I struggle with depression and anxiety on a all-too-regular basis. I practice mental health energy conservation on a daily basis.

Throughout each day, I’m constantly doing an internal MRI-like scan of my body, figuring out how I am doing and what I can handle. I’m constantly self-talking to myself for reassurance (“okay Karen, you’ve checked the lint and you’re right here, you can start the dryer and chances are high it won’t explode into a ball of flames…” and previewing what’s coming next. I know myself pretty well and know what kind of issues are triggers for me, or where I need to have control to be okay. I know what drains me and what rejuvenates me. I’m lucky to have those skills, and I think my occupational therapy training certainly contributes to those abilities.

I have what I call an anxiety budget, similar to the fibromyalgia “spoons” theory of where you only have so many “spoons” in a day so you have to use them wisely. My goal is to get through the day without using all my anxiety coins.

For example, parallel parking downtown is a HUGE stressor for me, as is giving blood. I would try hard to NOT allow those two big stressors to be on the same day, because I know I will be at a deficit. I try to space out big stressors. I make sure if I have to see a lot of people (at a “fun” event), that I hopefully only have to do it once that day, and have time after to rejuvenate.

Somedays I assess myself when I wake up and I can tell it’s going to be a hard day, maybe I’m extra anxious. If I don’t HAVE to do my laundry that day, I won’t. I need to save all the coins I can. Or, maybe I have to for some reason, but I am aware that on a good day laundry may take me “5” coins, and for this day it may take up “15” because I’m going to be extra worried today that the dryer is going to start a fire. Another example: starting a blender always kind of scares me, even with headphones on the noise freaks me out and sometimes I get scared of electrical fires in the walls or something. So on a good day maybe I make a smoothie for 3 coins because I can tolerate the noise and won’t obsess over a fire, on a bad day I won’t touch the blender because it would cost me 15 coins and I can’t waste them on that.

It’s a constant balancing act, but my awareness is very helpful. It also allows me some compassion and grace, because I have accepted that certain things are much harder for me than others, and that it also varies by day or even hour or even minute. It also allows me to be extra aware of doing harder activities when I feel okay, and saving littler ones for challenging days. It helps me be more functional and not beat myself up so much. (Believe me, there are plenty of times I beat myself up or can’t function – it’s an art, not a science.)

Sometimes, brushing my hair or just starting self-care routines make me want to cry because they seem so hard. That’s a day I’m just going to prioritize the absolute REQUIREMENTS to be semi-functional, and maybe I don’t get a shower that day, but if I brushed my teeth and put on clothes, it’s a win.

From what I can tell (see below for more details), there isn’t much awareness -or at least it’s not called this – of the concept of mental health energy conservation. I’d love to hear from occupational therapists (e-mail, Facebook, here…) who work in mental health on their thoughts on this concept, as I know they address these challenges, maybe with a different name.

The keys are to remember that every person has unique challenges, especially as it pertains to anxiety – my parallel parking may cost me 30 coins and may only cost you 2 coins, whereas my public speaking is 5 coins in my mind and in yours its 50. I think awareness of this need for energy conservation allows for a big step in acceptance, compassion, and potentially a change in functional approaches to the day.

I’m eventually interested in working with someone to do research on this, but not anytime soon!

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Okay, here’s what I just posted this on one of my OTD (occupational therapy doctorate) forums…I’m trying to be okay with B grades, I know this is not very well written, but hey….it’s a little assignment and I’m practicing mental health energy conservation by not obsessing over making it perfect. It was a qualitative query I came up with along with some discussion as to why (vague paraphrase of true directions)

How do adults (18-55) with mild depression describe their energy expenditure as it relates to participation in activities of daily life? 

 My review of the literature came up with no results that specifically focused on energy expenditure in relation to mental health and activities of daily life. The majority of articles focusing on energy conservation had to do with multiple sclerosis (Blikman, et. al, 2013), cancer (Mitchell, et. al, 2014), or other physical difficulties. Other articles focused on older adults and limitations in activities of daily life in the aging process, which occasionally addressed depression (Arbesman & Mosley, 2012). Others address activity limitations and depression with chronic conditions, but do not specifically focus on mental health. While I may have missed some articles in my non-exhaustive literature search, it’s clear that this is a very specific area that has had minimal attention.

Occupational therapists and many other health professionals have knowledge and experience in dealing with energy conservation, but it’s typically based on physical needs, not mental. Mental health occupational therapists clearly recognize that people with depression have limitations in ADLs, and that even an activity as benign and simple as pouring a bowl of cereal can seem exhausting. While they certainly address these issues, I don’t know if the therapists or clients are considering this or calling this a form of energy conservation. It would be interesting to see if adults with depression describe their energy expenditure for such tasks as physical or mental, or even perceive the limitation as an energy expenditure issue in the first place.

I think the occupational therapy field would benefit from a more evidence-based approach to managing energy conservation in younger adults with mental health challenges (I chose depression but I’d also be equally interested in anxiety). If there were an assessment that was linked to the COPM, it would allow the therapist and client to get the unique viewpoint of what activities take up the most energy expenditure for that particular client (emphasis on uniqueness), and give them goals for intervention. A support group and/or energy conservation program could also be appropriate for this population.

Occupational therapy is rarely seen in most major healthcare mental health settings these days, but mental energy conservation programs for ADLs could be a new way to promote OT in mental health, and a way to help more people handle their day to day ADL participation with more awareness, compassion, and knowledge, which may in turn reduce their limitations and allow increased participation.

References

Arbesman, M., & Mosley, L. J. (2012). Systematic review of occupation- and activity-based health management and maintenance interventions for community-dwelling older adults. American Journal of Occupational Therapy, 66, 277–283. http://dx:doi.org/10.5014/ajot.2012.003327

Blikman, L. J., Huisstede, B. M., Kooijmans, H., Stam, H. J., Bussmann, J. B., & van Meeteren, J. (2013). Effectiveness of Energy Conservation Treatment in Reducing Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Archives Of Physical Medicine & Rehabilitation, 94(7), 1360-1376. doi:10.1016/j.apmr.2013.01.025B

Mitchell, S. A., Hoffman, A. J., Clark, J. C., DeGennaro, R. M., Poirier, P., Robinson, C. B., & Weisbrod, B. L. (2014). Putting Evidence Into Practice: An Update of Evidence-Based Interventions for Cancer-Related Fatigue During and Following Treatment. Clinical Journal Of Oncology Nursing, 1838-58. doi:10.1188/14.CJON.S3.38-58