Mental health is something we all have, good or bad. It is often separated from physical health, as if the brain is floating in some cloud-like invisible storage centre. The overlap between physical illness and mental illness is clear. If depression makes getting out of bed seem too much, feeling well enough to exercise is not easy.

When my mental illness flares up, simple tasks seem as hard as flying to the moon in a paper aeroplane. This makes the feelings of failure (a common symptom of depression) worsen. When you cannot do the things others can, it can feel like confirmation of these thoughts. Feelings like this can compound with other symptoms of depression. A lack of motivation, negative thoughts and low energy levels can make doing everyday tasks complicated and distressing.

Over the past few years, through therapy and medication, I have developed ways to manage these symptoms. Despite this, I still held the belief that I should be able to cope with tasks the way society tells us we should.

The discovery of pacing has been a revelation.

Who knew that I could do the things I need to do, but in a way that suits me?

Pacing is best understood as a way of breaking down tasks to make it easier for you to do them. It’s advised to lots of people with different chronic conditions, such as; chronic pain, hypermobility conditions and Long-Covid. Pacing is a bit of a buzz word for medical professionals, and often isn’t explained beyond this. Jo explains some of the tools that can be used to help you pace in her pacing masterclass. Over this placement I have tried to use these tools to aid my learning and improve my mental health.

Microbreaks

One tool of pacing that has helped me on this placement is taking microbreaks. Every 20ish minutes, I have been taking a 30 second break. I adjust my posture, close my eyes and take some deep breaths. Think of it as checking in with your body:

• Are you tensing your muscles?
• Are you holding your breath?
• Are you biting your lips or insides of your cheeks?

This can help you to catch yourself before the tension of your body causes discomfort. Or the breath holding creates a flight/fight/freeze response. Using the logical part of your brain (the cerebrum) you can calm the emotional part of your brain (the limbic system), before the emotional part takes over and triggers a fear reaction.

A fear reaction is your body’s way of protecting you from a perceived threat. It is a reaction to internal and external factors that prepare you to fight, flee or freeze. Historically, this protected you from danger. Your heart races and your thoughts cloud. You become unable to think clearly.

This was very helpful to humans when the threats we were facing regularly were predators and natural disasters. Now, when it happens because of a missed email or approaching deadline it’s extremely unhelpful! The body is very quick at creating this feeling. It can be hard to override it once it has started.

Microbreaks are a way to pre-empt this, ensuring you aren’t sending or receiving signals that may trigger the reaction. Deep breathing, stretching and muscle relaxation can all help to reassure your emotional brain that you aren’t in danger. Noticing your needs is also a lot easier when you can think clearly.

Using Microbreaks to disrupt negative thoughts

Microbreaks can also be used to check in with your thoughts:

• Am I thinking about something that happened a long time ago?
• Am I predicting what will happen in the future?
• Am I being negative about myself?

If your thoughts are negative, you can take a longer break to start to challenge these thought patterns. Unhelpful thought patterns are also known as cognitive distortions. These are different ways your thoughts filter information that lead you to false beliefs about yourself and others. In your break, you could try to introduce affirmations or questions that challenge the cognitive distortions:

• What if I do well?
• What would I say to a friend about this?
• Will this matter in a year?

Sometimes it is helpful to write these questions and answers down. As with stopping the physical reactions, taking time to challenge these thoughts can begin to limit their impact on you.

Activity Alternating

Alternating activities can also help with reducing the difficulties concentrating (brain fog) that often come with mental health difficulties.

I try to manage this through swapping between three different tasks. Today, as well as writing this (a cognitive task), I am washing up (a physical task) and I am partway through watching Derry Girls (a restorative task). In a moment I’ll take a break from writing, wash another plate or so, then watch more of the show.

By the time I circle back to writing this, I’ll have changed positions and given my brain a break from the cognitive task. This switching helps me feel less like I’m wading through a fast-flowing river and more like using stepping stones to cross to the other side.

For those with anxiety and low self-esteem, the idea of starting a task can sometimes cause intense worry and a desire to avoid it altogether. Activity alternating can help make the task less daunting, as you have two activities you feel more confident doing, alongside the hard one. Tricky tasks become less all-consuming. You can start by doing one minute or one step of the harder task, and then swap away from it. By breaking tasks down into small steps, they become more manageable.

Using pacing as a tool for management of my mental health needs in placement, I have felt more validated in working to my own pace. When you are experiencing poor mental health, being kind to yourself can be hard, and pacing is a good way to be easier on yourself whilst achieving what you want to do.

I’d love to hear your experiences of using pacing to help your health, feel free to contact me if you would like to share your story with me:

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About me:

I am a first year Occupational Therapy MSc student studying at the University of Brighton. Prior to this I worked as a support worker for adults with learning disabilities and complex health needs and autistic people. My interest in occupational therapy grew from seeing the massive positive impact that access to fun, meaningful activities can make for the people I worked with. I have lived experience of mental illness, and through finding my own ways to cope I have developed an interest in using occupational therapy to promote better mental health. In my spare time, I love playing video games, reading, swimming in the sea and have recently started doing some crafts.