21 entitled "Burns Depression Checklist" of Dr David . D . Burns book "Feeling good" Answer the questions as honestly as you can. The way to analyse your score is also given in the following pages My preliminary view is that you stopped the anti depressants too soon which is well known as the suffer starts feeling better and erroneously assumes they can stop the medication when in reality they should carry on for at leadt a year after the scores have improved and stabilised.

Amanda Sat, Apr 9th 2016 @ 4:49pm

Gosh Frankie, that's a tough read but certainly hit home for me too. Spookily similar story here.
Hugely helpful to see this cycle written down.
Thank you.
Frustratingly Denial / Ambivalence Woman. (We'll get there!)

Frankie Sat, Apr 9th 2016 @ 7:36pm

Hello Amanda: I am glad it helps - yes, it is really challenging! And yes, you WILL get there! Good luck with it all ... Frankie

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