Compassionate trauma-informed healthcare does not emerge from policies, training sessions or good intentions alone.  It is created through the everyday actions, relationships, practices, self-compassion, understanding of trauma and cultures that shape how we meet ourselves and one another.  While this blog is focusing on healthcare the principles apply to social care and other sectors.

There are many factors that support compassionate, trauma-informed working including:

• Presence and awareness
• Understanding trauma and embodying trauma-informed principles
• Nervous system awareness and regulation
• Self-compassion
• Somatic and embodiment practices
• Compassionate leadership
• Effective team working, psychological safety and safeness
• Reflection and shared learning

These elements are deeply interconnected, and together support compassionate trauma-informed ways of working, relating and being.

Presence and Awareness

Presence and awareness are foundational in compassionate healthcare.  Compassion begins with noticing suffering and being willing to turn towards it.  Presence is not passive, it invites awareness and inquiry.

When we aren’t aware of suffering, we can’t take action to try and alleviate it and when we can’t tolerate discomfort, we will either avoid it, jump into trying to fix it, or become overwhelmed by it.

This can be supported by mindfulness-based practices, which trains awareness and attention — learning to notice experience moment by moment with greater clarity, steadiness, and openness.  Supporting presence, listening, and the ability to respond rather than react.

Everything is relational, compassionate healthcare is not simply about what we do, but about how we are with ourselves and others.  Presence supports us in listening deeply, understanding experiences, building trust, and responding wisely rather than automatically.

Empathy helps us understand and resonate with the experiences of others, while compassion adds the motivation and courage to respond wisely to suffering.

Professor Michael West describes the first behaviour needed in compassion as attending — being fully present with another person and listening with fascination.  This is something that resonates with me perhaps it does with you too.

Compassionate Questions

Compassionate healthcare is supported by simple but powerful questions that help us remain connected to ourselves and others.  Questions that support compassionate awareness, understanding and wise action, include:

• What is needed right now?
• What would be supportive right now?
• How can I help you? (something Professor Michael West often highlights the importance of asking)
• What matters most right now?

These questions shift us away from assumptions, fixing and rushing, and towards understanding, collaboration and more trauma-informed compassionate responses.

Presence alone is not enough.  Compassionate presence also requires care, curiosity, courage, humility and enough regulation to remain open to another person’s experience rather than making assumptions, or controlling the conversation.  Like compassion, presence is a lifelong practice.

Understanding Trauma and Embodying Informed Principles

As discussed in part one of this blog, compassion and trauma-informed practice are deeply interconnected.  Alongside the elements that support compassionate heathcare, trauma-informed healthcare is also supported by understanding the wide-reaching impact that adversity and trauma can have on individuals, relationships, organisations and systems and society.

This includes understanding the different types of trauma and how trauma can affect the brain, body, nervous system and whole person.  It is also helpful to consider how trauma has shaped communities, systems and society.  It’s important to recognise that there will be people who have experienced trauma within healthcare teams, as well as among those using healthcare services.

Being trauma-informed is not simply about having knowledge of trauma or embedding trauma-informed principles into policies and procedures.  It involves embodying the principles of safety, trustworthiness, choice, collaboration, empowerment, and cultural, historical and gender awareness in everyday interactions, leadership and organisational culture.  Like compassion, trauma-informed practice is something that needs to be lived and embodied, not simply understood intellectually.

Trauma-informed working recognises that experiences throughout life can influence many things, including: health and wellbeing, behaviour, our ability to be present for ourselves and others, how we experience healthcare, connection, relationships, and stress.

Together with compassion, these principles shape how people communicate, how decisions are made, how conflict is managed, and how individuals and teams respond when people are distressed or struggling.  They invite us to ask not “What’s wrong with you?” but “What has happened to you?”, “What is happening for you?”, and “What is needed right now?”

Compassion, presence, nervous system awareness, self-compassion, effective team working and compassionate leadership all help create the conditions in which trauma-informed principles can be embodied and sustained.  Together, they support environments where people feel safer, more valued and respected, more able to heal, collaborate, learn and flourish with greater connection and shared wisdom.

 Nervous System Regulation

Nervous system awareness and regulation are essential components of compassionate trauma-informed healthcare.

When we are overwhelmed, stressed or operating beyond our capacity, it becomes more difficult to stay present, think clearly, listen deeply and respond wisely.  We may become reactive, defensive, controlling, avoidant, or rush into trying to fix problems before fully understanding them.

Regulation does not mean remaining calm all of the time.  It means developing enough awareness and capacity to stay present with difficulty, respond rather than react, and reconnect and settle enough when we become activated.   We need enough capacity to stay present with suffering without becoming overwhelmed by it.  We need to understand our own nervous systems and how to stay regulated enough in the face of suffering, along with the challenges of lack of time and resources that are so often present.

When we can remain regulated enough in the face of suffering and challenge, we also support others in regulating.  This process of co-regulation has ripple effects within teams, services and organisations.  Also, beyond this as people carry the compassion out into their world.  In the same way that stress and threat can spread through systems, compassion, steadiness and connection can also spread.

Self-Compassion

Compassionate healthcare requires self-compassion as well as compassion for others, it’s something that is essential.

Many healthcare professionals are highly skilled at caring for others whilst finding it difficult to extend the same understanding, care and kindness towards themselves.

Self-compassion supports awareness of our own suffering, helps us recognise our limits, and encourages us to respond wisely rather than pushing endlessly through exhaustion and distress.

Far from being self-indulgent, self-compassion supports our ability to be present with our own suffering and challenges and to take wise action, along with remaining present and compassionate with others over time.  It is a foundation for sustainable healthcare.

Self-compassion can be supported in a number of ways, including through gentle inquiry.  In moments of stress, overwhelm or self-criticism, we might pause and ask:

• What is needed right now?
• What is helpful right now?
• What can I do for myself out of kindness in this moment?

These questions are not about avoiding difficulty, they help us respond to ourselves with the same care, understanding and wisdom that we would offer to someone else who was struggling.

 Somatic and Embodiment

Compassion is more than an idea or intention, or something to be ticked off a list, it is something to embody and to make away of being over time.

Somatic and embodiment practices help us develop awareness of our internal experience, recognise signs of activation earlier, strengthen our capacity for presence, support nervous system regulation, and choose what to embody.

They can help move compassion from something we understand intellectually into something we genuinely embody and enact in our relationships, leadership and everyday life.

Embodiment also helps us recognise when our words, actions, values and organisational practices are aligned — and when they are not.

Compassionate Leadership

Compassionate leadership is essential for creating compassionate trauma-informed cultures.

Research has consistently demonstrated the importance of compassionate leadership in staff engagement, wellbeing, team performance and quality of care.

Compassionate leadership is not soft, passive or about avoiding difficult conversations.  It requires the courage to lean into suffering, challenge and uncertainty, and act with wisdom and care.

It involves creating conditions where people can flourish, removing obstacles that prevent people from doing their jobs effectively, listening deeply, valuing diverse perspectives, and supporting people to contribute their skills and ideas.

Compassionate leadership is not only the responsibility of formal leaders.  Everyone working within healthcare influences others and the culture around them.  We are all leaders in how we show up, relate to others and contribute to the environments we work within.

Self-compassion is an important foundation of compassionate leadership, along with awareness, presence and nervous system regulation.  Compassion needs to be practiced in all areas of life and embodied over time to become genuine compassionate leadership.

Reflective Practice and Learning

Teams need time and space to reflect, share experiences, learn together and discuss challenges openly.  This requires environments that support psychological safety and safeness, compassionate challenge and genuine collaboration.  Research has shown that teams who take regular time to reflect together are significantly more productive than those who do not.  Reflection is important both within and between teams to help create a more effective, compassionate and sustainable healthcare system.

When people feel safe enough to contribute ideas, raise concerns and learn from mistakes, organisations become more adaptive, innovative and effective.

Collective intelligence is one of the most underused resources in healthcare systems.  The solutions to some of the challenges facing healthcare already exist within the collective wisdom of the workforce.  Creating opportunities to access this wisdom is a vital part of compassionate leadership and culture change.

Creating Compassionate Trauma-Informed Cultures

When compassion and trauma-informed principles are not embodied throughout an organisation and woven into leadership, policies, procedures and everyday practice, they risk becoming a tick-box exercise.

Culture is not only reflected in leadership teams, organisational documents and strategies, it’s shaped moment by moment through how we meet ourselves, how we relate to one another, how decisions are made, and how people are treated when they are struggling.

Creating compassionate trauma-informed healthcare requires commitment at every level of an organisation and the wider system.  It involves individuals, teams, leaders and organisations working together to create environments where people feel safe and have a sense of safeness — where they feel valued, respected, supported, and able to contribute.  It requires compassion and trauma-informed principles to be woven into leadership, team working, reflective practice, policies, procedures and everyday interactions.

This is not only beneficial for healthcare professionals and service users, it contributes to healthier workplaces, stronger communities and, ultimately, a more compassionate, trauma-informed society.  Compassionate cultures are created collectively through the relationships, behaviours and systems that shape how people experience work and care.

Summary

Compassionate trauma-informed healthcare is more than words or isolated practices; it is an integrated way of being and working.  It is supported by many interconnected elements, including: presence, awareness, understanding trauma and embodying trauma-informed principles, nervous system regulation, self-compassion, mindfulness-based practices, somatic and embodiment practices, compassionate leadership, effective team working, psychological safety and safeness, and reflection and shared learning.  When these are woven into individual ways of being, teams and systems, they help create cultures where people can meet challenge with greater steadiness, connection, shared wisdom and compassion.  This supports environments where staff and services users feel heard, valued and supported, contributing to more compassionate, effective and sustainable healthcare and, ultimately, a more compassionate society.

You can find part-one of this blog here, which explores what compassionate trauma-informed working is and why it matters: https://unityphysio.co.uk/?p=8390&preview=true

You can find out more about my work in this area here https://unityphysio.co.uk/services/compassionate-trauma-informed-working/

The post Creating Compassionate Trauma-Informed Healthcare appeared first on Unity Physiotherapy and Wellbeing.

Compassionate trauma-informed healthcare brings together compassionate care with trauma-informed principles.   It has compassion at the heart, which changes how individuals, teams, leaders and systems operate.  It’s about creating healthcare systems that support staff and service users, recognise that anyone can be affected by trauma, and support more sustainable healthcare.  While this blog focuses on healthcare, a lot of what’s shared here is equally relevant to social care and other sectors.

In compassionate, trauma-informed working, compassion is not only an individual skill – it’s embodied and enacted at every level of the organisation.  This requires shared responsibility, awareness, and practice, across leadership, teams, and systems.

Compassionate trauma-informed healthcare recognises that both service users and healthcare professionals are human beings with needs, vulnerabilities, strengths and life experiences that shape how they experience healthcare.

It supports us in being present with suffering, understanding people’s experiences and responding wisely.  As relational beings, connection, belonging, and compassionate relationships are fundamental to our health, wellbeing, and collective flourishing.  Trauma-informed principles help ensure this care is delivered in ways that promote safety, trust, collaboration, choice and empowerment.

Together they create conditions where people are more likely to feel heard, respected and supported.  They help to cultivate conditions of safety, trust, collaboration and compassionate care, along with reducing the risk of retraumatisation.

What is Compassion?

To understand compassionate healthcare it’s important to understand what compassion is.  Through the lens of compassion focused therapy (CFT), compassion is the recognition of suffering and the desire or motivation to try and alleviate or prevent it.  It is something we can train and it is innate within us.

In CFT compassion has three core qualities: a caring commitment to engage with suffering and try and alleviate it, the courage to turn towards difficulty, and wisdom which involves recognising the complexities of being human, understanding the root causes of suffering, and responding in ways that are wise and with the intention of being helpful.

CFT also describes a number of attributes and skills that support compassion.  Attributes include sensitivity to suffering, distress tolerance, and care for wellbeing.  Skills include compassionate attention and compassionate behaviour.  Other qualities often associated with compassion include patience, kindness, humility, non-judgement and curiosity.

Compassion can flow in three directions: towards others, from others, and towards ourselves (from ourselves).  Many people find self-compassion the most difficult of these.  Compassion directed towards ourselves is essential in healthcare, and in life more generally.   Without self-compassion, it becomes harder to sustain compassionate attention, behaviour and care over time.

Compassion is both a motivation and an experience.  We can feel compassion, cultivate it intentionally, and strengthen the qualities and skills that support it.  Through practice and embodiment, compassion becomes more than something we do occasionally — it becomes a way of being that influences how we relate to ourselves, others and the wider world.

Compassion is commonly misunderstood as soft and fluffy.  Whilst compassion can have a gentle and nurturing quality, it also requires great courage.  It supports us in leaning into suffering, conflict, challenge and difficulty, rather than turning away or rushing to try and ‘fix’ things.  This includes navigating difficult behaviour and conversations.

Compassion in Healthcare

Compassion in healthcare is more than being kind.  It is reflected in how we listen, relate, communicate and respond to suffering, and how compassion is embodied within teams, organisations and systems.

Compassionate care is a whole person approach to care and involves a variety of aspects like curiosity, non-judgmental listening, presence and being with the person and all of what’s present, awareness of ourselves and others, awareness of what is happening relationally, effective communication, clarity, and respect for individual experiences and values.

I like a term that Professor Michael West uses around presence and being with the other person and their experience, which is attending.  This refers to presence and deep listening and Michael says listening with fascination.

Before trying to help, we first need to attend and be with the person and their challenges or suffering, listening deeply with curiosity and a genuine desire to understand.  We need to acknowledge and validate what is present before moving towards wise action.

What Does Being Trauma-Informed Mean?

Trauma-informed working is not the same as trauma-sensitive or trauma aware, all of these matter.  Trauma-informed working recognises the profound and wide-reaching impact of trauma on individual lives and collectively.   There needs to be an understanding of trauma, the many ways it can present, and the need to prevent retraumatisation or further trauma.  There are 6 key principles of trauma-informed practice:

• Safety
• Trustworthiness and Transparency
• Choice
• Collaboration
• Empowerment
• Cultural, Historical and Gender Awareness

You can read more about Trauma-Informed Practice here: https://unityphysio.co.uk/services/trauma-informed-practice/

Trauma-informed principles are naturally supported when compassion is embodied at individual, team and organisational levels.  Safety, trust, collaboration, empowerment and choice are not separate from compassion; they are expressions of compassion in practice.

Why Does it Matter? 

We face significant challenges across health and social care, including workforce pressures, chronic work overload, high levels of stress and burnout, increasing demand and inequities in access and outcomes; and waiting lists in healthcare are long.  We need to address a variety of issues and better meet the core human needs of staff and the people using healthcare services.  There are some pockets of good compassionate healthcare, within individual practice, teams, and whole organisations and trusts.  This needs to be more the norm than the exception.

Compassionate healthcare has been shown to help decrease the risk of burnout, improve team working, improve job satisfaction, improve service user engagement and outcomes.  It’s also important for sustainability. It values diversity, supports inclusion, and enables organisations to benefit from the collective wisdom, experience and perspectives of their teams.  Compassionate trauma-informed healthcare recognises that sustainable wellbeing requires attention to both individuals and the systems in which they work.

“Compassion is the single most important intervention we have in healthcare” Professor Michael West

The potential benefits for staff include:

• Supports nervous system regulation, trust and a sense of belonging
• Enhances therapeutic relationship and professional relationships
• Improves wellbeing including mental health and overall wellbeing
• Reduces work-related stress
• Lowers the risk of burnout and vicarious trauma
• Increases work satisfaction

Burnout is often framed as an individual problem requiring individual solutions.  While personal wellbeing practices can help, they cannot compensate for systems that repeatedly fail to meet core human needs.  It is not a resilience issue of individuals, it’s largely a systemic issue.

When people have little autonomy, feel disconnected from others, experience chronic overload, lack resources, or feel unable to influence change, stress and burnout rise.   Part of this is core human needs not being met, this increases threat system activation.

It’s also wider than this — it’s a societal issue too.  We have a society that encourages over doing, striving, not resting, and feeling like nothings enough.

It is essential that staff feel understood, valued, trusted, and cared about.  Working within a compassionate culture supports this and creating well structured teams.

There are also a number of potential benefits for the organisation, including:

• Improved effectiveness and sustainability
• Reduced sickness absence and staff turnover
• Supports healthy boundaries and sustainable workloads
• Stronger team dynamics, communication, and collaboration
• Enhances service user experiences and outcomes

It also has a number of potential benefits for service users including:

• Supports nervous system regulation
• Decreases the risk of retraumatisation
• Improves engagement with services
• Enhances satisfaction and care outcomes
• Promotes healing and recovery

When healthcare is not compassionate and trauma-informed, people can leave encounters feeling dismissed, invalidated or blamed. Some avoid seeking support in the future, others disengage from treatment or lose trust in healthcare services altogether.

Creating compassionate, trauma-informed healthcare is about more than improving individual interactions.  It helps create cultures where staff can flourish, service users feel heard and supported, and compassion ripples out into families, communities and wider society.

Summary

Compassionate trauma-informed healthcare is not only about reducing harm and improving service user outcomes.  It’s about creating conditions where people, teams and organisations can work, heal and thrive sustainably over time.

When people feel heard, understood and supported, they are more likely to engage with care, communicate openly, and participate in decision-making.  This can contribute to improved experiences, more effective care and better outcomes.

Creating compassionate, trauma-informed healthcare is about more than improving individual interactions.   It helps create cultures where staff can flourish, service users feel heard and supported, and compassion ripples out into families, communities and wider society.

Part two of this blog explores what can support the cultivation of compassionate trauma-informed healthcare, including compassionate leadership, nervous system regulation, self-compassion, embodiment, reflective practice and collective wisdom.  You can read part two here: https://unityphysio.co.uk/?p=8420&preview=true

You can find out more about my work in this area here: https://unityphysio.co.uk/services/compassionate-trauma-informed-working/

The post Understanding Compassionate Trauma-Informed Healthcare appeared first on Unity Physiotherapy and Wellbeing.

What is a Word of the Year?

I see a word of the year as a quality, a felt sense of something, or a way of being that you’d like to invite more of in the coming year.  It can act as a gentle guide — something to orient towards, return to, and weave into reflections throughout the year.

Choosing a word can be a gentle mindbodyspirit practice (no spaces intentionally here) — a way to invite deeper alignment, inner guidance, coherence, and attunement into your life.  It becomes a thread through your days, helping you notice where you are in relation to your intentions, values, presence, and the rhythms of life within and around you.

I’ve chosen a word of the year for many years now, and I’ve found it especially supportive when combined with my way of living –in a mindful, compassionate & values-aligned way.

In 2025 I also began choosing a word of the month – each connected to my main word of the year.  Having both has felt nourishing and grounding, and has been helpful on a variety of ways.

Part of the how I choose my yearly word is by reflecting on the year that’s coming to a close.  This often includes exploring:

• What felt supportive?
• What went well?
• What was challenging?
• What do I want to invite more of
• What could I let go of?

Reflecting on the Year & Choosing Your Word

For me, this process begins mid-autumn and completes around the winter solstice – although my word often arrives earlier.  I reflect in a compassionate, somatic way: combing body wisdom with cognitive understanding, embodying my compassionate self.

Reflection can reveal what you would like to carry forward into the coming year — strengths, qualities, practices — and what may be helpful to let go of.  This can naturally lead into choosing a yearly word, a seasonal word, or words of the month.

End-of-year reflection can be really grounding and clarifying, though only if it feels okay for you.  Some people find it supportive; others may feel overwhelmed, partly depending on what is currently happening in life.

There’s no right or wrong way to reflect, and there’s no pressure to do it at all.  There’s also no set timing.

This time of year naturally calls us towards slowing down and turn inwards — especially when we tune into the seasonal rhythm of winter.  The commercial pace of Christmas can pull us in the opposite direction, but reflecting (in whatever form) can be an invitation to gently pause.

As we reflect it can be helpful to remember our shared humanity – every year contains challenge and difficulty, and also moments of things like joy, connection, love, wonder and support; each in varying amounts.  All of this is part of being human.

Somatic ways to reflect:

As you reflect, notice:

• What sensations are present
• What feelings and thoughts
• What your breaths like

You might explore by:

Travelling back through the year & noticing what events arise naturally — and how they show up in your body.

Exploring the strengths and resources that supported you in challenging times & what helped you to thrive.  Maybe also noticing what else could have been supportive, or what strengths it could be helpful to build upon

Consider which practices, strategies or resources were helpful — and what might support you in the future.

Look at the year as a whole, or in quarters, noticing: what was nurturing, what supported your energy & what drained it; and whether a word, image, colour, or piece of music captures your year.

Reflecting on your values — how they guided your choices, how have they been present, and where you’d like more alignment

Journalling in whatever way feels supportive

You can find more journalling ideas in my blog:  https://unityphysio.co.uk/end-of-year-journalling/

How to Explore Your Word of the Year

There are many ways to approach this. You might reflect first, or go straight to exploring possible words. There’s no right way.  Choose whatever feels right for you — there’s no rule.

Here are some steps you can use as a guide:

Reflect on the year

If it feels supportive, you might use journalling or the practices above.

Consider what you’d like to invite more of into your life

Write down any words that come to mind — qualities, feelings, ways of being.  Questions you could explore:

• What would support me?
• What would I like to cultivate or build upon?
• What does next year call me towards?

(The word cloud image below might give inspiration — there are many more word possibilities, including flourish, thrive, confidence & flow)

Notice how each word feels in your body

Pause with each one:

•  What sensations arise?
• What is your breath like?
• What thoughts and feelings show up?
• How do you experience this word?

Circle up to five words that feel most alive

Spend time with each one.  Sense and imagine how how each word might support you over the coming year.  Sit with them a little while and then let them be — often a word will make itself known.

If you haven’t chosen a word yet, give it space

Return to your list of narrowed down words over the coming days or weeks.  You might explore:

• How does each word align with my values?
• How would each word support the way I would like to show up for myself and others?
• How might they have supported me this year?
• How could it help having more of this?
• What small daily intentions could each one encourage?

Check in again

Sit with the word you’ve chosen, or the few you’ve narrowed it down to (if it hasn’t quite landed yet).  Notice:

• How do you experience this word, what do you notice as you focus on it?
• What sensations. emotions, or thoughts arise?
• Does it feel aligned with your values and your heart?
• Is it resonating with you?
• Is it a gentle yes, or a clear no?
• Does it feel like a warm, welcoming invitation to explore the coming year with?

It Doesn’t Have to Be a Whole Year

You might choose:

• A word for the first quarter
• A seasonal word
• A monthly word
• Or a yearly word supported by monthly ones

All of these can be equally supportive.  The invitation is simply to choose what feels nourishing, grounding, and helpful for you.

Summary

There isn’t a right or a wrong way to do this.  It’s about intention, compassionate awareness, curiosity, orientation, gentle guidance; and a way of listening inwardly as you approach the coming year.

If you choose to explore a word this year, I hope the process feels spacious, compassionate and rooted in your own wisdom.

The post A Somatic & Compassionate Guide to Choosing a Word of the Year appeared first on Unity Physiotherapy and Wellbeing.

The Window of Tolerance is a model of nervous system regulation developed by Dr. Dan Siegel.  It describes the optimal zone of arousal – the state where our physiology is balanced, we feel settled enough to connect with others, we can explore, learn and grow.  Inside the window emotions and challenges are tolerable, and we can respond rather than react – we can cope with life stressors.

Either side of the window are two dysregulated states — hyperarousal and hypoarousal.

• Hyperarousal is the fight or flight response, driven by the sympathetic nervous system.  Here we may feel, for example, anxious or agitated, or on high alert – our physiology is dialled up
• Hypoarousal happens when something is too much for too long, it’s the parasympathetic nervous system without the “vagal brake”, and we lack the enough mobilisation of the sympathetic nervous system that we need to function effectively day to day (this is not the same as the fight or flight response which of course we need too!).

Each of the three zones is associated with different emotions, thoughts, feelings, behaviours and physiology.  The window isn’t only about our emotions, it’s about the body and behaviour too – it’s about the whole person and being able to function in a balanced, or efficient, way aS much as possible.

The aim isn’t to stay in our window all of the time – that’s not realistic.  Instead, we can over time learn to spend more time there, gently expand the window and recognise its edges (a place of growth).  These edges are sometimes called our stretch zone: where we are challenged but not overwhelmed.  I’ve created an infographic below which illustrates these states.

(You’re welcome to use & share this infographic – please keep the copyright & logo visible so the work is credited)

(You’re welcome to use & share this infographic – please keep the copyright and logo visible so the work is credited)

Returning to Regulation

To return to regulation we first need to notice:

• What’s present and what the nervous system state is (hyperarousal, hypoarousal or in our window)
• The signs that we are moving beyond the edge of our window into dysregulation.

There are some suggested practices for hyperarousal and hypoarousal below:

Practices for Hyperarousal

• Compassionate awareness of what’s present
• Somatic tracking (either with a sense of safety noticing and tracking an unpleasant sensation, or leaning into a pleasant of neutral sensation)
• Breath practices, for example diaphragmatic soft slow nose breathing (normal breathing), Buteyko recovery breathing, extended exhale, coherent breathing, bee breath
• Grounding practices, for example the 5-4-3-2-1 practice, or noticing your feet on the floor and gently swaying if gentle movement feels accessible
• Connection with others
• Time in nature in a way that feels soothing or settling
• Soothing self-touch
• Soothing music or nature sounds
• Rhythmic movement, for example somatic shaking, walking, dancing, jogging, or swimming.  Other movement for example stretching
• Humming
• Sensory stimulation, for example a soothing essential oil, listening to soothing music or nature sounds, touching objects with a soothing texture or temperature, looking around and naming objects
• Self compassion practices
• Let be, let go let in (I’ve written more about this here: https://unityphysio.co.uk/the-mindful-compassion-based-5-steps-stress-awareness-management-model
  

Practices for Hypoarousal

• Mindfulness and somatic techniques, for example tapping, squeezing, or self-massage
• Energising movement, for example walking, stretching, jumping, somatic shaking, swimming, anything to energise the body that feels accessible and within tolerance levels
• Sensory stimulation, for example the smell of coffee, an essential oil, or another strong scent, touching objects with different textures or temperatures, looking around and naming objects, uplifting sounds, eating something salty/cold/crunchy, drinking a cold drink with a straw
• Cold shower or splashing cold water on face
• Stimulating breath practices
• Time in nature, gently connecting with energising elements
• Walking barefoot on a safe surface (grass is one option)
• Grounding practices. for example the 5-4-3-2-1 practice
• Self-compassion practices

Expanding the Window

We can expand our window by understanding and noticing the early signs from our body of being at the edge of our window and gently working here in a way that feels safe enough.  I often describe it as having one foot (or even a toe) outside the window and the other in regulation.  This supports nudging the window in a way that feels possible.

“Expanding the window isn’t about staying regulated all the time – it’s about awareness and finding enough safety at the edges, and returning from dysregulation with more ease”

Some ways I support people in expanding their window includes:

• Awareness of the edge of the window
• Somatic and embodiment practices (e.g. somatic tracking, somatic check-in)
• Meditationand mindfulness-based practices
• Compassion practices
• Mindful language and reframing
• Downregulation practices to support regulation after nudging hyperarousal
• Learning to trust the body
• Holding outcomes lightly
• Supporting connection with others
• Lifestyle changes, such as pacing of activities, including some restorative rest each day, good quality sleep and a healthy balanced diet.

In Summary

There are many things that support regulation — awareness, compassion, and regular practice are key. Expanding the window also takes gentleness, patience and time: finding what’s best for you, listening to your body’s signals, and trusting the wisdom within.  Remember, the aim isn’t to stay in the window all of the time – over time, we want to be able to return to it with greater ease, and to gently expand it.

You might like to reflect on:

• What are the signs of being in each of the three zones of the Window of Tolerance?
• What are the signs of being at the edge of your window, and what helps you to keep a foot in regulation?
• What supports you in returning to your window from hyperarousal or hypoarousal?
• What helps you expand your window over time?

The post The Window of Tolerance and Chronic Illness appeared first on Unity Physiotherapy and Wellbeing.

Somatic tracking is a mindfulness-based practice.  It involves gently bringing attention to physical sensations with a sense of safety, curiosity, and without judgement or expectation of a particular outcome.

It draws on principles from a mindfulness, somatic experiencing, interoception neuroplasticity research and pain neuroscience education.  The term “somatic tracking” was coined by Alan Gordon, who developed Pain Reprocessing Therapy as a way to change how the brain interprets signals from the body.  This approach supports nervous system regulation buy modulating the threat system and inviting a felt sense of safety.

How Somatic Tracking Helps

Somatic tracking helps build safety in the body.  It supports retraining the nervous system– not by trying to “fix” or change sensations, instead by changing how we relate to them.   Rather than controlling or eliminating what we feel, the practice encourages a gentle, curious, compassionate relationship with our experience.

It can also be used with emotions and thoughts by focusing on the physical sensations associated with them, and meeting those sensations with the same curious, gentle focus.

This practice can support:

• Inner awareness
• Emotional regulation
• Pain & symptom management
• Retraining the nervous system
• Changes in how symptoms are experienced

Sometimes it may even contribute to the resolution of symptoms – though resolution is not the goal of the practice.  The core aim is to shift how we relate to sensations with greater curiosity, non-judgement, gentleness, and safety.  By observing without trying to fix or control, we open space for the nervous system to recalibrate.  The body can begin to be experienced as a source of wisdom, rather than a problem to solve.

My Approach to Somatic Tracking

My approach grew from my own personal practices, and my training in:

• Trauma-informed practice
• Compassion-based practices
• Mindfulness and meditation
• Yoga
• Somatics and embodiment

I was using these elements long before I encountered Alan Gordon’s work.  I didn’t call it “somatic tracking” at the time, but his framework helped me shape and name one of my practices more intentionally.

Key Elements of Somatic Tracking

I see the core elements of somatic tracking as being:

• Intention to be curious
• Outcome independence (holding outcomes lightly)
• Letting go of having an agenda – there is no goal, and the aim is not to “get rid of” a particular sensation
• Mindfulness – observing gently with curiosity.  The way you might if watching a sunset, or clouds in the sky
• Noticing how sensations naturally change
• Cultivating a felt sense of safety
• Acceptance of what’s present, just as it is, in this moment

How I Guide Somatic Tracking: Practice Steps

1. Settle and Ground

Find a quiet space and settle into a comfortable position.

Notice your feet on the floor and the parts of your body that are supported by the ground or chair.   As you notice this support, you may notice a sense of being supported or held – and what this feels like in your body.

Set an intention to be compassionate and curious throughout the practice.  Take a few breaths and check in with how you’re feeling overall — noticing sensations, breath, energy levels, thoughts and emotions, and how this all shows up in your body.

2. Bring Your Attention to the Body

Gently notice a sensation of discomfort, tension, or pain that you’d like to focus on.  This could be tightness, tingling, throbbing, or anything else.

You can also do this whole practice with neutral or pleasant sensations.  This can be the place to start if it’s too activating to focus on discomfort/pain to begin with.

If you’re working with discomfort/pain, keep the intensity around 3–4 out of 10 (no more than 5).  Stronger sensations can make it harder to slow down, and stay present with curiosity.

3. Observe with Curiosity

Let your attention rest on the sensation, without trying to change it.

You might notice:

• Where it is
• It’s size or shape
• It’s temperature or texture
• Any other qualities
• If it shifts or stays the same

4. Notice Your Responses

If thoughts or emotions arise acknowledge them gently.

You might label them (“thinking,” “worry,” “criticism”) and return to the sensation.  Alternatively, if it feels helpful, you can also bring your attention to the physical sensations associated with the emotion or thought, using the same compassionate, curious awareness.

5. Stay Connected to a Sense of Safety

Consciously connect with a felt sense of safety, messages of safety, or a sense of “okayness,” if needed.  This supports paying attention from a place of feeling settled/safe.  One option is you might remind yourself:

“This is simply a sensation. It’s safe to feel.”

Let your attention be soft and compassionate, not effortful.

6. Close with a Somatic Check-in & Safety

Notice how you feel now compared to when you began.

If it feels right, gently shift your attention to a neutral or pleasant sensation — such as the rhythm of your breath, the warmth on your hands resting on your body, or a sense of ease in the body.

Observing this with the same soft, curious awareness.  This can help reinforce a felt sense of safety, ease, settling, and integration.

Take a few moments to move gently if needed.

7. Journal if helpful

Write down any reflections, or insights if that feels supportive.  This can deepen awareness and integration.

Interested in Exploring Somatic Tracking More?

I offer a guided Compassionate Somatic Tracking recording for the people I work with one-to-one, and in relevant group workshops.  You’re welcome to reach out if you’d like to explore this practice more deeply.

The post Somatic Tracking: A Mindful Body-Based Practice for Nurturing Safety appeared first on Unity Physiotherapy and Wellbeing.

This blog offers a compassionate trauma-informed introduction to nervous system regulation – what it is, why it matters, and how trauma and chronic stress can impact it.  We explore protective responses like fight, flight, freeze, and fawn, and share trauma-informed nervous system regulation frameworks such as Polyvagal Theory and the Window of Tolerance.  You’ll also be introduced to my own Compassionate Nervous System Regulation Framework, Polyvagal Theory infographics, and further resources that can support the journey back to balance, safety, and connection.

What Is Nervous System Regulation?

Nervous system regulation often refers to the state and balance of the autonomic nervous system (ANS).  This system controls automatic bodily functions like heart rate, breathing, digestion, and our stress responses.  Of these, breath is unique, as we can also influence it consciously.

The ANS is a network of nerves that extend throughout the body, with neurons originating in both the brain and spinal cord.  Two key brain regions involved in its function are the hypothalamus and the brainstem.  The ANS has two main branches: the sympathetic nervous system (SNS), which activates the fight-or-flight response, and the parasympathetic nervous system (PNS), which supports rest, digestion and restoration.

There’s also a third division: the enteric nervous system (ENS).  While it’s technically part of the ANS, it can also function independently and is often referred to as our “second brain.”  It governs digestion and communicates with the rest of the ANS, especially via the vagus nerve – the main part of the PNS, making up about 75% of it’s nerve fibres.  Like the rest of the nervous system, the ANS communicates through a complex network of electrical signals and chemical messengers.

The ANS is a functional division of the peripheral nervous system, which connects to the central nervous system (the brain and spinal cord).   When we talk about nervous system regulation, it’s broader than the ANS alone – everything in the body is deeply interconnected.

It’s important to understand: it’s normal to move in and out of regulation throughout the day.  No one lives in a perfectly regulated state all the time, and that’s not the goal.   Life includes challenges, and our nervous system is designed to respond.  Sometimes it may over-respond, but that’s still it doing its job based on previous experiences.  With time and support, the system can learn when we are safe, helping the threat response settle more easily, when the environment is actually safe.  The aim isn’t to avoid dysregulation, but to notice when it happens and gently support ourselves in returning to balance, again and again.  This helps build nervous system efficiency, capacity, and resilience.

Understanding our nervous system, gently coming home to a regulated place, and befriending the body can support many things including healing & thriving.

My Working Definition of Nervous System Regulation

When I talk about nervous system regulation, I’m not referring to being calm all of the time or never getting dysregulated – this is normal and part of being human (though when we are dsyregulated too often/too much, and struggle to return to regulation, is when it’s problematic).  Regulation isn’t a fixed state – it’s a dynamic process.

To me, helpful nervous system regulation means having the ability to move flexibly between different states, in response to life’s demands and stressors. It’s about matching the level of arousal to what’s needed in the moment – and being able to return to a more regulated state with some degree of ease when dysregulation happens.  This supports a sense of safeness, connection, optimal functioning, growth, and healing.

Understanding Dysregulation: The 5 F’s

When we experience threat/stress in general, chronic stress or trauma our nervous system shifts into protective states that help us survive.   These protective states are referred in different ways, one is the 5 F’s:

• Fight – activation of the SNS (mobilised)
• Flight – activation of the SNS (mobilised)
• Freeze –blends SNS activation (mobilised) with the PNS (immobilised), initially this is state is SNS driven – we are mobilised with physiological changes that are needed to flee or fight e.g. an increased heart rate and muscle tension.  It’s a brief pause whilst the options to get to safety are assessed automatically and quickly, if there is no escape we begin to shift into a state of dysregulated immobility (flop).  Freeze can be understood as part of a spectrum – with a more activated freeze at one end and flop (shutdown) at the other
• Flop – this is a shutdown state, it is the body’s last resort for protection when there is perceived to be no escape
• Fawn – this is also referred to as appeasing, the protection response is to please and pacify the threat for safety.  It’s a complex blended state of fight/flight and freeze

At its core, nervous system regulation is about returning to a place of balanced physiology and a sense of safeness after being in one of the dysregulated states.  It’s important for us all to be able to re-regulate quickly and efficiently, with some level of ease.  This can be challenging for people who have experienced chronic stress or trauma, and/or are struggling with chronic health conditions such as ME/CFS, PoTS, fibromyalgia, or Long Covid – dysregulating more easily, taking longer to return to regulation and getting stuck in dysregualtion, over time this can be changed.

Why Regulation Matters

The good news is that your body knows how to come back to regulation – it knows the way home.  Sometimes, it simply needs compassionate, trauma-informed support, this is part of my role in my work – to walk alongside people in the journey to remembering the innate state of regulation and connection.

Nervous system regulation is a foundational aspect of how we feel, think, move, and relate to others.  For example, when we are in a fight or flight state (SNS) our experience may include anxiety, restlessness, difficult concentrating and a racing mind, we may be impatient, there may be insomnia, stillness may be difficult and movements are likely to be quick.  When your nervous system is dysregulated, it can affect everything, including:

• Sleep and rest
• Pain and fatigue management
• Emotional resilience
• Concentration and memory
• Your ability to connect with others

Nervous system dysregulation is not a sign of weakness—these responses are wise protective responses, however, when they persist beyond the original threat, they affect our health and wellbeing and limit our ability to thrive – we can move from surviving to thriving.

What Regulation Isn’t

Nervous system regulation isn’t about pushing through, ignoring or fixing symptoms. It’s about learning to:

• Feel safer in your body
• Gently restoring balance
• Expanding capacity to be present and grounded even when life is challenging

Various things support nervous system regulation including understanding it, along with  trauma-informed, compassionate, and somatic approaches – to support shifting out of survival mode and into a state where healing, connection, and thriving become possible.

We are social beings, nervous system regulation enables us to co-regulate—to be present, steady and attuned with others, both in our work and with the children and loved ones in our lives.   It’s especially important with children as initially they can’t regulate themselves initially and then they learn to self-regulate from co-regulation.

The Nervous System Regulation Tools and Models I Use

The tools I use are grounded in compassionate trauma-informed care, compassion and mindfulness-based practices, somatic and embodiment practices, and clear frameworks that help to understand and support the nervous system with compassion and clarity in sustainable ways.  The main frameworks I use are:

Window of Tolerance

This was developed by Dr. Dan Siegel, this model describes the optimal nervous system state (the Window of Tolerance) which is sometimes referred to as the optimal zone of arousal, where we are settled/safe, alert and engaged, and the two dysregulated states either side of it (hyperarousal and hypoarousal).  Hyperarousal is the fight or flight response and hypoarousal is dorsal vagal in Polyvagal Theory – the parasympatehtic nervous system without the vagal brake and without the mobilisation of the SNS that we need to function day to day (this is not the same as the fight or flight responses of the SNS, which of course we also need!).  The aim isn’t to be within our window all of the time, instead to know how to stay there as much as possible and keep gently expanding the window over time.  The edges of the optimal zone are our stretch zone, here we can learn and grow.

There is a Window of Tolerance infographic I created below and a few links to more information on this model.

A helpful short video about the Window of Tolerance by Lewis Psychology https://m.youtube.com/watch?v=TNVlppGz0zM

A helpful Window of Tolerance blog by Dr Sarah Davies https://www.drsarahdavies.com/post/what-is-window-of-tolerance-emotional-regulation-model-explained

Polyvagal Theory

Developed by Dr. Stephen Porges, this theory explains how the autonomic nervous system moves between:

•  Ventral vagal (safety, connection & social engagement)
•  Sympathetic (fight/flight, mobilisation)
•  Dorsal vagal (shutdown, immobilisation)

Understanding and mapping these states helps us better understand our nervous system and gently support return to regulation.  The three main states are shown in the first infographic below and the two blended ventral vagal ones are shown in the second infographic (please feel free to share these infographics, kindly ensure the credit is visible).

A helpful blog about what Polyvagal theory is by the Polyvagal Theory institute https://www.polyvagalinstitute.org/whatispolyvagaltheory

A useful video on Polyvagal Theory by Lewis Psychology https://m.youtube.com/watch?v=SlhFrBoEnxU

The Three Circles Model (The Three Emotional Systems Model)

This is part of Compassion Focused Therapy and was developed by Professor Paul Gilbert.  The three emotional systems in this model are:

• • Threat (protection and safety seeking system, activating/inhibiting)
  • Drive (incentive/resourced focused system, pursuing and achieving, activating)
  • Soothing (connection, safeness & care, non-wanting/affiliative)

No one of these systems is good or bad, we need them all, the aim is for them to be in balance.  Many people I work with have overactive threat systems and underactive soothing systems, which is a very common pattern partly due to the way our society is in general.  One of the ways I use this model is to support people in growing the green (the soothing system) with practices and strategies that feel safe, nourishing and sustainable.

Trauma-Sensitive Mindfulness (TSM)

TSM was developed by David Treleaven, and I have completed his Advanced Trauma-Sensitive Practitioner training.   It’s grounded in the 4R’s of trauma informed practice:

• Realising the widespread impact of trauma
• Recognising the signs and symptoms of trauma
• Responding with informed, supportive practices
• Resisting (or avoiding) Retraumatisation

You can read more about the 4 R’s on my Trauma Informed Practice page: https://unityphysio.co.uk/services/trauma-informed-practice/

Mindfulness can be a powerful tool for nervous system regulation—when it’s offered safely. I use mindfulness in a trauma-sensitive way: the practices are choice-based, gentle, and paced to meet each person’s needs.  Regulation, choice, and empowerment are central to this approach.

My Framework: A Compassionate Path to Regulation

In both my workshops and 1:1 sessions, I use a visual framework that I developed to support regulation through compassionate awareness and curiosity.  It’s non-linear – each element is interconnected, and many experiences may sit in more than one circle at a time.

The process usually begins with noticing your internal state through compassionate awareness with a gentle curiosity.  From there, you might explore settling, grounding, letting go, or receiving what feels nurturing and supportive.  Each part of the framework reinforces the others, helping you reconnect with safety, presence, compassion and self-trust at your own pace.  Over time, this helps build your capacity for regulation, connection, and thriving.

There’s no one right way to move through this—it’s a path of compassionate awareness and curiosity that you can return to again and again.

Summary

Nervous system regulation is a vital, ongoing process of gently returning balance for us all, and is especially important with chronic health conditions, or healing from chronic stress or trauma.  It isn’t about fixing ourselves (we are all already whole)—it’s about gently understanding our bodies, restoring balance, and reconnecting with a felt sense of safety and compassion towards ourselves, others, and the world around us.

Understanding protective responses and using compassionate, trauma-informed frameworks, supports us in reconnecting with safety, regulating and building nervous system capacity, and moving from surviving towards thriving.  This journey is unique for each of us, and it’s important that it’s grounded in curiosity, patience, compassion and kindness toward ourselves and others.

Would You Like to Explore More?

If you would like to explore nervous system regulation more take a look at:

Nervous System Regulation https://unityphysio.co.uk/services/nervous-system-regulation/

You can also book a free 15 minute discovery call to see if this work feels like a good fit for you 1:1, alternatively you are invited to take a look at my 4-week nervous system regulation workshop series on:

The Awakening The Body’s Wisdom: A Somatic Workshop Series https://unityphysio.co.uk/services/awakening-the-bodys-wisdom-somatic-workshops/

The post Nervous System Regulation: A Gentle Path to Coming Home to Your Body appeared first on Unity Physiotherapy and Wellbeing.

Stress often gets a bad press, which is because it negatively affects our health and wellbeing when it’s certain types of stress, prolonged and repetitive.   Stress is part of our daily life in many ways and some of it we need for adapting including the stress from exercise.  Chronic, or ongoing stress, also impacts chronic health conditions, it amplifies pain, fatigue, gut issues, anxiety and other symptoms.

Many things contribute to stress, including health inequalities, which I’m not going to go into in this blog.  There is also often a negative perception of stress and a stigma associated with it which isn’t needed or helpful.  I’m not going to go into this because it would be a whole other blog, however it’s important to mention that being stressed isn’t a weakness and recognising it and taking action is a strength.

We cannot change stress if we aren’t aware of feeling stressed, or we don’t notice when stress is increasing and/or are not aware of the factors that we can influence.  The rest of this blog will focus on my compassionate mindful 5 steps stress awareness and management model which can support stress awareness and management, and optimising health & wellbeing, alongside lifestyle factors, including: exercise/movement, diet, sleep, time outside, and connecting with others and nature.

The 5 steps stress awareness & management model

1. Slow down & pause

2. Awareness – Notice what’s present in the body (somatic check-in) with compassion & curiosity

3. Let Be –  allow what’s present as it is without judgement as best you can, noting how things ebb & flow

4. Let go – let go of what does not serve

5 Let in – choose what’s helpful, what you would like to invite more of.  Connect to what’s nurturing & supportive, and focus on this.

Using this model we start by slowing down and pausing, perhaps noticing the feet on the floor and the position of the body (eg sitting or standing).  It can also be helpful to connect to an intention to notice how we are and what’s present with a compassion and curiosity.

Step 2 is noticing what’s present in the body (a somatic check-in), this includes how the external environment is impacting our physiology, for example the nervous system state.  Doing a somatic check in creates an embodied awareness of what’s present.   A somatic check-in can include noticing what sensations are present where, what the breath is like, what energy levels are like, what thoughts & feelings are present and how they show up in the body.

Step 3 is letting what’s present be, allowing it to be as it is as best you can with compassion and curiosity, and also noticing how things ebb and flow.   Acceptance of what is present is part of this, there are many misconceptions about acceptance, it doesn’t mean liking or wanting something, nor does it mean something won’t change, and it’s not a one off thing (it’s an ongoing relational process).  Alongside allowing and accepting we can also notice how what we are paying attention to changes moment by moment, everything’s always changing.   To be with what’s present and allow it we need to have a wide enough window of tolerance, this could be seen as nervous system capacity to maintain some regulation with the impact of stressors, this is something that we can expand over time.  We also need to know what helps us keep a foot or at least a toe in some regulation whilst we are being with what’s present when it includes suffering or things that are challenging.  If our window of tolerance is narrow and we don’t know what anchors us in regulation, what supports us to stay settled and grounded enough (regulated enough) we will become too dysregulated to be with what’s present, mixed with previous experiences, and can become overwhelmed.  We need a number of things to support being with suffering especially compassion, courage, nervous system regulation and a sense of safety in the body.  The being with what’s present and listening to the body often holds much wisdom, this can guide us towards what’s helpful.

Step 4 is letting go of what does not serve us.  This is not always an easy process and can take some time, it’s not necessarily a one off in the moment thing, nor a do one practice and we have magically let go of something, although sometimes it can be like this (usually when there has been prior work with something).  Letting go can be related to a variety of things including worry, self-criticism, impatience, unhelpful beliefs, unsupportive/unhealthy habits and excess tension in the body.  Things that support letting go include the wisdom from within the letting be step, embodied movement, other somatic and embodiment practices, breath practices, compassion practices, compassionate phrases/mantras, meditations, visualisations, and other things like journalling.  As well as needing some nervous system regulation to be with and let go of what does not serve us the process of letting go usually creates more nervous system regulation.  We can also purposely use practices to support regulation as part of letting go which can support the process.

Step 5 is letting in what supports our health & wellbeing and being able to thrive.  Letting in what’s nurturing or supportive can include many things, for example: noticing a sense of ease, spaciousness, or freedom from letting go of tension in the body, or through connecting to a slow soft smooth breath; noticing a sense of being cared for/loved; recalling a sense of being appreciated; noticing kindness and being kind to others; connecting to a sense of what you can do being enough; and moments of joy.  In this step we aim to take in the nurturing moments as they happen and/or recall them, letting them soak in and noticing how this impacts us, for example a change in breathing or nervous system state.  This is what Dr Rick Hanson calls ‘Taking in the good.’  One of the things you can do here is consider what you would like to invite more of into your life, for example more connection, more kindness, or more strength.  We can choose to embody what’s helpful here, for example self-compassion, a gentle strength, a sense of ease, or feeling cared for.  With regular practice of letting in what’s nurturing and supportive, letting in the ‘good’, it changes our whole being.  It impacts our physiology, how we relate to ourselves, others and the world and we are training our brain to take in what’s helpful, positive and nurturing.  This supports our health and wellbeing, whilst not pushing things away or ignoring them (the noticing and allowing steps) – there’s much wisdom held within these steps.  This letting in step could also including letting in the changes that with repetition become helpful habits.

This 5 steps mindful compassion based stress awareness and management model is really about connecting to the body, awareness, compassion, being with, letting go and letting in/bringing in what’s helpful/supportive/positive.  Compassionate awareness is foundational to this, and I think in many things if not in all things.  If we pay attention to what’s present with self-criticism, blame, or frustration it increases the stress, one of many reasons why compassion and awareness are like two wings of a bird, we need both to fly.  The model isn’t 1-5 steps that we rigidity stick to, we move back and forth between different stages, there’s a flow and flexibility within it.  For example, we might be working with letting go and then go back to noticing and letting be before going back to letting go again, or we might be working with letting in and go back to awareness and noticing and even more letting go, and there might not be a clear distinction between the steps always.

As mentioned at the start of this blog there are various lifestyle factors which support optimising our health and wellbeing and stress management.  Developing helpful habits by focusing one habit and one step at a time can be a helpful starting point, over time habits become a way of being.  You could also use this model to support developing habits that support health and wellbeing, I could write how but then this blog would be even longer!  Do let me know if you would like a blog with some tips for this.

If you would like to learn more about these steps in relation to the frame of compassion and compassionate mind training check out the ‘Compassion Focused Approach to Stress Management’ blog which I wrote for Balanced Minds https://balancedminds.com/a-compassion-focused-approach-to-stress-management/

Letting be, letting go and letting in has been a practice for me for some time, it will always be ongoing as part of a way of living and being, and I use it in my work.  I’m not sure if I developed this practice fully myself or if it’s something I picked up and from Dr Ricki Hanson’s work and modified in my own way based on all my learning and personal practices.  I always acknowledge other people’s work and where I get ideas from, in this instance I’m unclear if one of Dr Rick Hanson’s books or attending one of his workshops inspired this model and my work with ‘Let Be, Let Go, Let In’ so I’m mentioning it in case it did.

What do you think? Could this be a helpful model/practice for you for you? Maybe something like this is a practice, or part of a way of being for you already.

The post The Mindful Compassion Based 5 Steps Stress Awareness & Management Model appeared first on Unity Physiotherapy and Wellbeing.

The festive period commonly brings with it a lot of stress, a variety of feelings and emotions, decreased routine and lack of sleep and other things.  These are are things that can turn up the dial on pain and fatigue.  Strategies/tools/practices that help to manage pain & fatigue in general, to manage stress and regulate our nervous system can be helpful.  Practices/tools that can support stress management and nervous system regulation include:

• Breath practices
• Mindfulness & Meditation
• Self-compassion practices
• Being mindful of our language & reframing it (watch out for the ‘shoulds’, more on this a little later)
• Gentle yoga or other mindful movement practices
• Somatic practices
• Time connecting with nature

Commonly over the festive periods routines get thrown out of the window, people try and fit way more in than usual and more than they have capacity for, this is another reason symptoms increase.  There are different contributors to this including feeling pressure to do things a certain way, to do more & make everything ‘perfect ‘ at Christmas.   There’s no such thing as a perfect Christmas or a perfect anything for that matter, one of my wise sisters once said to me ‘it’s the imperfections that make us perfect.’  Christmas has become very over commercialised and there is quite a lot of unhelpful messaging that can make people feel they aren’t good enough unless the Christmas they have matches all the adverts and social media posts.  It can be helpful to remember that it’s only one day of the year and we can choose what we want to do on that day, it doesn’t have to be a certain way.

When managing any condition associated with pain and fatigue there needs to be flexible routine and pacing of activities.  By flexible routine I mean doing the things that support us each day though not in a fixed or prescriptive way.  For example, maintaining a sleep routine, eating food that supports health & wellbeing, pacing activities, using breath practices and other practices to support nervous system regulation, maintaining our boundaries, connecting with others and nature, and used in a way that meets what’s needed each day.

Sticking to your daily routine as best you can in terms of using the resources/practices that support you in managing the condition you’re living with is important, as well as setting some compassionate boundaries over the festive period.  Creating a flexible plan each day, prioritising and planning what you need and want to do, considering what’s realistic, what supports you, what’s meaningful to you, and consideration of what’s in the week ahead can all help with pain and fatigue management at anytime of year and is especially important with events like Christmas.

It can be helpful to explore our beliefs, expectations & our language, for example, noticing when we are we telling ourselves that we must do something, that we have to do something, that we should do more/should do something a certain way.  It’s quite likely that if you tend to overdo things that this language is appearing quite a bit, commonly there are a lot of shoulds (this comes from our threat system).  When you catch this language ask yourself where these come from & explore reframing the language.  For example, maybe reframing something from I have to do ‘x’ to I get to do ‘x’ and I’m going to ask for some help to make it easier.  Are your beliefs about Christmas supportive of your wellbeing & values?  It’s not always easy to reframe unsupportive beliefs, expectations and language sometimes support is needed to do this, especially when there is a history of trauma.

It’s important to know your toolbox of resources, knowing your resources and nervous system well can help you to choose which tools/practices are supportive each day, as well as bringing in additional practices to support you over the festive period as needed. It’s helpful to know what your energy nurturers are, what is restful for you and what regulates your nervous system so that these things can be included each day.  We all need rest and when living with a long-term health condition we need extra rest and more so if experiencing an increase in symptoms (often referred to as a flare-up).  The winter time is also the time we need more rest and the busyness that has now become a ‘norm’ of Christmas pulls us out of our natural rhythm with nature and our time for rest and restoration.

Things I see as foundational, are using mindfulness, self-compassion & listening to your body’s wisdom to guide management of pain & fatigue.  Mindfulness simply means being aware of the present moment, or being aware of our experience as we our experiencing it.  If we aren’t aware of what’s happening and how we are then how can we take helpful action?  The way in which we pay attention matters too, it is important that we are aiming to be compassionate and non-judgemental.  Turning a loving awareness towards ourselves is most supportive and it takes ongoing practice.  Being mindful of what’s present in our body in a compassionate way means that we can hear our body’s wisdom and we can use this to guide our choices.

Here is a summary of tips (there are more than I have written about above, the blog would have got rather long if I wrote a bit about each tip!):

• Have a flexible daily plan
• Have a flare up plan (what supports settling systems down)
• Pace things in a way that supports you (5P’s to remember planning, prioritising, play & purpose, problems solving.  My blog on pacing for pain is linked at the end of this blog)
• Take regular rest breaks
• Check-in with your body regularly
• Listen to your body’s wisdom
• Practice self-compassion
• Be kind to yourself
• Remind yourself what you can do is enough
• Include what’s meaningful each day
• Connect to a sense of playfulness
• Set compassionate boundaries (it’s ok to say no)
• Communicate what’s possible
• Ask for help when needed (asking for help is a strength not a weakness)
• Use daily practices that support you
• Use nervous system regulation practices (for example breath practices, meditation, mindfulness, yoga, somatic & embodiment practices, self-compassion practices, singing/humming)
• Prioritise sleep, rest & restoration
• Manage stress
• Communicate with family & friends
• Reach out for support
• Connect with others & nature
• Spend a little time outdoors each day if you can, or look out of the window & see what you can notice
• Remind yourself Christmas doesn’t have to look or be a certain way
• Explore beliefs & expectations, reframe them if it’s helpful & possible
• Watch out for ‘I should…’, ‘I have to…’, ‘I must…’
• Connect to a sense of joy, wonder, vitality and other nurturing feelings each day

The tips with this post can be helpful for us all and are especially important when living with persistent pain & other conditions.  You don’t need to do them all, trying to change too much at once often has the opposite impact, instead pick one or a few things that feel helpful for you and take action on them.  Maybe you have some tips you would add, I would love to hear them if you do.

It’s important for us all to remember there is no such things as a perfect Christmas & whatever we choose to do is ok and whatever we can do is enough.

Here’s the link to the pacing for persistent pain blog mentioned in this blog (a lot of what is in the blog applies to ME/CFS and long covid too, though pacing for these is slightly different): https://unityphysio.co.uk/what-is-pacing-how-can-it-help-with-persistent-chronic-pain/

The post Managing Pain and Fatigue Over the Festive Period appeared first on Unity Physiotherapy and Wellbeing.

Some people like to use end of year journalling as part of reflecting on the year as it draws to a close.  Journalling can be helpful as part of reflecting on the year and see what’s gone well, what’s not been easy or challenging and what helped navigate these times, what’s been meaningful and other aspects too.   Some people like to reflect on the year and journal and others don’t, either way is ok.

As we reflect it is important that we notice what has been helpful, supportive or ‘positive’ as well as the more tricky and challenging times.  Our brains have a ‘negativity’ bias, this means that we will naturally remember the challenges and focus here if we don’t intentionally explore the ‘positives’ too.

This time of year is often a reflective time and when we align with nature seasons it’s a time for slowing down.  Our society and the commercialisation around Christmas tends to make people busier which can take us away for our natural need to slow down, turn a little inward, to rest and restore.

Before we look at different types of journaling and some tips I feel that it’s important to mention a few things:

• We all struggle and suffer sometimes and these will be part of everyone’s years to varying degrees, this is part of being human.  There will also be joy, connection, love, wonder and other nurturing emotions and feelings to varying degrees too
• There isn’t a right or wrong way to reflect or journal
• It can feel too much to reflect on the year, this is normal and it’s ok not to do it.  We can reflect and journal if it feels ok to do so and like it might be helpful for us and if not we don’t have to do it.

Types of Journalling

There are many types of journalling I have listed some of them below along with examples of how they can be used as part of end of year reflections:

• Free flow journalling/stream of consciousness journalling – this basically means writing whatever comes into your head even if it doesn’t seem to make sense.  Instead of choosing one focus like gratitude or feelings as journal prompts free flow journalling doesn’t have a focus and it is writing without editing
• Gratitude journalling – this is basically noticing and focusing on what you are grateful for.   For end of year journalling you could notice a few things that you are grateful for each month of the year as you explore the year that’s gone by and simply list them and/or use one, or a few of them as journalling prompts
• Art journalling – this type of journalling uses visual representations of things like your thoughts and feelings.  You could draw or find illustrations/visuals that you feel reflect your year as you review it
• Nature journalling – this type of journalling relates to what you are noticing in nature.  It can be combined with other types of journalling like art journaling.  One way this can be used is to gather nature pictures that you have from throughout the year and then journal with what arises through connecting with the picture memories, this may also lead into other types of journalling like what you are grateful for within the year
• Yoga journalling – this type of journalling is where people write in their journal after a yoga practice.  An example for end of year reflections could be to hold the intention to reflect and review the year, take this onto the yoga mat and then journal with any thoughts, feelings and insights that may have come up
• Strength based journalling – this journalling focuses on your strengths and exploring these through journalling.  For example, see if you can notice something that has helped you to thrive and/or manage the challenges this year and journal about this
• Values based journalling – this uses your values as a prompt for your writing.  One way to do this is to note down your core values and then journal with each value and how you brought it to life this year.  If you’re unsure of your values do a values exploration exercise first, there are some in my book, linked at the end of this blog
• Bullet journalling – this can be any sort of bullet point list.  For an end of year review you could list the things that you are grateful for, the values in your year, the strengths that helped you navigate challenges and helped you to thrive, and/or inspirational quotes that reflect your year.

There are many more types and you can blend different ones together and of course create your own journalling style

Questions for journalling:

Questions can be used as journal prompts, some examples for end of year reflections/journalling:

• What has gone well the last month/last few months/this year and why?
• What are 1-5 things that I am most proud of this year and why?
• What has been tricky or challenging & what have I learnt from this/what am I taking from it?
• What helped me navigate the challenges?
• What strengths helped me this year?
• What’s been supportive for me this year?
• What 1-5 things am I grateful for right now/over the last few months/this year?
• Did I set boundaries, did I stick to them and were they helpful?
• What’s created some balance, some ease, some stability this year?
• How have I related to myself most often this year? (For example, with self-criticism or self-compassion)
• Is my daily routine supportive of my wellbeing?
• What 1-2 things could I keep doing or start doing regularly that would make a difference to my wellbeing?
• What are my core values (3-5 values) and how have they been part of this year?
• What is most important to me & why?
• What do I want to take into the new year?  What feels welcome to have more of? (This ties in with word of the year if you do this)
• What would I like to explore more of, what qualities do I want to embody next year?
• What could it be helpful to let go of?

Journalling tips

Some people like to reflect prior to journalling and then deepen the reflection through journalling and other people prefer to journal first and then reflect more in some way, for example through a yoga or other somatic movement practice, and others prefer to do something like a yoga practice first and then journal.  There isn’t a right or a wrong with journalling or reflecting, it is simply what feels ok for you and what’s helpful.

Before starting reflection and/or journalling I suggest people do a somatic (body) check-in and notice how they are.  The way I guide a somatic check-in is by encouraging connection to the body with compassion and curiosity to notice what’s present, for example noticing sensations, energy levels, the breath (if it’s ok to notice this), what thoughts are present and how they show up in the body.  I also encourage people to reflect and journal in a somatic way, this basically means noticing the bodies reactions, the body’s wisdom as you reflect, for example, what sensations do you notice, what’s your breath like, is there a temperature change, how are you feeling, what do you notice where in your body?  Without doing this we are only reflecting on a head level and this means we are missing important information and the body’s wisdom.   It is important to slow down and pause regularly, this can help us to notice what’s present in the body and increases our awareness and understanding

I encourage people to journal and reflect with compassion and curiosity, holding the intention to be curious and compassionate can be part of this.  As well as holding this intention you can connect to your compassionate self to support with journalling in a compassionate way, there are various exercise available that can guide with this.  There are a few in my book and there are some audios freely available like this one by Dr Shelley Kerr: https://on.soundcloud.com/kSyVQUZu923v9HYz7

It can also be helpful to use soothing rhythm breathing from compassionate mind training, this can be used as part of connecting to your compassionate self or simply to connect to your body, settle and slow down.  I have an audio freely available for this here: https://on.soundcloud.com/kqJdxtjerKGMUHBq6  There are a number of other soothing rhythm breathing practices freely available, you can find a few of them here: https://www.compassionatemind.co.uk/resource/audio

If reflecting on the whole year feels overwhelming consider what feels ok, perhaps exploring the last month or last few months, or something else that feels better to you.  If nothing feels ok and it feels too much don’t do it and perhaps reach out for some support instead.

One way you can reflect using end of year journalling is by reflecting back on the year by moving back through time from now and noticing what events/memories come to mind and what is present in your body, noting feelings or something else down in your journal.  Once you have reviewed the whole year you could choose a common feeling to journal with, or use some things that you are grateful for that have come to mind.  If journalling on the whole year feels too much you can split it into chunks, maybe quarters.

When you have finished your reflection one of the things you may wish to explore may be what would it be helpful to have more of in the following year, what would support you and what may you wish to let go of.   You can journal with these as prompts as well.  What you wish to have more of can be used as a word of the year (or words) for the following year, something I see as a kind of gentle guide.

Summary

• There are many types of journalling and you can blend different types together
• You don’t have to use a specific journalling type you can create your own approach
• You can review the whole year working backwards from now or split it into chunks, for example review each quarter
• Do a somatic check-in before beginning and during the journalling
• Slow down, this helps you to notice what’s present in the body
• Go at your own pace and take breaks as needed
• Use the body’s wisdom along with the minds understanding in your journalling
• Hold the intention to be curious and compassionate
• Connect to your compassionate self and use soothing rhythm breathing if these feel helpful for you
• Journalling can be combined with yoga and other somatic practices
• You could explore what it would be helpful to invite more of in the following year, what would build on your strengths & resources and support your wellbeing
• There isn’t a right or wrong way to journal or reflect.

In this blog I mentioned that there are some values exercises in my book you can find the book here: https://www.amazon.co.uk/Dancing-through-Life-Guide-Living/ dp/B08P1CFDNW/ref=mp_s_a_1_4? crid=3EHSYPASVND90&keywords=ann+parkinson+book&gid=1671047573&sprefix=ann+patkinson+ %2Caps%2C65&sr=8-4

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There isn’t an agreed definition of pacing, I would define it as flexible way of structuring your day in a way that supports both function and wellbeing.  Pacing essentially means breaking down tasks and activities into manageable chunks with consideration of the different types of activities, including enough short rest breaks in your day and flexibly adjusting things each day/throughout the day as needed.  Pacing needs consideration of different activity types, for example what activities are more physical/cognitive/emotional and how they impact you.  It needs a number of things which I will touch on in this blog, especially awareness, compassion, noticing what’s present in our experience within our body (what’s embodied), flexibility, knowing our values & what’s most meaningful, and exploration.

Pacing is helpful for us all and more so when living with persistent pain and/or other health conditions.  A quick note here, pacing for persistent pain is similar and different to pacing for ME/CFS and long covid (where post exertional malaise is present), this blog is focusing on pacing when living with persistent pain.

The way I suggest exploring pacing with the people I work with includes discussing what pacing is and is not, there are some examples of what pacing isn’t below, perhaps the commonest misconception is that it means doing less.  I also encourage an understanding of nervous system regulation through a cognitive understanding and an embodied understanding (body based).  Part of this includes developing a toolbox of strategies and practices that support compassionate awareness & nervous system regulation, both I see as key aspects of pacing.   I often use the window of tolerance model by Dan Siegel, polyvagal theory by Stephen Porges and the three circles model from compassion focused therapy by Paul Gilbert as part of exploring understanding nervous system regulation in an embodied way.  I explore what’s meaningful with people and what their values are for a number of reasons, including because it helps people make choices about which activities to prioritise and engage in.

As already mentioned pacing can be misunderstood (and often is), here are some of the things pacing is not:

• A rigid/restrictive daily plan
• Doing less
• It’s not another thing to be ‘done’
• Only being able to do certain things a certain way
• Only doing things that don’t cause a pain flare

Pacing is not a rigid daily plan, it’s a way of flexibly adjusting our day as we move through it.  It is helpful for us to bring a non-judgemental compassionate awareness to how we are relating to our world (both the internal and the external), which is changing moment by moment.  From a place of being the compassionate observer we can take conscious wise action, where it’s possible to meet what’s needed (part of pacing).  A quick note here, there isn’t really any division between our internal world and the external world (not something we are exploring in this blog).

Avoiding doing things that tend to increase pain because of worry of a pain flare is not pacing and doing this over time this increases threat system activation, decreases our tolerance levels for the activity being avoided and often also tolerance for different activities.  It increases sympathetic nervous system activation (fight-flight), essentially there is more threat in systems and a sense of safety is lacking or has significantly decreased (pain is part of our threat system).  Tolerance levels decrease for a number of reasons, mainly due to an increase in sensitivity levels to different stimuli and a decrease in fitness levels.  Stimuli that gets overreacted to (we become more sensitive to it) often includes sitting and standing still and moving a certain way.  When systems are super sensitive all movements can trigger a protection response, doing certain activities and even thinking about doing a particular activity can create a pain response.  A quick note here about cause and pain, rarely does one specific thing cause pain or an increase in it, it’s complex and there are many variables that we don’t see.

Another thing that pacing doesn’t mean is ignoring pain and pushing on regardless, this tends to ramp up the protection responses and sensitises systems more.  This is the opposite of avoiding activities, it is sometimes referred to as the boom-bust cycle (not a term I use unless someone is using it and relates to it in a helpful way).  Both avoidance and regularly exceeding tolerance levels by too much are both problematic.  A quick note here, choosing not to do something that doesn’t come from a place of threat may well not be avoidance.  Doing a lot more than tolerance levels tends to result in having to do less for a few days, or even longer, it increases sensitivity and the threat in systems.  Doing a lot less also increases sensitivity and threat in systems too, along with tending to decrease strength and fitness as well.  However, doing a little more with a sense of safety, understanding your nervous system and using practices that help regulate your nervous system can help to gently nudge tolerance levels over time.

Pacing is not another thing to be ‘done’, it’s a way of flexibility adjusting to how we are and what feels needed throughout our day.  The way I see it is that pacing becomes a way of being that supports both effective function and our wellbeing.  For example, compassionately relating to ourselves and others, taking regular pauses in the day (these are needed for everyone, whether living with pain or not) and having nurturing daily practices that are part of a way of being and living, these could be seen as helpful habits.

(Image: my Grandad when he was 90 doing a meaningful activity – time in nature with one of his grandchildren – made possible by having something to sit on & only walking a very short distance)

How Can Pacing Help With Persistent Pain?

Pacing encourages people to work around their normal tolerance levels, this means knowing your baseline for different activities and where your soft limit/soft edge/soft boundary is.  This means knowing what level of different activities is generally ok (the baseline) and also having an embodied knowing (an awareness from what’s present in your body related to your whole experience).  Knowing your soft boundary includes knowing the whispers from your body that indicate you are near this point and indicate that taking a rest break or changing tasks would be helpful.  I have found it helpful over the years, with myself and working with others, to combine the cognitive understanding of a variable baseline with an embodied knowing of the signs we are near our soft boundary or soft limit.  One reason combining these is helpful is because our baselines are always changing and are impacted by many factors/variables, for example lack of stress and increased stress, and our body will reflect dysregulation consistently – we can come to deeply know it’s whispers when we listen compassionately.

Pacing can help in many ways, here are some of the ways it can help with managing and changing pain:

•  People living with pain can often more consistently do what needs to be done and what’s meaningful to them by breaking things down into more manageable chunks of activity interspaced with rest
• As well as taking short rest breaks changing to a different activity, for example changing more of a physical task for more of a cognitive one can be helpful
• With a pain flare-up things may need to be broken down into smaller amounts with more rest breaks to help systems to calm down
• Pacing can help people to engage more often and more fully in what’s meaningful along with using the strategies & practices that help them to manage pain
• It can help to modulate pain, for example taking a break and doing a breath practice helps to regulate the nervous system – down regulating the threat system can potentially modulate pain
• Pacing can help with both nervous system regulation and retraining the nervous system.  So, it can be part of both managing and changing pain over time
• It can help to decrease sensitivity to different stimuli, increase tolerance & fitness over time along with other things

Pacing Tips

It can be helpful to have an understanding of why pain doesn’t necessarily equal harm, knowing that we are safe to do things even with pain.  Having an understanding around this is one thing that can help people to pace activities and create a sense of safety.

I use 5 P’s with people for pacing, if they find this helpful, these are planning, prioritising, play, purpose & problem solving.  I have a pacing handout, that includes these that I offer to the people I work with who are struggling with persistent pain, to support their exploration of pacing.

As already mentioned listening to the body and integrating enough rest, along with having daily practices that help to regulate the nervous system is important.  Many things can help to regulate the nervous system and help with pacing when living with pain, for example, breath practices, meditation, gentle yoga or other mindful movement, singing/humming, time in nature.  Including a variety of activities, including exercise, in pacing is important, finding what’s helpful for you needs exploration.  There is a link to an exercise and persistent pain blog that I wrote in the resources at the end of this blog.

It is important to explore what is restful for you and the sort of rest that certain activities/tasks offer, there are a number of different forms of rest which I am not going to go into in this blog.  The picture below is child’s pose, this is often referred to as a pose of rest in yoga and is known to be calming, grounding, restful and restorative.  It is important to remember just because something is said to be calming and restful it doesn’t mean it will be for you, this highlights again the importance of embodied awareness (what is showing up in the body).  Understanding what is showing up in your body and how your nervous system is responding is part of developing an embodied awareness.  I encourage the people who attend my 8 week Creating A Healing Path workshops for people with pain/fatigue/anxiety, and my 4 week nervous system regulation workshop series to do this.  Even though we didn’t specifically cover pacing in my Creating A Healing Path workshops people reported pacing better and being more able to engage in what was meaningful to them.  You can find the link for more information on these workshops at the end of this blog.

As already mentioned pacing is not rigid, it needs flexibility as everything is changing moment by moment.  Our internal and external environments are constantly changing, our tolerance levels and nervous system state are in a constant state of flux (with everything else), it another reason why having an embodied awareness matters.  We need a cognitive understanding combined with an embodied awareness of what practices and strategies are helpful when, along with the different ways that we can adapt them.  Without a body based understanding (embodied awareness) we will be running on cognitive understanding alone and missing out on what our nervous system is communicating and the wisdom of our body.

Here is a common example of how our tolerance levels and nervous system state are always changing, imagine that you haven’t been sleeping well for a few nights and you keep on doing things in the usual way.  There are some common impacts of this, including: increased fatigue, increased stress, making poorer food choices, getting hooked in unhelpful thoughts, and increased pain which may also stop you sleeping (one of the many cycles in pain).   Lack of sleep in itself sensitises systems, increases threat system activation, increases the perception of pain, our baselines and soft boundary change, and it impacts our concentration and focus.  So, rather than keeping doing things in the usual way we need to explore what’s helpful and adapt what we are doing.  This might look like breaking things down into smaller chunks than usual, having more rest breaks during the day, including more meditation, or having a few minutes outside a few times during the day, and doing less exercise than normal (the body responds differently to exercise with lack of sleep and it responds differently with persistent pain too).  Making these adjustments like these are examples of pacing.

When there is something that’s important for you to do and you know it’s over your tolerance levels one way to manage this is to engage in what gives more safety messages to your body for a few days before the event, during it if possible, and again for a few days after.    Factoring in more rest afterwards and even before the activity/day can be helpful.

Remember what is helpful on one day, or in one moment won’t be exactly the same as what’s needed in another.  This is why we need an embodied awareness (body awareness) and a toolkit of practices and strategies that we have explored and used regularly.  This helps us to select what feels most helpful and then notice how our nervous system and body are responding, adapting what we are doing from this as needed.

Here’s a list of some more examples that can be part of pacing with a flare-up of pain:

Modulate your usual activities, like with the example above

Use additional helpful strategies from your toolkit if needed, a few examples are mentioned above

Do what helps to regulate your nervous system more frequently during the day

  Practice self-compassion, an example would be reframing your language (the self-critic can get loud when things during a pain flare-up)

For some activities where you are doing less than you normally would due to a flare-up remember to ensure that you have a plan to build things back up gradually as things start to settle (something which can be forgotten).

Some questions you can ask yourself:

•  Do you pace your activities in a way that’s supportive for your wellbeing
• Do you make adjustments to your day for factors like lack of sleep and increased stress?
• Do you know your baselines for activities and do you the know the signs of your soft limit/soft edge/soft boundary?
• Do you do what’s important to you or do you avoid doing it out of fear of making the pain worse?
• Do you push on regardless?
•  Do you incorporate the helpful strategies/practices into your day or just when the pain is worse?
• Do you know what helps give you a sense of safety with doing different things?
• What daily practices/strategies support you?

In Summary

This blog has covered what I see as the basic principles of pacing when living with persistent pain, these are:

• Planning & prorating tasks
• Problem solving
• Breaking things down into manageable chunks
• Understanding different activities (physical/cognitive/emotional) and your tolerance levels for them
• Integrating enough rest (with consideration of different forms of rest)
• Changing activities for a break is helpful (alongside having rest breaks)
• Having a cognitive understanding and an embodied awareness (body based understanding/knowing)
• Knowing the whispers from your body that you are near or at your soft limit/soft edge/soft boundary
• Using the practices and strategies that support you and help to regulate your nervous system and manage pain
• Remember there isn’t a right or wrong with pacing and it needs flexibility.  There isn’t a perfect way to pace!
• We need to be able to flexibly adjust during the day, this needs an embodied compassionate awareness & ongoing practice

No-one paces the same way, no-one walks in the same shoes, yet we create similar footprints.  This means that we can learn from each other and use the principles of things like pacing and different practices and adapt them to meet what’s needed.  There are common tools/practices/strategies that can help regulate the nervous system, manage and modulate pain, support wellbeing and effective function, these need adjusting for each person.  This is something I explore with people as part of 1:1 work and it is part of my workshops  With regular practice people understand the many ways they can adapt practices to meet their needs and as part of exploration and regular practice they create their own toolkit of resources to manage and change pain.

Learning how to pace and manage pain is a journey of exploration that takes many directions, there isn’t a destination/an end point with pacing, instead pacing supports pain management and engaging with what matters each day.  I would say that understanding nervous system regulation, noticing how we are relating to ourselves and practicing embodiment (noticing what’s present in our body) are all key parts of pacing.

I have written this blog from my understanding of working as a pain specialist physiotherapist & integrative somatic practitioner as well as lived experience of persistent pain, ME/CFS & PoTS.  If you would like to learn more about pacing and/or would like help with management of persistent pain in general get in touch to book your free 15 minute call to see how I can help.

If you would like to find out more about the 8 week online Creating A Healing Path workshop series for people with any condition associated with pain/fatigue/anxiety, or the 4 week nervous system regulation workshop series click the links below:

https://unityphysio.co.uk/services/ahealingpath/

https://unityphysio.co.uk/services/listening-to-our-inner-wisdom-workshops/

Pacing Resources

There are a number of resources specifically for pacing for persistent pain and related topics, here are a few:

There is a little about nervous system regulation in part one of my healing blog https://unityphysio.co.uk/healing-within-connectedness-love-part-one/

This is a blog that I wrote on exercising with persistent pain and can help with pacing of exercise/physical activities https://unityphysio.co.uk/exercising-with-persistent-pain/

A blog written about pacing in the context of neuropathic pain http://livingwellpain.net/persistent-pain-pacing

A short pacing video https://www.paintoolkit.org/pain-tools

Q&A: Pacing & Chronic Illness http://natashalipman.com/qa-pacing-chronic-lllness-resting-pain-fatigue/

(Images in this blog: icon with heart in hands and man walking are authors own, childs pose image is from Shutterstock by Rasterbird, time for change image is from Shutterstock by Trueffelpix)

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