The Circle Of Influence As A Tool To Reduce Stress In Chronic Illness
Receiving a chronic health diagnosis is a scary and challenging life event. This is especially impactful when that diagnosis challenges your ability to engage in all the activities you love. Feeling like you have lost control of your life, and the ‘unpredictable nature of a chronic illness’ as described by Gruszczyńska et al (2002) often contributes significantly to an individual’s stress levels and their ability to cope with daily life.
An internal locus of control describes the situation where a person feels they have control over their own actions. People with an internal locus do not feel like they are at the mercy of their circumstances or environment. It has been well documented that individuals with an internal locus of control tend to engage in more health behaviours. They remain in better health physically and mentally, than individuals with an external locus of control (Botha & Dahmann, 2024)
Patients who feel like they are more in control of their own health tend to adhere to medication regimes, have lower levels of stress and can cope better with managing healthy lifestyles despite health conditions (West et al, 2018).
Chronic illness is often outside of our direct control, whether we want it to be or not. Identifying the elements we can control and separating them from the things we can’t control allows us to reduce stress and anxiety around our health and contribute proactively to mental and physical wellbeing.
A few years ago, I was diagnosed with end stage kidney failure. This illness limited my physically abilities significantly. As a triathlete and a performance coach, I struggled to maintain my professional status and balance it with my personal life.
My social life was impacted by fatigue as I couldn’t train or compete. This impacted my mood, my sense of self and my ability to connect with my peers.
Sport is associated with many physical health benefits. It is also strongly associated with mental and emotional wellbeing (Okechukwu, 2021). I knew that in order to optimise my health outside of my illness, I had to take control of my behaviours and not allow myself to be swept up in my diagnosis.
One of the tools that I discovered at a this time was the ‘Circle of Influence’ (Stephen Covey, 2015). I found this tool profoundly helpful as a means of excluding things from my list of worries. It allowed me to identify which issues were within my control and worth spending energy on. It also allowed me to identify which of those concerns were completely outside of my control.
It honestly made me feel an intense ‘lightness’ when I realised that worrying about the things outside of my control was a waste of my energy.
I’m going to share with you how I utilised this tool and how it allowed me to shift my perspective.
The first thing I did was to write down a list of my concerns or worries.
I separated these into things I could control, things I could influence and the things that I had no control over.
Two things at the top of my ‘concern’ list were that I would be judged by my peers and prospective clients for not training and competing. I also worried about fatigue reducing my ability to perform and consequently being excluded from my social network.
In separating my worries into different lists, I realised that I had absolutely no control over what other people thought. I realised that even though I wasn’t training and competing at that time, my identity was still aligned with being a triathlete. I realised that my hiatus from competing didn’t devalue me as a person in any way. The gratitude I felt having had this reflection was huge.
My second worry was the fact that I was excluded from social gatherings. This, in turn, was negatively impacting my mood. Reflecting on my circle of control at this point allowed me to develop acceptance for the fact that I was unable to train or compete. Lindsay et al (2018) highlighted the impact of acceptance on stress and reduced stress reactivity. This acceptance allowed me to look beyond my identity as an athlete and achieve my referees licence.
While I couldn’t control my fatigue and my ability to train, I could still attend events in a different capacity meaning I still got to spend time with my peers in a sport I love.
The uncertainty surrounding a transplant could challenge anyone’s coping skills.
But these things, I have decided, are not ‘happening to me’.
I can’t control the fact that I need dialysis, but I can decide what to do in my free time.
I can’t change that we have a busy household, or that I have two children in exam years. But I can allocate resources to do fun things at the weekends.
The Circle of Concern has allowed me to acknowledge and accept that life is hard right now. There are things happening that worry me and make me feel high levels of stress. But I also understand and accept that worrying and stressing about things I can’t control is a terrible waste of my energy.
Even though I am in the limbo of perpetual waiting for that phone call that says “We have a kidney for you”, I am focussing on all the elements in my life that I have control over.
If I am too tired to train, I can decide to rest and read a nice book.
I can put my energy into learning and growing in a new environment of education.
I can choose to continue to eat healthy food, stay active and spend small pockets of time with friends, even though I can’t go nightclubbing or enjoy a dinner out for fear of overloading on salt.
This tool has been useful to me, not only in this instance of managing my long term illness. It has allowed me to develop the skill of acceptance for things outside of my control in my daily life and it is now an almost automatic response when I experience stress.
Is this something that you would find useful? How would you integrate this tool into your life?
References
Botha, F. & Dahmann, S. (2024)
Locus of control, self-control, and health outcomes.
SSM Population Health Mar; 25:101566
Gruszczyńska, M., Bąk-Sosnowska, M., Daniel-Sielańczyk, A., Wyszomirska, J., & Modrzejewska, A. (2022) The style of coping with stress, the health-related locus of control, and the level of mindfulness of patients with chronic somatic diseases in comparison to healthy people.
Healthcare 10(9), 1752; https://doi.org/10.3390/healthcare10091752
Lindsay, E., Young, S., Smyth, J., Brown, K., Creswell, D. (2018). Acceptance lowers stress reactivity: Dismantling mindfulness training in a randomised control trial. Psychoneuroendocrinology 87, 63-73
Okechekwu,C.E. (2021)
Role of Sports in Social Health Promotion
International Journal of Preventative Medicine; 12:44
West, L.M., Borg Theuma, R., Cordina, M. (2018).
Health locus of control: Its relationship with medication adherence and medication wastage.
Research in Social and Administrative Pharmacy Volume 14, Issue 11, Pages 1015-1019.
Stephen Covey. (1989)
The 7 Habits of Highly Effective People (Infographics Edition, 2015). Mango Publishing Group.
