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This page will look at pacing that can be used as interventions by an Occupational Therapist when working with people in mental health settings. They can be built into OT groups or individual interventions.
When running task orientated groups you need to consider the needs of the individual and the group as a whole.
Read through the information and watch any videos below
Ensure you scroll to the bottom of the page.
Energy Conservation
Pacing
Pacing means doing an activity at a steady pace to avoid overexertion. Physical or activity pacing helps to build up stamina and reduces the risks associated with overactivity, including pain, fatigue, and frustration. Cognitive pacing involves mitigating risks associated with overexertion of the brain. Cognitive exertion relates to any activity requiring mental effort such as studying or learning a new skill. Pacing helps to reduce stress and anxiety and improve mental health.
Mental Health conditions can cause disabling tiredness and fatigue. Energy conservation is a technique patients can use to manage the energy they have, choosing how they use it on occupations which they value.
The big push approach
Climb all the stairs at once. You’ll have to rest for 10 minutes at the top, and feel achy and tired the next day.
(RCOT, 2020)
The pacing approach
Climb five steps, rest for 30 seconds and repeat. You won’t need a long rest at the top and won’t feel so tired the next day. (RCOT, 2020)
Pacing for a better mental health
Activity Alternating
Activity Alternating
Alternating activities can also help with reducing the difficulties concentrating (brain fog) that often come with mental health difficulties such as anxiety.
Swapping between different tasks which challenge our brain and body in different ways can help. It can also break up a task which might feel over whelming to start.
cognitive task (writing 200 words of an essay)
physical task (20min exercise or house work)
restorative task (30 min Watching TV or relaxation)
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, The OT might encourage an individual to select two activities they feel more confident doing, alongside the hard one. Tricky tasks become less all-consuming. By breaking tasks down into small steps, they become more manageable.
Microbreaks
Microbreaks
One tool of pacing which OTs can support service users to develop is the concept of 'Mircobreaks'.
This could be every 20ish minutes, having a 30 second break. Encouraging your service user to adjust their posture, close my eyes and take some deep breaths.
The mirco break can be a way to checking in with their body:
Are you tensing your muscles?
Are you holding your breath?
Are you biting your lips or insides of your cheeks?
This can help individuals with anxiety catch themselves before the tension of your body causes discomfort. Or the breath holding creates a flight/fight/freeze response. The mircobreaks encourage and individual to use the logical part of their brain (the cerebrum) to can calm the emotional part of their brain (the limbic system), before the emotional part takes over and triggers a fear reaction.
Microbreaks are a way to pre-empt this, ensuring you aren’t sending or receiving signals that may trigger the reaction.
Using Microbreaks to disrupt negative thoughts
Using Microbreaks to disrupt negative thoughts
Microbreaks can also be used to check in with 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 individuals with anxiety are experiencing negative thoughts, the microbreak can be extended to challenge these thought patterns. Unhelpful thought patterns are also known as cognitive distortions. These are different ways thoughts filter information that lead people to false beliefs about self and others and can increase anxiety an individual experiences.
In mini 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?
Top tips for pacing with Mental Health conditions.
Break activities up into smaller tasks and spread them throughout the day.
Try adjusting different parts of an activity to reduce the energy demands.
Build rests into your activities; they’re key to recharging your energy.
Stop, pause and rest between activities where possible.
Sit and rest wherever possible.
Evidence Based Practice
Occupational Therapy practice needs to be led by evidence.
This is a list of relevant scientific research and articles relevant to pacing and mental health.
Please take the time to familiarise yourself with the research base in order to provide the most up-to-date care to your patients.
Relevant Articles
Antcliff D, Keeley P, Campbell M, Woby S, Keenan AM, McGowan L. Activity pacing: moving beyond taking breaks and slowing down. Qual Life Res. 2018 Jul;27(7):1933-1935. doi: 10.1007/s11136-018-1794-7 .
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