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How to ask for the unwanted: A guide to activity pacing and assertiveness in condition self-management

Liz Ruth

12 Oct 2023


Pacing is a widely-used tool in Long Term Condition (LTC) self-management, particularly when patients experience symptoms of chronic and disabling pain and fatigue (Murillo et al., 2022; Abonie et al., 2020), which can be delivered by Wellbeing Practitioners as a stand alone intervention or to enable safe engagement with a core CBT- based Low Intensity treatment intervention. Pacing is not a standardised intervention - although efforts are being made to bring standardisation into practice (Antcliff et al., 2021) - and can involve supporting patients to change the amount and type of activity that they undertake, or to make changes to the duration and frequency of different activities. There are many potential barriers to effective pacing for condition and symptom management.  

Putting pacing into practice will often create challenges for patients as they have to manage the impact of changes in their activity on not just their self-perception but on the social aspect of their lives (Engel, 1977). An understanding of the role of assertive communication skills is not required by the core PWP training curriculum but, like relaxation skills and pacing, these can be an appropriate supplement to the core Low Intensity interventions. Assertive communication involves being able to clearly express wants and needs and stand up for yourself, without impinging on the rights of others to do the same. Skills for assertive communication have previously been of fundamental interest to psychologists and psychotherapists (Speed et al., 2018) and can be a useful tool to offer to patients who may face social opportunity barriers (Michie et al., 2011) to implementing helpful behaviour change. 

The event will be equivalent to 2.3/4hrs of CPD.


This workshop will include:
• A brief overview and discussion of approaches to pacing for self-management in LTC/PPS and how pacing fits with core Low Intensity psychological interventions
• Consideration of the social challenges to implementation of pacing
• An overview of key psychoeducation on assertiveness skills
• Consideration of how assertiveness skills might fit within a course of treatment

Learning Objectives

You will learn:
1. What pacing is
2. What the role of pacing might be within Low Intensity psychological interventions
3. How and awareness of the Biopsychosocial model can inform your COM-B assessment and help to identify barriers to behaviour change
4. Core information and skills to support patients to practice assertive communication

Training Modalities

Didactic content, Q&A, live role play, polls

Key References

Abonie, U.S., Sandercock, G. Heesterbeek, M. & Hettinga, F. 2020. Effects of activity pacing in patients with chronic conditions associated with fatigue complaints: a meta-analysis. Disability and Rehabilitation, 42:5, 613-622, DOI: 10.1080/09638288.2018.1504994

Antcliff D, Keenan A, Keeley P, et al. Testing a newly developed activity pacing framework for chronic pain/fatigue: a feasibility study. BMJ Open 2021;11:e045398. doi: 10.1136/bmjopen-2020-045398

Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977 Apr 8;196(4286):129-36. doi: 10.1126/science.847460. PMID: 847460.

Geraghty, K., Scott, M.J. Treating medically unexplained symptoms via improving access to psychological therapy (IAPT): major limitations identified. 2020. BMC Psychol 8, 13.

Kellett S, Webb K, Wilkinson N, Bliss P, Ayers T, Hardy G. Developing services for patients with depression or anxiety in the context of long-term physical health conditions and medically unexplained symptoms: evaluation of an IAPT pathfinder site. Behav Cogn Psychother. 2016;44(5):553–67.

Michie, S., van Stralen, M.M. & West, R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Sci 6, 42 (2011).

Murillo, C., Vo, T-T., Vansteelandt, S., Harrison, L.E., Cagnie, B., Coppieters, I., Chys, M., Timmers, I., Meeus, M. 2022. How do psychologically based interventions for chronic musculoskeletal pain work? A systematic review and meta-analysis of specific moderators and mediators of treatment.
Clinical Psychology Review. Volume 94.

Speed, B. C., Goldstein, B. L., & Goldfried, M. R. (2018). Assertiveness training: A forgotten evidence‐based treatment. Clinical Psychology: Science and Practice, 25(1), Article e12216.

About the presenter

Liz Ruth is an Assistant Professor and Psychological Wellbeing Practitioner course leader at the University of Bradford. She trained as a Low Intensity Psychological Practitioner at the University of Sheffield in 2010 and practiced as a PWP, Senior and Lead PWP in IAPT for more than a decade before transitioning into education. Liz is an elected member of the Board of Trustees in the BABCP, the author of and co-author of A Pragmatic Guide to Low Intensity Psychological Interventions: Care in High Volume (2023).

Who should attend

This event is suitable for anyone with an interest in the role of pacing and assertive communication skills within Low Intensity psychological interventions. There will be a focus on delivery of interventions to adults in Primary Care settings but the learning may be applicable to other patient groups and settings.

Low Intensity clinical contact hours survey - BABCP Low Intensity Special Interest Group

Please click below if you are interested in contributing to the survey.


The BACP Low Intensity SIG are interested in the impact of clinical contact hours on Low Intensity/Wellbeing Practitioner wellbeing. This questionnaire contains six multi-choice questions and a free text box for you to share your experiences. The answers to these questions will help the BABCP SIG plan how to meet CPD topics and other developments within the SIG.  The SIG hope to produce a write up of the answers to this questionnaire to be shared with SIG members and to be used in training.

View Survey

This FREE conference is for Psychological Wellbeing Practitioners working in Talking Therapies for Anxiety and Depression services and is brought to you by Bespoke Mental Health in collaboration with the NHS England Talking Therapies National PWP Leads Network

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