Fiona McKechnie is an Advanced Clinical Occupational Therapist and Mindfulness-based Therapist with over 25 years experience of working in this specialist field. She looked at the concept of rest, and how it is challenging for people with fatiguing conditions, so that they often live in a ‘tired and wired’ state.

Definitions of ‘rest’ from the Cambridge dictionary

‘Recovery, strength and support, cease work or movement in order to relax, sleep or recover strength, allow (land) to lie fallow

Stability, steadiness, dependability

Resting our hope in something or placing confidence in

Dead, not working, left out, stopped

Body being laid to rest, actors may use it to indicate they are out of work, or leave (a player) out of a team temporarily, to euthanise (to put to rest)’

So how we define and consider underlying beliefs about rest, may influence our attitudes to it. For example the idea of ‘the protestant work ethic’ which can condition us to believe that rest is ‘a waste of time’.

Rest vs sleep?

Many people who come to the fatigue clinic where Fiona works, use sleep as a means to meet the need for rest. Her clinical experience, however, shows that often this doesn’t actually help the fatigue, because counterintuitively an excess of sleep can actually lead to more fatigue.

*Prof. Marie Åsberg, at the Karolinska Institute in Stockholm. From Mindfulness: Finding Peace in a Frantic World, Williams and Penman Piatkus 2011*

Studies that have looked into rest

Claudia Hammond’s 6 ingredients for rest in ‘The Art of Rest’ is a very helpful guide to the necessary ingredients to enable rest to be effective. However, given the nature of fatigue conditions, there are, Fiona cautions, some caveats here.

*Hammond C. The art of rest: how to find respite in the modern age.. Canongate Books; ; 2019.*

Fiona says,’Patterns for self-care are really disrupted with long Covid or ME/CFS. Some people are quite isolated. Worry and distraction can be very challenging, especially when you stop doing things. In light of this, there is a need to develop an adapted approach to mindfulness, for example.

On the other hand, post-exertional symptom exacerbation/malaise can be experienced if using activity to rest the mind as suggested by ‘exerting your body in order to rest your mind’.

Rest can also be associated with guilt - the idea of being ‘unproductive’. It is a very difficult place to be for some people because of what it can bring up.

‘Boom and Bust’

This descriptor is used to describe the tendency for those with ME/CFS to operate in these two extreme places of over-exertion (boom), and collapse with a flare up of symptoms (bust). Fiona says that there is a lot of nervous system activation in this experience which makes stopping very difficult, and ‘dropping’ can generate more of a stress reaction, rather than promote recovery or rest.

The key to recovery, Fiona argues, is to stop before dropping. It can take many cycles of the above pattern to work out when and how to stop.

Going down the gears rather than just stopping

How to rest

Plan to ‘stop before dropping’. A useful metaphor to bear in mind is ‘going down the gears’.

To find good rest needs techniques plus strategy plus implementation. Consider rest and activity on a continuum; and within each aspect itself you will also find continuum.

For example:

Sleep = deep to light.
Rest = low-level activity (like listening to an audio book), to something more engaging or absorbing (like deadheading roses).

Thinking about the types of rest and what are we doing.

Fiona suggests ‘thinking about punctuation (paragraphs, full stops, chapters). How can I have these ‘punctuations’ of rest in each section of time e.g. over a year, season, month, day. Thinking about what we do in longer rests such as holidays or a day off - are we resting or decorating the hall? Lunch breaks are a great punctuation; and restful moments can punctuate a task or an enjoyable activity.’

Fiona suggests that It can be helpful to look at the various body systems (brain, muscles, circulation, breathing, senses, digestion etc) and how we have survival instincts with how the body protects itself with fight, flight or freezing. What we need is ‘rest and digest’ - we need to do this on purpose and make time for it.

Keys for doing this through the body

Brain: Intention to switch an activity from one that is engaging, to one that is more restful. No screens, but instead meeting a friend. Noticing the thoughts ‘I should be sorting out the electricity bill etc’. Visualisation, mindfulness and meditation can be used to support this. Note that this can be difficult with brain fog, however.

Muscles: Purposefully relaxing muscles

Circulation: We cool down when we rest. If you lie down and keep yourself warm, take a deep breath. ‘Coming home to the body’ - in other words, being aware of what it needs, ask yourself what may need to happen to be 5% more comfortable, and let the body guide this sense.

Breathing: Or we might use a deep breath or use the breath like an anchor; or it could be the warmth in your hands. Intentionally coming back again and again to these sensations during rest or during a punctuation point in activities.

Senses: Adopt a ‘wide gaze’ - it helps to unhook the brain a bit and be more restful.

If we start somewhere, the other parts of the system join in.

“we are rested when we let things alone and let ourselves alone, to do what we do best, breathe as the body intended us to breathe, to walk as we were meant to walk, to live with the rhythm of a house and home…. When we give and take in an easy foundational way, we are closest to the authentic self, and closest to that self when we are most rested”

— David Whyte's definition of rest in consolations

http://t.ted.com/6m4jmqV TED conferences

Action Plan

Fiona concludes that we need to see rest as important. It’s not so significant for survival in evolutionary terms now, but we still need to take it into account. If you are more rested, you can be more more present for what or who is important. If we wait until everything is done, we probably won’t get it all done and it’s not really rest as it’s more crashing. If it was a medication you would take it even if you didn’t really understand what it’s doing. Fiona suggests seeing rest as important as if it was a medication.

She says, ‘planning where and what is going to happen so that it increases confidence that the action plan makes changing behaviours more likely to actually happen. The more detail that there is to a plan (when, what, how etc) also increases the likelihood of it happening’.

Fiona Mckechnie is an Occupational Therapist and Mindfulness-based therapist and coach and has worked in fatigue services for 25 years. She currently works for Bristol ME/CFS service as a senior clinician and mindfulness lead, and as an Associate with Vitality360.

Fiona as an MSc from the Centre for Mindfulness Research Practice and investigated the use of mindfulness in ME/CFS services. She is also qualified as coach, yoga teacher and EMDR therapist. She has developed a mindfulness programme within the Bristol ME/CFS service which is being published as a book in Autumn 2023. She is particularly interested in pragmatic approaches that support an individual’s goals, for example in the workplace. She is currently developing online mindfulness courses and training for people with fatiguing conditions who cannot access them via local services.

She has written a book ‘Mindfulness-Based Therapy for Managing Fatigue: Supporting People with ME/CFS, Fibromyalgia and Long Covid’ which is published in September 2023.

References:

BACME An introduction to Dysregulation in ME/CFS

ME animation by Alexandra Hohner https://www.alexandrahohner.com/

Hammond C. The art of rest: how to find respite in the modern age. Canongate Books; 2019

Hammond C, Lewis G. ‘The rest test: preliminary findings from a large-scale international survey on rest’ in The Restless Compendium. Palgrave Macmillan, Cham; 2016. p. 59–67.

Whyte D. Consolations: The solace, nourishment and underlying meaning of everyday words, Canongate Books; 2019.

Burch V and Penman D, Mindfulness for Health: A practical guide to relieving pain, reducing stress and restoring wellbeing, Little Brown; 2013

Mckechnie F, Mindfulness-based Therapy for Managing Fatigue. Supporting people with ME/CFS, Fibromyalgia and Long Covid; Jessica Kingsley Publications, 2023 (Sept) fionamckechnie.co.uk