Elizabeth Turp Counselling, Psychotherapy & Training Merseyside and North West

Archived articles. pacing

Pacing for wellbeing, fatigue & post-viral recovery

Psychological and physical factors in COVID-19 recovery.

I am a counsellor specializing in helping people with the mental health impact and self-management of chronic physical illness (chronic fatigue syndrome/ME, fibromyalgia, chronic pain, endometriosis... etc.) With both lived and professional experience of fatigue and pain conditions I understand well the complexity facing people who have had COVID-19: health can take longer than you think to regain, the medium-term effects of serious illness can be debilitating and the emotional challenge is often as big as the physical. With support from your specialist rehab team, if you have one, consultant or GP, here are some key areas to consider if you are in recovery from COVID-19, or are supporting someone who is:

1) Everything might feel ‘wrong’ for some time
After a viral infection there can be a period of time where everything feels difficult: energy levels are low, you can’t think straight or concentrate, you may have pain in strange places, your sleep might be poor when you need it most, your appetite and guts don’t feel right, you are on an emotional rollercoaster. A lot of this is normal following a viral infection as the body recovers and rebalances. It
needs deep rest to do this. Emotions are messages communicating to us about our experiences, if you have felt near death you will feel fear, especially if you have never been ill before, so it is important to know that:

2) Fear is natural but needs expression:
When we experience a serious threat, our brains respond to protect us: it scans for threats so we may worry about symptoms, question whether we might die, we may fear for our sanity. If this continues for some time the part of the brain that protects us from threat, the amygdala, may become over-alert, or hypervigilant, and this can contribute to physical symptoms in the body such as digestive problems, pain and sleep difficulties. If we have been unable to process our experiences, we may have flashbacks, nightmares and feel overwhelmed. It is really important that you seek medical attention if you have any ongoing symptoms, to rule out anything serious and understand the recovery process. If your physical recovery is going well but you have these issues, you may need some help with the psychological impact. Working with clients who have chronic pain and fatigue conditions, I often see people whose systems are stuck in experiencing extreme physical symptoms after the original infection, injury or trauma has passed. If the brain continues in ‘protect’ mode it’s harder for our systems to relax into rest and healing.

3) Fatigue is not the same as tiredness:
As people with chronic illness know all too well, fatigue isn’t eased by sleep, rest or exercise in the same way tiredness can be. It is not something you can just ‘push through’, ‘pull yourself together’ from and it’s not ‘all in the mind’. When we have been very ill, especially with an infection that challenges the immune system, lungs, and heart, fatigue can be present long after the original infection is gone. This is normal and understanding that can ease the fear that prolonged difficulty can bring and help calm the nervous system, supporting recovery, so know that:

4) Pushing yourself won’t help:
Jumping ahead of where you are physically won’t get you further, but it can set you back. If you were physically active before you got ill you will need to be gentle to regain muscle strength and stamina before doing anything near what you are used to. One week of bedrest diminishes muscle mass by 12% (Jiricka, 2008) so going gently back to moving around is important or you can crash backwards into fatigue. Whatever your previous activity level it is important that you start to move around again slowly as soon as you can, sitting on a chair rather than lying in bed for a gradually increasing time during the day helps with this. All activities need to be gradually increased, even standing or talking to loved ones can be exhausting. The psychology of our response to illness is also vital to be aware of. Maybe your identity is bound up in being a fit, healthy person; maybe you use exercise to manage emotion; or believe not being productiveequals being lazy; maybe your life is very physically active so to take it easy and slow down as you recover is difficult? If you are under pressure from employer or family to get back to ‘normal’ it is important to be honest about how you are feeling if you are still unwell, though you may experience disbelief. None of this can take away the fact that you are not well right now, no matter how much you
might want it to be so:

5) Pacing yourself is vital:
Pacing is a set of strategies that help manage limited energy, and give you back some control by focussing on what you can do. It encourages a balance of activity and rest, can result in fewer symptoms and assist recovery. It includes breaking down activities, practicing radical rest and putting your needs into all decisions as you recover. It is too complex to fully do justice to here but my comprehensive free resource is available above this article as a pdf. A gentle paced return to normal activity levels can support you to make a full recovery.

6) Strange bodily symptoms are to be expected:
The human brain and body are a complex system and science still has a lot to discover about their interactions. There is a lack of medical explanation for a surprising number of common conditions that are multi-systemic: for example, bodily pain doesn’t always indicate injury and people can be housebound in the absence of any positive test results showing disease. There is an increasing
understanding among some more holistically-minded medical practitioners about how the brains control of the circadian rhythms, or body clock, can go out of balance and create difficulties across bodily systems: endocrine, digestive, immune and the sleep-wake cycle. Making sure you are receiving medical treatment for any damage COVID-19 may have done to lung function, etc, consider how other bodily symptoms may be linked to your experience of illness, fears about your health or physical recovery of muscles, etc. Seek help for any ongoing effects from the trauma that you may have experienced, especially if you are unable to relax, rest and sleep deeply.

7) Getting physically better doesn’t necessarily mean you feel emotionally ok:
Often the emotional impact of serious illness doesn’t hit us until afterwards, we realise what we have been through when are no longer facing immediate threat to our survival and we can process what has happened to us. Unfortunately, sometimes other people don’t understand this, expecting that if we are physically ok we should feel the relief and gratitude that they feel on our behalf. This can be risky because if we aren’t heard and feel unable to express our emotional responses so suppress them, we can experience depression, anxiety and isolation. A lot of therapy addresses mental health difficulties that stem from our culture not allowing for distress, grief and sadness. You may feel overwhelmed, scared, traumatized after COVID-19 and these are natural responses to human experiences that need expression, not disorders that need to be fixed. Speaking to a trained professional who understands this can help.

8) Asking for help can be transformative:
In an ideal world everyone would be offered physio, occupational and/or psychological therapy following serious illness. Unfortunately, under-resourced health services can mean we are left to own devices in recovery, so it is important to seek medical support if you are struggling with an unexplained symptom, the length of your recovery or the impact on your mental health. The information in this article is evidence-based but comes from personal research, learning and experience of surviving undiagnosed chronic illness and post-operative complications rather than any doctors advice. Sometimes sharing your fear or getting checked over by your GP can address a particular concern quickly, or you may need more in-depth support. Seeing a psychotherapist who specializes in the mental health impact of physical illness can help with the emotional impact of serious health events.

9) Acceptance is key:
The most useful shift I ever witness a person make in their coping with illness and recovery is that of accepting where they are RIGHT NOW. That might seem strange and your reaction might be a strong ‘no way!’ but it is actually only when we stop fighting against the reality of our pain, fatigue and anxiety that we can move forward. Acceptance does not mean that you think you will always be ill or that it is ok, it means that you are ill right now and there is a reason why. Telling yourself it’s not the case doesn’t make it go away, but pushing through physical limits can cause setbacks. Mindfulness, yoga, talking about your fears, etc can help you relate to your body more gently as you recover.

10) Deep rest is vital for recovery:
Everyone is different. As humans we compare ourselves to others to measure progress and set goals, but with complex illnesses this can be detrimental to recovery. Especially with a ‘novel’ or new illness such as COVID-19 when there is little research available on the factors that influence severity or the recovery process. Whatever feels restful for you, sitting outside, reading, meditation, listening to
music... must be prioritized as you recover. When you feel ready to return to work or caring responsibilities try to do so in a phased, gradual way if at all possible, enlist the help of your workplaces Occupational Health Doctor.

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