When I’m suffering a crash or relapse*, it’s very easy for my mental health to decline along with my physical health. Here’s what I try to do to stop this from happening.

When I’m in physical decline, looking at all of the different aspects of my life can lead to overwhelm. It’s hard to ignore, there are visual reminders everywhere - the emails I need to reply to, laundry that needs doing, seeds that won't plant themselves, friends waiting for a catch up, cancelled outings I want to reschedule, many chores and fun things that I want to do, but simply can't.

This can lead to a negative spiral of thinking, about all the things I've missed out on in the past, all the things in the future that I might miss out on, and wondering how long this crash/relapse will last, and if I will ever recover or regain the progress that I had made.

This is when I know I need to STOP! Switch lenses, stop viewing the whole picture and giving myself a headache. In other words, take off the wide-angled lens and put on the macro lens instead. And zoom right in!

Then I ask myself 3 questions:

• What does my body need right now?
• What's one thing I can do today?
• What's one thing I am grateful for?

"practice makes progress"

In the depths of chronic pain and fatigue, thinking about and finding answers to these questions isn’t easy. I definitely can’t do it all of the time. But, I have found that practice makes progress - I try to resist the compulsion to aim for perfection, it is a mere illusion!

Here are some ideas on how I answer these three important questions.

As hard as it is to face the reality of our pain and our fatigue, acknowledging that they are there and at what level they are at can be really useful. I spent many years just thinking “I’m in pain and I have fatigue all the time” without stopping to realise that both actually ebb and flow all the time. Yes, they’re always there, but they’re not solid, they are ever-changing, increasing and decreasing with each moment. A regular mindfulness practice can foster a better awareness of what your body needs each day and even in each given moment. It can help us see when we’re pushing too hard or succumbing to overwhelm.

A shorter, simpler form of mindfulness exercise can be to just stop for a minute, close your eyes, take some slow, deep breaths and tune in to how your body is feeling at that moment in time. Are your shoulders hunched up? Is your stomach feeling tight? Are you screwing your face up against pain? I find this alone can be quite enlightening, it can help me to realise quite how exhausted I am feeling, how much I’m tensing my body and adding to the pain, Therefore, moving on to my next task, without a rest first, is not going to be the best thing for my body. See my blog post “Fatigue - Friend or Foe?” where I talk more about our relationship with fatigue and adding to the suffering layer by layer.

Another way to see how your body is feeling and what it needs each day is by tracking your Resting Heart Rate (RHR) and Heart Rate Variability (HRV), seeing what your usual baselines are and recognising that when they deviate greatly it is time to give your body some rest. There are various devices available to track RHR and HRV. In the future, I hope to write more about tracking both of these variables, and how they can help with managing chronic illness, pain and fatigue.

"it is good to make careful choices when we’re able to."

Once we have a better understanding of how our body is feeling, we can hopefully make wiser choices (where choice is possible) about what we try to put it through. Ideally we can then tailor our activity level to our body’s needs and give it more rest when it is needed. Of course, I completely appreciate and understand that we don’t always have a choice about how we spend our day or energy, there are always some things out of our control. But it is good to make careful choices when we’re able to.

You could spend a whole week in a crash, in loads of pain and fatigue, believing that you’re not able to accomplish anything. And that might well be the case in some instances. We all experience these things differently, at different levels and every crash is different. But I know I myself can often take an all or nothing approach. The perfectionist in me cannot stand doing just a bit of something, I want to do the whole thing in one go. But, I could spend the whole week in bed, telling myself I can’t do anything. Or, it might be possible that on one day I can file one piece of paper, on another I can make a call to reschedule a dentist appointment, another day I might be able to reply to an email, and another day I might even be able to have a shower.

During a crash I could look at all these things in a list and feel overwhelmed and think "it’s too much, I can’t do it!" And, if I was aiming to do them all in one day, I would be right. But, by listening to my body and asking “Is the brain fog really bad today? Is the fatigue really high? Is interacting with people too much today?” I can then home in on “What’s one thing I can do today?” I find it can be easier to list all the things that I want to do but can’t, than the ones that I can. However, dwelling on that negativity is what brings me down. So, regularly focusing on just one thing, no matter how small it is that I can do (remember that macro lens) can help to lift my mood. It’s all about perspective and expectations. We can set ourselves up to fail, or we can make our aims more attainable.

"Looking after the one body we travel through this life in is the most important job we can do!"

Often, especially during a severe crash, that one thing I can do is to ensure that I give my body the rest that it needs. That’s still being productive. Looking after the one body we travel through this life in is the most important job we can do! Think how you would treat a loved one in that situation or what advice you would be giving them. Then give that love and care to yourself. You ARE worth it!

When you have completed that one task, relish in that accomplishment, “I feel my absolute worst today, but I did that one thing!”

I’m not saying that reducing our expectations is easy, believe me, I know only too well how hard that is. But I feel I have to do it for my own sanity, otherwise I may just drown in disappointment in myself!

With a regular gratitude practice over time, the gratefulness muscle has been exercised, then I can see more - the love and devotion of my cat, watching a Red Kite soaring above the houses from my sitting room window, the warm sunshine pouring through my bedroom window, the smell of my first coffee in the morning, a message or voice note from a friend etc.

A gratitude practice improves and gets easier over time. It certainly has for me. Now I find I don’t need to stop and think about what I am grateful for. I just tend to see the positives each day more easily. Again, something much easier with that macro lens. For example, the day a loved one died holding my hand, I could have just looked at the bigger picture - our loved one had died, that was tragic and extremely sad. But, zoomed in, with the macro lens, I could see so much to be grateful for - their passing was peaceful, the staff at the hospice looked after us all so well, the rota of people who had provided lifts on a daily basis and the neighbour who automatically fed the cat for us while we spent all day at the hospice. Yes, I was still feeling the sense of loss, sadness and grief. But, recognising that not every single element of the day was sad and negative helped to prevent a negative downward spiral.

There we have it, my three tips for preventing a downward mental health spiral. Listening to my body and acting within its needs, accomplishing one thing and acknowledging something that I am grateful for, can turn a bad day into a not so bad day, or maybe even a good one! I am not saying for one minute that any of these things are easy to do, just that in my own personal experience, with practice, they do become easier and they do help me. Why not give them a try? You might find they help you too.