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.

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.

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/

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Aligning mind, body & heart

Terms like aligning mind, body and heart can seem a bit abstract so I’m going to define this in the way I see it before we explore connectedness more.  To me aligning mind, body and heart means living in a loving and embodied way aligned with our purpose and what’s meaningful, living from a place of love, compassion & connectedness.  By living in a loving and embodied way I mean noticing how, for example, our thoughts and feelings, are showing up in the body in a compassionate and non-judgemental way.  Part of healing is awakening our senses and being able to fully be in the present moment in an embodied and loving way.  We can’t do this if we are stuck in hyperarousal or hypoarousal, where we are stuck in our heads or rushing around all the time, disconnected from ourselves and the world around us, and not feeling safe/settled and secure.  Aligning body, mind and heart helps us regulate our nervous system, awaken to a deeper way of being and reconnect to the connectedness of everything.

Living in an embodied and open hearted way can also help us see that the obstacles and challenges that appear as part of life can help us awaken and grow.  We can ask questions that support with this like how can this help me grow? How can this help me serve myself and others?  How might this help serve my heartfelt intentions or aspirations?  Sometimes things are overwhelming, these times we won’t know the answers to these questions and we will struggle to connect to our bodies, these times we may need to find a suitable therapist to support us.

Love & connectedness in healing

One of the things that is really important in healing is that our suffering is witnessed and acknowledged in a compassionate and non-judgemental way.  Suffering that is not witnessed and acknowledged, or done so in a critical way, often causes more trauma.   Love, compassion & connection are needed here because when we aren’t fully present and connected we can’t truly notice our suffering, or that of another, and without love and compassion there is judgement and criticism.

Acceptance is important in healing, it isn’t a one off thing, instead it’s ongoing and it can be said to be a moment by moment process.   Acceptance isn’t passive, it doesn’t mean putting up with something, or that things won’t change (things are always changing right down to each moment).  A great strength or courage is needed to be able to let go and trust in our inner wisdom and the process.  With curiosity, openness, courage and a compassionate loving presence (a heartfelt presence) we can notice and allow what’s present in the moment to be exactly as it is, even if it’s not how we would ideally choose it to be.  Being present with love & compassion helps us accept and allow what’s present to be without, for example, self-blame or self-criticism, and when these do appear they can be met with compassion and love too.   Allowing what’s present to be needs a sense of safety, or feeling safe enough in the present moment.  This means that we need the nervous system to be balanced or close to balance (where we are within our window of tolerance/ventral vagal system).

From a place of noticing what’s present in the body we can increase our understanding, connect to our inner wisdom and discern what’s supportive for us.  Any action comes from our inner wisdom rather than from a threat based reaction, for example a pushing away, trying to get rid of something, or avoiding.  It’s important for us to stop over controlling and resisting, this is part of being in a regulated nervous system (resistance & over control are part of our threat system and protection mechanisms), as it calms our nervous system and allows new possibilities to begin to surface.  Allowing what’s present to be with an acceptance or openness is a place where fear softens and we can start to see what’s resting underneath.  Holding whatever is present, in love compassion isn’t always easy and this is part of the practice and the healing.  Things can reappear that we thought we had dealt with once, that we had healed, new layers surface for healing, here again we practice acceptance and compassion.

We need trust to allow the healing process to unfold in its own time without wanting it to be a certain way or create a certain outcome, without pushing or resisting, easier said than done I know (that’s part of the practice too).  We naturally push away or resist what causes suffering and grasp what creates joy and the things we want more of.  Part of suffering is in the pushing away and grasping, we can learn to allow things to flow through (an ever ongoing practice).  We can, for example, notice that pain is present and allow it to be in the background as best we can, rather than trying to get rid of it and getting frustrated, angry or self-critical when nothing works.  This doesn’t mean we don’t take action to try and alleviate the suffering, instead it comes from a different place and we take wise action.  This may be no action sometimes, or something simple like after noticing what’s present and allowing it to be, offering ourselves some soothing words or soothing touch (this could be part of Tara Brach’s R.A.I.N practice or Kritsin Neff’s self-compassion break, for example).  We also need to learn to hold the outcome lightly, we cannot control this as there are many variable (some we don’t see) we can influence the outcome and control how we relate to it.

Often when we are suffering we lose trust in ourselves, I have seen this time and time again working with people with persistent pain, other long-term conditions and felt it myself.  The decreased trust, or the loss of trust, brings an opportunity to connect more deeply to it and develop more of a kind of unshakeable trust.  Part of trust is trusting that we have the skills, knowledge, resources/practices to manage, or if we don’t then believing that with support we can develop them.  Learning to trust the healing process is important and it means we need to trust in uncertainty too.  Trusting in uncertainty isn’t easy, it’s important because so much is uncertain in life, this means we need to let go of over control.  Being safely grounded in compassion and love links with trust in holding us steady enough within the uncertainty, within what feels like a vulnerable place.

Reconnecting to our inner wisdom is so important in healing, it supports and guides us.  Terms like inner wisdom and our true nature or essence, can seem a bit abstract, they aren’t tangible things we can see.  Our inner wisdom and true nature both hold love & compassion and connecting to them is important in healing.  Connecting to our inner wisdom through our body guides us in many ways, for example it can guide us when to explore something to deepen understanding and when to allow something to be in the background for the time being.  Sometimes we need help to access our inner wisdom especially if there is unprocessed trauma, the light of compassion and love can be hidden under layers.

Feeling the connectedness to love, nature and the wider whole is also important in healing and our overall wellbeing.  Research is showing us that it is not necessarily the amount of time that we spend in nature that is significant for our wellbeing, except in terms of physical wellbeing, there needs to be a sense of connectedness too (physical wellbeing needs this too, so again it’s not just the time in nature that’s important).  Sometimes we have disconnected from the interconnectedness of nature, reconnecting to this is part of our healing and it’s needed for natures healing.  Nature’s wisdom combines with our inner wisdom and can guide us when we listen.  If we haven’t lost the connection to the connectedness with nature then the sense of connectedness with this tends to deepen as part of healing.  Nature is part of us and we are part of nature, our wellbeing and natures wellbeing are inextricably interlinked, connecting to this helps our healing and also the healing that nature is desperately calling out for.

The interconnectedness with nature and something bigger than us may resonate with you or it may not, either way is ok.  If these things are of interest one of the books that I would recommend is called ‘Reconnection: Fixing Our Broken Relationship With Nature’ by Miles Richardson.

Common Humanity & Healing

As human beings we all experience joys and sorrows, love and loss, easier times and tough times, suffering and healing.  This is the common humanity we all share, we share many things as part of being human and connecting to this is important in healing.  Connection to others is important in healing, we are social animals.  We self-regulate and we co-regulate, our nervous system talks to other nervous systems.

Adapting to and processing many losses is part of being human and is often part of healing too  This can be for many reason, for example, from the multiple losses related to living with a chronic health condition, from life being different from the way you wished it to be, and/or from the loss of a loved one.  There isn’t a right or wrong way to grieve.  I wrote a grief and loss in persistent pain & other long term health conditions blog which you can find this here:

Part one https://unityphysio.co.uk/grief-loss-in-persistent-pain-other-health-conditions-part-one/

Part two https://unityphysio.co.uk/grief-loss-in-persistent-pain-other-health-conditions-part-two/

It is the tough times that we learn the most from and these times that we need a toolbox of practices to draw on, these can also be referred to as strategies or resources.  The tough times strengthen our heart and allow our heart to open more fully, to be present with love, compassion and courage, connect to the depth of our strength and to connect more deeply to the connectedness of everything with a sense of spaciousness.  We cannot heal until we learn what supports our nervous system regulation and have some resources/practices to support this and healing, we create more resources along our healing journey too.

What supports healing?

There are many things that can support us each day, that can become part of a way of being and part of healing, including: embodied self-awareness practices (awareness in the body), meditation, mindfulness, breath practices, self-compassion, yoga, exercise and movement, walking, time in nature, journaling, distraction (sometimes this is needed, for example when things are over whelming) and many more things.

When I had a really tough couple of years due to some health conditions I leaned deeply into my yoga and compassion practices and drew on many other resources that I had, my gratitude for these deepened and I developed many more resources through this time too.  I also reached out for additional support, remember we can’t heal on our own.

What practices and resources/strategies do you use to support you day to day?

Summary

To heal we need many things including: to restore balance and retrain our nervous system, a sense of safety and trust, an embodied loving awareness, acceptance, a variety of resources/practices along with a daily commitment to practice, belongingness, support of others, connection and connectedness, and of course compassion and love.  Healing takes time and a toolbox of strategies and practices, it’s not one thing that helps us heal it’s many things.  We can’t heal on our own, we need the co-regulation and support of others which can take many forms.  Sometimes support needs to be in the form of a therapist, other times it could be a coach or mentor, friends, or a wider community group that we are part of.

As we heal the confusion that we had in our suffering evolves into clarity and we awaken a little more to our true selves and the interconnectedness in everything too.  There are times that we think we have healed and everything is going smoothly and then something happens that opens up new layers that are ready to be healed.   Healing is something I have come to see as being ongoing, maybe you can relate to this too.  I don’t think there is a destination unless it is to return to our true selves and wholeness, to the alignment of mind body and heart and live from this place, and return again and again.  Each time there is a challenge or an obstacle it gives us an opportunity to grow and connect to our true selves, our inner wisdom, and more deeply to the connectedness within and around us.

We all already have what’s needed for healing within us, to access and nurture this we need to be able to safely connect to our bodies and we often need to change how we are relating to ourselves, from being critical, for example, to being more compassionate.  Sometimes we need help from a psychologist, or another psychological clinician to do this, for example when there is unresolved or unprocessed trauma.  We all have within us a core essence of compassion and love, this light never goes out, sometimes it’s under layers and we need help to be able to start to see it, and the more we connect to this place the more brightly it shines.

Healing has many aspects and perhaps we could see it as being rooted in connectedness and love, and aligning mind, body and heart.  I have come to understand that our healing rests within the love that is within and around us all and the connection to the interconnectedness of everything.  Healing is a place where enougness, okness, compassion, love, trust and freedom all rest.  Connecting to the wisdom of our body, heart, inner trust, compassion and love over and over again helps us to heal & develop an unshakeable inner core, or at least a less shakeable one.  The inner wisdom that is within us all, our core of love and compassion, is a place that we can come to know more deeply with time and once we have an embodied knowing (a felt sense in our body) we can return again and again to our true selves and a balanced state (our ventral vagal system/window of tolerance) that supports healing.  As we heal we can live more fully in an open hearted presence, developing a new way to be, relating to ourselves in a more loving and compassionate way and extending this love and compassion to others and the world around us.

To finish this blog I’m sharing a poem that I wrote called ‘Healing Within’:

Many things were unknown

Couldn’t be seen

In the darkness there was always some light

Flickering gently

Leading the way

Slowly, step by step

Pauses scattered through

Compassionate awareness enveloping

Body wisdom guiding to explore

What’s resting inside, to be seen, accepted and loved

Slowly, never to be rushed

Each footstep exploring

Heart trusting

A loving presence guiding

Exploring and listening

Natures wisdom shining

Deepening a knowing

Harmony evolving

Learning a new way to be

Compassion, love and trust united

Deeply embedded within

Shining brightly

Holding the steadiness

Resting in aliveness

Connected to the unity

Being & healing

You may also like to check out the poem I wrote called The Body Remembers The Trust

https://m.youtube.com/watch?v=2pgR3COJLPk

I would love to hear your thoughts on healing and this blog, do drop me an email if you would like to (info@unityphysio.co.uk) or share some thoughts in the comments on social media where I’ve shared this blog.

The post Healing Within Connectedness & Love (part two) appeared first on Unity Physiotherapy and Wellbeing.

I’ve especially been considering healing in relation to trauma, persistent pain, ME/CFS, long covid, PoTS and other long-term conditions, which is probably because these are the areas I work within and have lived experience of some too.   Many people are healing from trauma and/or a long-term health conditions in our modern world.  Last week I read in a new report by The Health Foundation it has suggested that 9.1 million people in England are expected to live with a major illness by 2040 and that a significant proportion of this will be related to certain conditions, including anxiety, depression, chronic pain and diabetes.   In my opinion there are many factors that need consideration here including healing and the innate connectedness that we need to reconnect to and nurture.

What does healing mean?

There is no agreed definition of healing, healing in acute terms means repairing damaged tissues, or fixing an injury, for example.  Things get complex when it’s not a simple acute injury and there isn’t a specific time frame to heal or repair the wound/injury.  When there are, for example, layers of trauma, or many symptoms from fibromyalgia, or someone is living with persistent pain healing becomes trickier to define.

Before reading on I invite you to consider what healing means to you?

I think we could say that healing is always an individual experience that involves reducing or transforming suffering.   However, if we were to say healing is only a change in suffering this would be a simplistic view, especially as suffering is complex and it is always changing, everything is always changing, and because healing is about more than the suffering or struggle that is part of the picture.

Another thing to consider with what healing means is that it may or may not mean full resolution of pain, anxiety, or other symptoms.  Often people have shared with me themes around alignment with their heart and what’s meaningful, connectedness and wholeness as part of what healing means to them, and these are things I can relate to from my own healing journey too.   Some people may say that not feeling whole implies that something is broken and needs fixing.  I don’t see it this way and instead see it as a disconnection from our true selves, disconnection from nature and a disconnection from the wider whole/universe (there are different terms for this, it can essentially be seen as something bigger than ourselves).  Although we may at times feel broken we never really are, our true self is like the sky in that it is always there and can never be broken and the weathers come and go.

A journey to wholeness is something I see as a heart based connection, a connection to meaning and purpose, to a sense of belonging, and to the love, trust and compassion that’s within us all.  We could maybe say that healing is a coming home to ourselves, reconnecting to our inner wisdom and connecting to the interconnectedness of everything.  I would say healing is also an alignment of mind, body and heart, a place where we can live fully connected from an open hearted presence with a gentle strength and love.  We will explore this a little more in part two of the blog.

I think that it is helpful to consider what nervous system regulation means in the context of healing, especially because we can’t heal with a nervous system that is dysregulated too often/too much.

What is nervous system regulation?

Nervous system regulation includes the whole nervous system and is often discussed in terms of the autonomic nervous system.  Everyone’s nervous system dysregulates many times a day and then re-regulates, the problems come when the nervous system is dysregulating too often or too much relative to the context and not re-regulating well.  A well regulated nervous systems helps us to feel safe or safe enough to be fully present and to engage with others and the world in general, and it helps all of our systems to function optimally.

There isn’t an agreed definition of nervous system regulation, this is one that I created for my Creating A Healing Path workshop series:

‘Nervous system regulation can be thought of as when our nervous system is flexibly able to move between different states in response to stressors & the level of arousal matches the context/what you are required to do.  It is where it is working in a balanced way that supports optimal function & healing.’

A quick summary of the autonomic nervous system (ANS) could be helpful here.  The ANS unconsciously controls and regulates our organs and unconscious body functions, including heart rate, breathing (which we also have conscious control over), blood pressure, and temperature.  It is split into two branches, the sympathetic nervous system (SNS), fight or flight, and the parasympathetic nervous system (PNS), rest and digest.  These work together to maintain a state of balance in the body (homeostasis) and we need both branches of the ANS, neither is good or bad.  The levels of activation of the SNS and PNS are always fluctuating, our central nervous system CNS) and autonomic nervous system are constantly adjusting, along with all other systems, to try and maintain homeostasis.  Our ANS and the CNS (mainly the amygdala and hypothalamus in the limbic system in the brain) are constantly monitoring for threat/danger or safety.  The ANS and CNS are constantly surveying our internal environment (information from all systems), along with our immediate and wider external environment, including how the interactions with others feel.  Our nervous system takes a better safe than sorry approach and our previous experiences and modern society mean it is often dysregulated by things that aren’t actual threats.  Once the threat, or potential threat, has gone we need to be able to return to regulation to function optimally and feel safe and settled again.  When this doesn’t happen automatically or takes sometime we can assist this process and there are many ways in which we can do this, this is part of healing.

It is important to mention that changes in ANS activation are associated with different chemical messengers which of course impact all of our systems.  Our thoughts feelings and emotions are also in themselves associated with different chemical messengers, they are part of our biology too.

There are different models that can help us to understand the ANS and nervous system regulation, the ones I use most often are Dan Siegel’s window of tolerance and Stephen Porge’s polyvagal theory, combined with the 3 circles model by Paul Gilbert (part of Compassion Focused Therapy).  For this blog I’m going to touch on the window of tolerance model and polyvagal theory.

The window of tolerance model was developed by Dan Siegel to describe the optimal level of arousal, it has three parts:

• Hyperarousal (too much SNS – fight or flight)
• Window of tolerance – optimal zone of arousal (balanced ANS)
• Hypoarousal (not enough SNS & PNS without the vagal brake)

In this model a dysregulated nervous system is one that is too often, or too much for the context, in hyperarousal or hypoarousal, and/or takes longer to regulate from these states back to regulation, and sometimes gets stuck for a while in one of these threat/protection based states.  When the nervous system is dysregulated in the direction of hyperarousal a variety of things associated with this can be present including: fear, panic, initial freeze (deer in headlights) emotional overwhelm, anxiety, irritability, anger, over-activity, lack of clarity, worry, gut issues, increased muscle tension, pain, insomnia, a tired and wired feeling.  When the nervous system is dysregulated in the direction of hypoarousal a variety of things associated with this can be present including: disconnection, dissociation, low mood, depression, decreased muscle tone, shame, guilt, feeling numb, fatigue, shut down.

(infographic by Dr Sarah Davies, the link to the blog that this is in is below)

Through the lens of the polyvagal theory by Stephen Porges we see the ANS protection responses as:

• SNS (fight or flight, includes the initial freeze response)
• Shut down or collapse (PNS minus vagal brake, termed dorsal vagal in this model)

Porges suggests that there are three pathways in the ANS, being the sympathetic nervous system (SNS) (mobilised/activated, protect/survival mode, unsafe), the ventral vagal circuit (safe, regulated, sympathetic and parasympathetic activity balanced with the vagal brake, and able to be socially engaged) and the dorsal vagal circuit (unsafe, protect/survival mode, shut down).   These three systems/states are also included on the above infographic).  The SNS part is where there is increased SNS activation (hyperarousal in window of tolerance).  The initial freeze response (deer in headlight type response) is SNS dominant, this is where we freeze whilst a decision is automatically made as to whether we can fight or flee, if neither are possible and this response continues eventually the SNS is overwhelmed by the PNS (we lose the ventral vagal regulation, the vagal brake – the rest and digest part of the PNS).  Here we go into a primitive survival response of shutdown or collapse, this is termed dorsal vagal in this model (it’s where there is increased hypoarousal in the window of tolerance model).  The ventral vagal system is where we are said to be safely activated, in other words the SNS is balanced by the PNS with the vagal brake.  Here all systems can function optimally, the ANS is in balance, the limbic system in the brain is settled and the frontal lobe is online.  When we are in the ventral vagal system we feel safe and secure, this supports social connection and full engagement in a heartfelt presence with ourselves and the world.

The wider our window of tolerance, the more frequently we can be in the ventral vagal system and the more easily we can return to this place again and again.  This helps systems function optimally and we can, for example, find ease within challenges.  Being in our ventral vagal system or window of tolerance helps create the conditions that support healing.  Also with a wider window of tolerance we can more often be in a full heart felt presence and have a greater tolerance to be with our own and others suffering, along with being able to access the wisdom to discern what may be helpful in alleviating or decreasing the suffering.

There is a lot of information on the window of tolerance model and polyvagal theory available, like this blog on the window of tolerance model:

https://www.drsarahdavies.com/post/what-is-window-of-tolerance-emotional-regulation-model-explained

You can find a free beginners guide to polyvagal theory on Deb Dana’s website here:

https://www.rhythmofregulation.com/resources

Considering nervous system regulation alone would be a reductionist way of looking at things, it needs to be considered as part of the whole picture.  This includes considering all systems, what is happening in our body, the thoughts and memories that are present, our behaviour, previous experiences, essentially the whole of our experience and the connectedness of everything.

Summary

Healing doesn’t have an agreed definition except in acute injury.  Healing involves changing or transforming suffering and creates a new way of being through reconnection to our true self and living aligned with our mind, body and heart.

When our nervous system is not well regulated, we don’t feel safe, we can’t see the bigger picture and are disconnected from ourselves, others and the wider whole, and we can’t heal from this place.  It is important we remember that we don’t control any of our nervous systems threat/protection responses (hyperarousal/hypoarousal), they are quickly automatically activated when protection is deemed as needed.  When we are within our window of tolerance or ventral vagal system enough (a regulated and balanced nervous system state) we are safely able to fully connect to ourselves and others, have a more expansive view, and conditions are optimised for healing.  A healing state is one that rests in safety and connection, a place where strength & gentleness are balanced, a place where the seeds of change can be planted, begin to grow and later flourish and these are all part of having a well-balanced regulated nervous system.

Perhaps we could see healing as a return to wholeness, or an alignment of mind, body & heart.  An alignment and wholeness that means that we can live a life full of meaning, with a sense of purpose, fully connected to ourselves, others & to something bigger than ourselves (the wider whole) in an open hearted and grounded way.  These will be explored a little in  part two of this blog.

What do you think, does this way of seeing healing resonate with you?

Link to part two of the blog https://unityphysio.co.uk/healing-within-connectedness-love-part-two/

(brain in hands image with this blog is from Shutterstock by Sergey Nivens, all others are owned by Ann Parkinson at Unity Physiotherapy & Wellbeing)

The post Healing Within Connectedness & Love (part one) appeared first on Unity Physiotherapy and Wellbeing.

What Can Help

We need resources to help us in the grief process, resources help balance the challenges & vulnerabilities that arise.  Two really important inner resources are compassion & being able to regulate the nervous system, I think these are foundational in many things including in grief & loss.  Other resources include the process of learning itself, the support of others, perspective taking, being able to connect to safety and trust, and awareness (mindfulness).  If someone is under-resourced they are more likely to need some support from a counsellor or psychologist.  Also this can be needed, for example, if the grief triggers into previous traumatic experiences, which I think it often does, especially if someone is under-resourced and it’s still needed sometimes even if someone is well resourced too.  It’s important to recognise when help is needed and also remember that there is no right or wrong way to grieve.

One way to identify what could be supportive for you to nurture is to ask yourself:

What’s challenging for you?

What would help if it was more present in your mind? (for example, compassion, love)

What would it help to connect to in your body? (for example, love, kindness)

You can then nurture what you identify would be helpful, the more we practice and work with something the easier to is to access as it becomes more hard wired.  There may be a time when growing what’s nurturing creates more sadness, it’s important we listen to the not yet and reassure ourselves it’s ok to feel these things and see if it feels ok to continue the practice.  A practice where you can nurture what you identify as supportive could be one like this one, to nurture what’s supportive in the body:

https://soundcloud.com/user-103516027/nurturing-whats-supportive?si=2ef7028b5d334d2e8f6860c9cbfcfebf&utm_source=clipboard&utm_medium=text&utm_campaign=social_sharing

Our self-talk matters, as mentioned in part one of the blog our self-critic can get over active and we take the losses and grief and turn them into a big stick to beat ourselves up with, when this happens the compassionate self can help.  Let’s look at a couple of examples and some compassionate reframes: “I need to stop wallowing and get on with living life”, perhaps you could notice how this statement lands in your body and what state of mind it’s associated with?  The self-critic’s view is not very helpful and doesn’t acknowledge the impact, that it’s normal to not feel ok and settled after a loss/losses for a while (how ever long that while is).  Here’s a compassionate reframe example, “my grief reminds me of how much I’ve lost, it’s completely understandable that I’ve been struggling and how I’m feeling is normal, everyone grieves and experiences losses and it’s not easy to navigate this.”  How does that land with you?  Here’s an example that combines guilt with the self-critic, “if I had worked harder to get rid of this pain I wouldn’t have lost my ability to walk further than I can, do the garden and the housework, I really should have stopped it happening, I just wasn’t strong enough to do it.”  Wow that’s harsh isn’t it, how does this land with you?  Let’s look at a compassionate reframe here, “this has been really hard to manage and I did my best to maintain my function and do what I needed to.  I had no control over how things have turned out and I’m doing my best to find what’s helpful for me.”  How does this land in your body, what about your mind?

Being aware of where our attention is automatically resting is helpful, pain and losses take our attention automatically and become a default until we become aware and start to change this habit (it doesn’t mean ignoring the pain and losses).  We have tricky brains in that they are wired for protection and survival and so have a bias towards things that are perceived as a threat.  If, for example, we have our attention in anger, anxiety, fatigue or pain all the time it becomes a habit and what we are growing.  Also, when we do this we are functioning from our sympathetic nervous system way too much which impacts us in many ways.  Being mindful of where our attention is, acknowledging what is present and learning about it, then unhooking from this and choosing a more helpful place for our attention is part of creating space around pain, fatigue and associated losses.  In this way we can learn from what’s showing up and deepen our awareness without being hijacked by it.

When I did Rick Hanson’s Grief and Loss course recently (linked at the end of this blog) he mentioned that Peter Levine talks about being like a pendulum swinging into the intensity and discomfort and back out.  The rhythm of the pendulum and how long it stays with the discomfort can be whatever is right for you, perhaps this could be helpful in being with the losses and grief and how it’s showing up without feeling overwhelmed.  Over time we can swing into the grief and discomfort and stay a little longer if it’s helpful.  If someone can’t create space in their pain and time and time again they get pulled into it, or maybe even are stuck in it, reaching out for help may be needed.

Dr Rick Hanson also talks about even as the storm passes through the mind for your own grieving there is a place inside, a knowing that a small part isn’t swept away and is alright, even if it’s a tenth of 1%.  Can you notice this?  This basic alrightness as he calls it can be a place of refuge, a soothing place to rest and grow.  Keeping returning to it and building this indestructible, trustworthy, reliable, unshakable core, as Rick says, is helpful.

It’s important to acknowledge the losses through pain, fatigue and various long-term health conditions, honour them and when we are ready create something meaningful, something that’s helpful for ourselves and others.  A ritual can be part of this, for example, drawing something, creating a memory scrapbox or memory box, lighting a candle, planting a tree or other plant, writing a letter, getting a group of people together to acknowledge & honour the person that once was with compassion and love.

Here’s a list of other things that help, I’m not talking about them all else this blog will be way too long (this is not an exhaustive list, there are many more things):

The post Grief & Loss in Persistent Pain & Other Health Conditions (Part Two) appeared first on Unity Physiotherapy and Wellbeing.

The suffering associated with losses and grief affects us all many times throughout our lives, losses and grief are part of the human experience and living with love and an open heart.  One thing that I feel is important to mention at the start is that grief has no right or wrong way, no specific length of time, it’s individual.

I am writing this blog as I’m passionate about helping people with conditions associated with persistent pain and fatigue, including fibromyalgia, ME/CFS and long covid, and I feel that the associated grief and losses aren’t talked about enough.  I am not writing this as a psychological clinician instead as an integrative somatic practitioner and physiotherapist who has done additional related trainings, supported people with losses and grief resulting from various long-term health conditions, and through my lived experience of many losses related to ME/CFS & PoTS as well as other losses.  I’ve supported people by holding a compassionate space for the grief, acknowledging it and allowing people to process it in whatever way they needed to (alongside a psychological clinician when needed).

There are many losses in life, including death losses, losses of relationships, losses of role, physical and mental losses, climate related losses, societal losses, loss of trust and confidence in ourselves, loss of hopes and dreams, right down to the loss of each moment as we never get the same moment back.  Losses through living with pain and other health conditions can be sudden, or they can appear gradually, they commonly affect many domains of life and can be completely life changing.  Many things need consideration in living with losses and grief related to health conditions, non-finite losses or living losses as they are also called, I will mention some of the important aspects in this blog.

Grief & Our Assumptive World

We all create what is known as our assumptive world, a lot of this develops when we are very young, which is part of our attachment system.  The assumptive world includes how we see ourselves and others, how we feel safe in the world, how we feel that we fit into social systems and how we think the world should work.  It forms a foundation of how we navigate the world feeling safe and ok.  Sometimes things bump up against the assumptive world and we adjust it, other times it’s more affected and it can be shattered.  When this happens we often no longer know who we are, we struggle to know how to be in the world as our old way of being no longer works/is no longer possible and the world no longer makes sense to us.  I think this happens more than is recognised in persistent pain and other health conditions when losses impact multiple domains of life.

When multiple losses wipe out the world we once knew it results in a state of disequilibrium.  This often feels a very vulnerable place to be and we can feel out of control, so a sense of agency is important.  Here’s an analogy I developed, maybe you can relate: A small rowing boat was out at sea, it had been impacted by the many storms, it couldn’t orientate to where it was anymore and it had lost its trust in navigating the sea’s ever changing environment.   It had taken on too much water, this happened so quickly it was overwhelming, consequently it started to sink.  After a while it was possible to work out how to offload some of the water and some dolphins came to help support the boat whilst it brought itself to a state of floating once more.

Once floating it had no idea how to get to shore again even though it could see the glimmer of the lighthouse.  The dolphins were still present providing a sense of safety and comfort whilst the boat rested and floated a while.  It had decided to simply float whilst it reflected on its journey, learning more about the current, the changing waters and the storms.  It began to feel bigger and a little more spacious and ready to start to travel the tricky waters to the shore.  The boat turned towards the direction that the lighthouse glimmer appeared to be arising from, slowly rowing and pausing, rowing and pausing, checking in on the water and the changing tide.  From time to time it let go of a little more water that came on board, the dolphins accompanied the boat as it travelled which was soothing and provided a sense of safety as it learned to trust and navigate again.  The boat had the choice of when pausing was needed and when to change its speed and it kept checking in with what felt right for it.  It became aware of the importance of spaciousness as it travelled and being able to see the wider view once more,  it became aware of distant islands and much more that it could see on the horizon and closer by.  It felt connected to all around and the wider parts of the sea and sky that it couldn’t see, it was soothing to feel connected to all of this.  This was the start of re-learning about the world and the journey towards creating something meaningful for the boat.

Some of the aspects for consideration with grief and loss in persistent pain & other health conditions

There are tangible losses, things that can be more easily seen, and intangible losses that are not so easily seen and expressed.  Intangible losses include: a change in identity, loss of purpose, loss of trust and loss of safe connection to the self and others.  Losses when struggling with persistent pain and/or fatigue commonly include losses of: independence, physical function, joy and playfulness, finances/financial stability, relationships, roles, identity, trust, self-confidence, belonging, ability to do what’s needed, work, and being able to engage in hobbies & activities.  Often there are many layers with losses and things can be complex.

The intangibility of some losses can make grief feel isolating and it links into a sense of feeling helpless and hopeless.  These are linked to suicide risk which is one reason why keeping connected to a sense of community is important.  People also often feel isolated when living with pain and/or fatigue and other symptoms, like some losses pain & fatigue lack tangibility, so this can be a bit of a double whammy with the isolation aspect.  It’s important to connect to the bigger picture view, that pain, fatigue, grief, loss and suffering are part of being part of being human and many people feel isolated sometimes.  Acknowledging others feel like this too and having a community to connect to is important, it can bring a sense of relief and having a sense of connection can feel soothing and healing.  Also holding our losses in the bigger container of common humanity rather than in a small container can help things feel less overwhelming.

There is what is sometimes referred to as primary and secondary suffering with pain and fatigue, for example, the primary suffering is the pain/fatigue and then we have the secondary suffering which commonly incudes anxiety, frustration, anger, guilt, self-criticism, and grief.  With losses the primary suffering is the loss and grief, the secondary is, for example, guilt, anxiety, rumination, anger and frustration.  Tara Brach talks about this as first and second arrows, Dr Rick Hanson calls this the first and second darts.

Those close to the person living with persistent pain and/or fatigue, or other long-term health issues, are also often grieving the loss of the person that once was.  This can be forgotten, it’s important that it’s acknowledged that the people close to the person living with the health condition(s) are also grieving the person they knew.

Grief is commonly influenced by unhelpful social messages, it’s important that we do what feels right to us with grief and not what societal expectations and norms might dictate.  In society there are many harmful messages for example: pick yourself up and get on with it, you need to try harder, that it’s strong to suppress and strictly manage emotions, and that being self-reliant and fiercely independent is the ideal.  None of these are true!  There are also deep rooted, messages in society around expectations of a fix or cure which puts pressure on people to be ok and on others try and fix things, rather than simply being with the grief and allowing it to be present exactly as it is.

Losses trigger our threat system, initially the sympathetic nervous system is more activated, and many different emotions and feelings can be present.  Parts of ourselves associated with our threat system, show up and some stay a while, and our protection mechanisms are generally heightened.  There can be numbness, a lack of emotions, and an emptiness too.  Two of the protective parts that show up commonly are the critical self and the anxious self.  It’s completely understandable that these parts of us show up, especially as uncertainty can be tricky at the best of times and the unpredictability of pain and other health conditions add into this.  Anxiety may also have been present before the grief and losses too and it can be a strong undercurrent sometimes in grief, it can be woven through the grief too.

It can feel like we have no control and as a result we end up over controlling things to try and manage the uncertainty.  There are common questions I have been asked, and I’ve asked myself too, including: what if I don’t get better?  What if I get worse?  Will I be able to handle it?  These questions are coming from fear of uncertainty usually, and often the anxious self has all sorts of responses that aren’t particularly supportive in the long-term.  We need to acknowledge this part of ourselves and any others showing up that are needing to be seen, heard and understood and bring in our compassionate self to calm the protective parts down and create more helpful guidance and support.

Through unhelpful self-talk, perhaps combined with previous experiences and beliefs, we may also have attached unhelpful meanings to some of the losses, for example that we are not good enough, or we are weak, or we may be carrying unnecessary guilt.  It can be helpful to explore what meanings we have attached to things, seeing if they are true or helpful (likely neither) and creating a compassionate reframe.

Also there can be worry and rumination linked to the losses, this is usually serving a protective function, like the anxious self and critical self do.  When we look under rumination there may be a lot of fear, anxiety, sadness, anger, shame or other protective feelings and emotions.   It’s really common for people who have a lot of losses due to pain, fatigue and other health conditions to have a fear of if they will manage in the future, and even if they will get worse and the potential impacts of this happening.  In my experience of working with people with pain and fatigue it is commonly fear, anxiety and shame that lie underneath the rumination and worry.  Sometimes people need to work with a psychological therapist to explore this, this is partly related to previous experiences and internal resources.

When someone dies we have a ritual, a few of the various important things about this include recognising and honouring the loss and bringing a community together, people united in loss with love and care for each other usually.  In non-death losses we don’t have a ritual and this is something that can be helpful.

We need to make sense of things, acknowledge and honour what’s been lost and what we miss.  Sometimes we need to let go of things and old ways of being, to then move into re-learning and compassionately rebuilding a new assumptive world that maintains safety.  Rebuilding creates meaning, this is different to making sense of everything, it’s the what now?  It could be seen as building and growing something that’s helpful for the self and others from what’s been lost.  It’s said to be deep work that goes right to our core, maybe you have been there and can relate to the depth, I can.

Grief generally never fully goes away but we grow around it, which means there is more space for it, it shrinks a bit and it’s not so often present.  Sometimes when grief shows up again there may be something to acknowledge, notice & allow to flow through as we deepen awareness.  When this happens sometimes there is a message/some learning in it and we may decide to make some changes.  When grief surfaces again it could be seen as an opportunity to understand things even more deeply, let go of anything that’s not serving us, make any changes that are supportive for us/ develop more resources for navigating the tricky times.

Here’s the link to part two which covers some of the things that can help, there is also a short summary and some resources that may be helpful https://unityphysio.co.uk/grief-loss-in-persistent-pain-other-health-conditions-part-two/.  Please remember grief has no right or wrong way and to ask for support if you need it.

(Some images are the authors own, others are as follows from shutterstock: heart in hands by SewCream , dandelion by JanBusson; from stock.adobe.com: man in boat by fran_kie, words on clipboard by Syahrir ).

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