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Thinking about the Biopsychosocial Model of Fatigue

I do not claim to be an endurance athlete, nor a sports psychologist. But, one thing I am is a running enthusiast. And, as we madly rush towards the end of the year it is natural that at points we might stop and reflect over our year. One of the things I noticed in doing that this year, is that I have run nearly 3 times more than I have any other year. I am likely not alone - many of us laced up our running shoes during the first lockdown and set to moving.


During these many hours of running I have spent time listening to a variety of podcasts and most recently I listened to an audiobook. Ross Edgley’s – The Art of Resilience. A book he wrote as part of his 157-day, 1,780 mile swim around Britain – an amazing feat of endurance if you ask me! This audiobook is all about understanding the potential of the body and the mind to withstand. It is a practical, and inspiring message he delivers, he reintroduces concepts you might already know, and some you do not.


I will not ruin it for you – it’s worth a read, or a listen depending on your preferences. But he offers up rules of resilience, his concepts of stoic sports science. But, one of the more interesting concepts for me (besides slow is strong, so my turtle running pace is ok) was connecting to the biopsychosocial model of fatigue.


This model sees perception of effort to be key. Perception of effort being the conscious experience of how hard, heavy, too much a task is. There is rapidly expanding evidence to show that thoughts, emotions and experiences, alter the relationship to perception of effort significantly. Like pain, this perception is an output of the brain, not always indicative of physical capability. This also is impacted by any prior experience of similar activities/experiences, knowledge of how far you need to go and how much further is left.


Linked to this is the idea of potential motivation. There is a lot of research about intrinsic vs. extrinsic motivation, but the idea of “what’s in it for me” is key here, because potential motivation depends heavily on the strength of the motivating factors. Why are you doing this? How much effort are you willing to put in?


So – why am I writing about this? Because we are all experiencing some level of fatigue right now.


Is it because we are completing an endurance sporting event? No – but for some it could really feel like right now we are in the middle of one of the longest endurance events of our lives. So, some of the lessons of stoic sports science may apply here.

Things might be feeling extremely heavy and hard right now, we have extremely limited experience of similar activity other than what we have seen and experienced this year, and we have no clue how much further [or longer] we must go on. No wonder there may be some fatigue about this?


And if we move into potential motivation? At the beginning, when people stood and clapped for the NHS, when we were activating the “we are all in this together” vibe. Motivation was high, but every day we continue with this, and the perception of effort climbs. It impacts our motivation to continue.


And, with Christmas at the end of this week, and some parts of the country moving into Tier 4 restrictions – the why may not have an answer. And, for some the hope of the vaccine could help. But, for others it might not.


I found this podcast so useful not because it gave me an opportunity to reflect on some of these aspects, whilst I was running. But also, generally. It gave me a moment to reflect on my values, my motivations, my strengths, and weaknesses. It helped me think about why some days are harder than others. As a country we are recognising the mental health crisis that is looming.


We have been plunged into a world of uncertainty. Anxieties surrounding the virus are understandable, but we are also having to navigate monumental changes to our day-to-day lives in the measures we have been asked to take to respond to it.


If you feel as though you are struggling now, know that you are not alone. Fear and anxiety are normal and healthy responses to the situation we are living through. We are all likely to be feeling the emotional impact of adjusting to a new daily reality.


Depending on your situation, you may be feeling this in a myriad of different ways: anxiety, low mood, grief, anger, stress about your own and loved ones’ health and wellbeing, financial uncertainties, employment uncertainties, isolation and so on.


Consider spending some time thinking about what is important to you right now, look at the main areas of your life, and develop an understanding of your goals and values, and explore ways to stay connected to your meaning and purpose right now. Living your life in a way that is consistent with your values during this difficult time. If you need help with that, reach out and together we can develop a shared understanding.



Below is a list of other options:


If you don't feel you can keep yourself safe right now, seek immediate help:

If you need urgent support but don't want to go to A&E, you could:

  • Contact NHS 111.

  • Contact your local crisis team (CRHT), if you're under their care.

  • Contact your GP surgery and ask for an emergency appointment. Note: GP surgeries are closed on Bank Holidays but, if you phone your nearest surgery, the answering machines will usually give you advice on how to get hold of an out-of-hours doctor.

  • Call Samaritans for free on 116 123 or email them on jo@samaritans.org – they're always open and are there to listen.

Helplines

  • For mental health crisis support, you can ring the SANEline on 0300 304 7000 between 4:30pm-10:30pm, each evening.

  • For general mental health help, you can access help via text from Shout. Simply text SHOUT to 85258 for 24/7 crisis support. This service is available for free on major mobile networks, for anyone in crisis anytime, anywhere.

  • Childline is a confidential line offering support for young people under 19 (and their relatives), offering advice about any topic. You can speak to a counsellor by calling 0800 1111 or via one to one chat between 7:30am and 3:30am every day.

  • The Campaign Against Living Miserably (CALM) is a helpline for men and is open from 5pm-midnight on 0800 58 58 58. The CALM webchat is also open during these hours.

  • Switchboard is a line for LGBT+ support: 0300 330 0630. The helpline is open 10am-10pm 365 days a year. Or you can email: chris@switchboard.lgbt

  • The Silver Line is a line, open 24/7, for those over the age of 55 offering information, advice and friendship: 0800 4708 090.

  • For eating disorder support, contact the Beat Helpline on 0808 801 0677. The phone line will be open 4-8pm from 24 December to 1 January. Sometimes their lines are busy so, if you can't get through immediately, please try again or try their one-to-one webchat.

  • The national Rape Crisis helpline is open today and every day 12pm-2.30pm and 7pm-9:30pm. The helpline offers confidential emotional support, information and referral details.

Online support services

If phone lines are busy or you don’t feel able to make a call for help, there are other ways you can access support.


  • Mind’s online community Side by Side is a supportive place where you can feel at home talking about your mental health and connect with others who understand.

  • Join Togetherall, the leading online mental health support service in the UK, which has professionally trained and registered moderators available around the clock.


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