Communication Skills

Two women smiling and talking

  • Why is communication important when you have ME∕CFS?

    For many living with ME/CFS, a big part of your fatigue pie is the ‘social slice’. Many of you will have faced stigma around your diagnosis, or a lack of understanding in the world around you, from medical professionals, or even those closest to you including your friends and family. At the same time, we know that talking about ME/CFS is not easy, and is difficult to explain, even for clinicians.

    This difficulty in communicating about ME/CFS can have a big impact on life. For example, it can affect how easy it is to access help, whether this is medical, financial or other support you need. This can be incredibly frustrating, upsetting, hurtful and stressful. It may have understandably led you to giving up on talking about your experience of ME/CFS an what is happening for you, or not having your needs met.

    It can also affect your relationships with others. For example, if you think “They’ll think I’m a burden”, this might hold you back from seeking help, or trying to explain when you need a rest or you are feeling overwhelmed. You have likely found yourself feeling guilty about cancelling plans or you have decided to ‘push through’ even when you don’t feel well, leaving you feeling exhausted even after you have rested.   

    However, talking about ME/CFS is not easy, especially when you have been faced with unhelpful or hurtful responses in the past. Because of this, it can be essential to find ways to communicate with others more easily and effectively. One skill that can help with this is assertiveness.

  • What is Assertiveness?

    Many of you will have heard people say “You need to be more assertive!” but it can be really difficult to know exactly what this means. Being assertive is a style of communicating that allows us to express our own feelings, thoughts, beliefs and opinions in a way that does not ignore the rights of others.

    You may have heard of other styles of communication, for example aggressive, which might prioritise your rights over those of others, or passive, where your own needs and rights are not met. You may have also heard of ‘passive-aggressive’, where someone is being aggressive in a passive or indirect way.

  • What happens when you are not assertive?

    When you use aggressive, passive, or passive-aggressive communication styles with others, this can affect your life and your relationships in several ways. There are certainly benefits to these communication styles, but they also come at a cost.

    For example, if you communicate in a passive style, you are not giving yourself the opportunity to say what you think or feel, or to have your voice heard. These emotions can also contribute to activation of our threat system and when active you might have given up on asking for help, or are not getting the support you need. Or you may be in ‘drive’, and find yourself always agreeing with others, or feeling like you have to say yes, even if someone is making an unreasonable demand. Whilst you might feel good about helping others, and people might praise you for your behaviour, this comes at a cost. Often you end up feeling you have little control over our life. You may feel stressed, anxious, or even resentful of others and if you try to force yourself to help, or feel unable to ask for help, this can make your ME/CFS symptoms worse.

    On the other hand, if you tend to communicate in an aggressive style, you can stand up for what you believe in, share your opinions and your beliefs, but in a way that violates the rights of others. This means that you might get what you “want” more often, and you can feel powerful in doing so. However, you may also start to lose your relationships with those around you, or no longer enjoy being with those close to you. Being angry and tense can also keep your threat system active, which can contribute to increasing the symptoms of ME/CFS.   Over time, aggressive communication means your interactions with others are often based on negative emotions like anger or hurt, and you might feel guilty and ashamed of your behaviour. This can impact on your ‘social slice’ of your fatigue pie and leave you feeling isolated or lonely.

  • What difference can being assertive make?

    When you are assertive, you are communicating your thoughts, feelings and beliefs in an open, and honest way. It is based on the idea that your needs, wants and feelings are as important as those of others. Whilst being assertive can be difficult at first, and there is no guarantee that it will get you “what you want”, it is a middle ground, which increases your chances of having your needs met. It allows you stand up and express yourself directly when you need to.

    Remember, you don’t always have to be assertive, and it is your choice when it will be most helpful to you.


    • Sarcastic or condescending
    • Talking fast, or abrupt
    • A firm voice or cold, harsh tone
    • Use of threats or put downs "Don't be so stupid!" "You better watch out!"
    • Offensive or hurtful remarks
    • Opinions expressed as facts
    • Getting too close
    • Pointing, fist clenching
    • Crossing your arms
    • Scowling
    • Jaw firm and body tense


    • Long or rambling sentences
    • Hesitant, pausing
    • Frequent throat clearing
    • Apologising often or filling in words "maybe, um, sort of"
    • Soft tone or monotone
    • Apologies "I'm so sorry to bother you"
    • Qualifiers "I might be wrong"
    • Self-dismissal "It's not that important"
    • Averting your gaze
    • Looking down
    • Slouching
    • Wringing hands
    • Crossing arms for protection
    • Lip biting


    • Firm relaxed voice
    • Fluent, few hesitations
    • Steady even pace
    • Middle tone, rich and warm
    • Not too loud or too quiet
    • Using "I" statements "I like, I want, I don't like"
    • Co-operation "What are your thoughts on this?"
    • Expressing opinion "My experience is different."
    • Constructive criticism "I feel upset when you interrupt me."
    • Exploring solutions "How can we get around this?"
    • Receptive listening
    • Direct eye contact
    • Balanced, open body posture
    • Smiling when pleased
    • Frowning when angry
    • Jaw relaxed
  • How can we start to be more assertive?

    When you start, it can be helpful to practise and explore what all three communication styles feel like. You can do this by having a conversation about something ‘benign’ with a friend or someone you are close to. For example, you could have a conversation about your favourite vegetable!

    When you have the conversation, try out being passive, aggressive and assertive and think about how it feels to act that way. You can also ask your friend to change their communication style, and see how it feels for someone to communicate with you in that way.

    You can then start to think about what difference it could make to practise being assertive in the more difficult, or important conversations in your life with friends, family, healthcare professionals or others.

    If you want to read more about different assertiveness skills, such as how to “say no”, or deal with “criticism”, you can find some self-help guides below which talk about different ways of responding in these situations: