Physical, psychological and spiritual exhaustion seems as a key theme in people’s conversations that I hear in this holiday season.  I feel the exhaustion too, body, mind and spirit. Dr. Paul Thagard describes COVID fatigue as people experiencing a range of emotions, such as, sadness, loneliness,  anxiety, fear, anger, frustration due to the restrictions from the COVID-19, such as, severe limitations in  outings and social gatherings.  This post will explore and reflect on the concept of fatigue, exhaustion, strength and endurance building in body, mind and spirit through concepts in psychology, religion and spirituality.

Fatigue and Exhaustion

The Harvard Medical Schools publication of Harvard Health Publishing  , describes the stress response system and how chronic stress response system impairs overall  health.    The stress response system consists of two mechanisms: first the sympathetic nervous system and second, Hypothalamic-Pituitary-Adrenal Axis (HPA) . When a person perceives a threat in the environment, his/her amygdala (limbic system) in the brain is activated and this activation generates a series of chemical reactions in the mind and body, resulting in the classic fight or flight system, which the person uses to get rid of the threat. Other stress responses may also be freeze or please. After the sympathetic nervous system is activated (heart beat and breathing rate speeding up, blood flow increase to muscles for action etc.), the hypothalamus, connecting the nervous and endocrine system,  is activated. This leads to the activation of the Hypothalamus, Pituitary and Adrenal gland (HPA), part of endocrine system , which propels the fight of flight response to continue. Chronic activation of the stress response system has been linked with health problems, both physical and psychological.  The pandemic has likely activated the stress response system in many people. The impact of the pandemic may impact people differently based on their individual risk factors (e.g. history of trauma, or mental health issues) and protective factors which help them deal with stress in healthy and adaptive manner.  

 Strength and Endurance Building Strategies

Endurance has also been referred to as strength or hardiness to maintain well being in the most stressful circumstances or resiliency (bouncing back from stressful events).Coping strategies are tools that people use to deal with stressful life events. People’s perception that they have effective tools to deal with stressful events also decreases the impact of the stress on the mind and body. . Coping strategies  have been divided into categories: problem focused  coping versus emotion focused coping. 

Problem focused strategies are actively using tools with dealing with problems at hand.  Emotion focused coping strategies is to deal with the emotions of exhaustion, depression and exhaustion. During crises, we may need to deal with feelings and experiences , Hunger, Anger, Loneliness and Tiredness (HALT), discussed by Gudrun Zomerland.  

When flooded with HALT experiences, often due to crises, we tend to make poor decisions, and demonstrate lapses in judgment. In the world of recovery, states marked by HALT characteristics are high risk of relapse. HALT states require us to stop and reassess the situations at hand.

In building strength and endurance in facing difficulties, we need to be mindful of these factors:

  1. Acceptance and normalizing receiving help. There is a huge crisis before us and many of us are struggling in one form or another. It is Ok to ask and receive help. I believe that many people have a easier time with giving help to others rather than receiving help. One key theme in the psychotherapy work that I do is affirming that  it is Ok to receive help. I encourage people to explore what receiving help means to them and help them challenge maladaptive ideas that receiving help is for  lazy and weak people. In the pandemic, I will argue that everyone needs help in some form or another. Human beings are not solitary creatures. If the feelings of the situation are overwhelming, please seek professional mental health services.
  2. Self care: adequate sleep and nutrition, and safety measures for protection against COVID-19. Dr. Thagard discusses that with prolonged COVID fatigue and exhaustion, people may be less likely to engage in safety measures despite their knowledge of safety behaviors.
  3. Physical activities
  4. Positive emotion has been linked with resiliencyPlease see post on Positive Psychology in the Pandemic for different practices which have been  linked with generating positive emotion
  5. Unplug from the external environment (people, media) for  practices of silence or mindfulness. These practices help us slow the endless chatter of the mind.             
  6. Seeking support, connection and community
  7. Utilizing adaptive self-soothing strategies to deal with negative emotions, such as HALT states, anger, loneliness and tiredness. Marsha Linehan, the founder of Dialectical Behavior Therapy , developed a body of work in teaching people healthy strategies to sooth and cope with negative feelings. One of the powerful strategies of self-soothing is engaging in a calming activity through any one of the sensory systems (vision, hearing, touching, smell, and taste.) Self soothing strategies may vary from listening to encouraging music, watching beautiful flowers, or flickering of candlelight, smell of lavender scent or drinking certain teas.
  8. Cultivate skills to develop hope. Part of endurance is making it through day by day, with hope  that difficulties will pass. It is reminding oneself “this too shall pass”. Positive psychologists, such as Martin Seligman and Shane J. Lopez about written about hope.  Margaret Tartakovsky reviewed  Shane Jackson’s book  , Making Hope Happen: Create the Future you want for Yourself and Others. She discussed hopeful people tend to  have core beliefs such as “future will be better” “many paths to many goals” and “obstacles are part of life”.  As a psychotherapist, I encourage client to explore, identify maladaptive  core beliefs and challenge them to formulate adaptive schemas. This challenging of hopelessness schemas is important in this time. In order to cultivate hope, we have to nurture and embrace core beliefs promoting hope .
  9. Remembering how we overcame past adversities can facilitate building psychological strength.  Eleanor Roosevelt demonstrates much strength and resiliency in her devastating experiences of adversity where she lost both her parents early in life. She  became a powerful and inspirational icon who championed humanitarian causes.  Eleanor Roosevelt  summed up this idea with her statement, 

    “You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, ‘I have lived through this horror. I can take the next thing that comes along.’

    In my experiences as a psychotherapist, I have found that many people tend to underestimate their psychological strength in persevering through difficult times. I often find myself pointing out to my clients about their strength in getting through and handling difficult things much better than they anticipated. The anticipatory anxiety that we will fall apart in difficult situations is often worse than facing the hardship.
  10. Adopting a growth mindset can be important in building psychological fortitude and resiliency . Carol Dweck developed the growth mindset concept and found that students with a growth mindset are more likely to master difficult learning material as they are more like to view difficulties as  challenges to overcome by trying different strategies. Students with growth mindset seem to be more accepting that learning incorporates struggle and that mistakes are opportunities to learn from and become academically successful.  The growth mindset has been linked with academic success. I believe that this growth mindset can be powerful in creating resiliency in life. Growth mindset and resiliency are critical to handling stressors and difficulties in life. I agree with the statement   that how we handle our failures are more powerful testament to our characters than the successes we experience.  I love the growth mindset because it incorporates elements of self compassion (acceptance that it is Ok and human to make mistakes rather than chase the mirage of perfection), self encouragement (learn from the mistakes without punitive comments about the self ) and psychological flexibility (try different strategies to overcome obstacles).
  11. Envisioning imagery of achievement and endurance is powerful in developing mental strength. One of my favorite advertisements is : “It is a crazy dream until you do it. Just do it” by Nike. I will argue that envisioning a dream is not so crazy because this leads us to achieve it.  One of my favorite women of history is Eleanor Roosevelt.  She said “You must do the thing you think you cannot do”. This quote inspired me to push through and complete the last work needed to set up the blog. I also love her quote, “No one can make you feel inferior without your consent”. I wholeheartedly agree. This demonstrates the power of mental strength and fortitude in moving forward and onward regardless of external obstacles.
  12. Relaxation exercises and rest is critical in building strength and endurance.    Relaxation exercises activate the parasympathetic nervous system, which calms the body and mind. The importance of rest and recovery is highlighted by the sports psychology literature that the key to building strength in endurance training and sports are time periods of recovery and not just continuous overload of the body. Helen Richards  states that recovery periods are the body’s rest periods to adjust to new demands, restore and recuperate. It is fascinating that recovery periods are key to building strength training. Recovery periods may last up to 2-3 days after strenuous workout routines.

    There is  interesting research on pregnancy that   expenditure of energy by the female body during a pregnancy is equivalent to a high endurance athletic activity. A season of pregnancy requires periods of rest.

     Recovery is critical to endurance. If one were to apply this endurance training model, this pandemic, has been like continued strenuous training for nine months straight, not a day of recovery or rest. In the world of sports psychology, an athlete who is continuously driving himself or herself with strenuous exercise routines is setting himself/herself for failure, exhaustion, giving up and burn out. In the world of the pandemic, people have been living under very difficult circumstances with no break. It is no wonder people are exhausted and experiencing fatigue.

  13. Strength building through prayer,  reliance on faith , God and spirituality are critical. For me, God is a Source of Strength for things I need to do (action) and also rest (nonaction).  I heard about Thomas Moore’s book “Religion of One’s Own” in Oprah Winfrey’s conversation with Thomas Moore in the Super Soul series. The book is beautiful as Moore discusses that religion is necessary,  personal, and speaks to our soul.  He states that everyone is born with  his or her individual spirituality (Divine Spark within us). It is as one my clients says that “we are all Baby Yodas”.I love Moore’s idea that everyday spiritual practices are opening doorways of the soul to the sacred and the Divine. Thomas Moore describes God as “Infinite” and “Unknowable” and beyond the rational mind. Moore argues that in creating your own religion, the “Infinite” and “Unknowable” nature of the Divine Source does not change, but, that we ascribe characteristics to God in developing our relationship with the Divine. When thinking about religion of one’s own, I think of a philosophy of living and developing relationship with the “Infinite” and “Unknowable”. For example, based on my walk with God, I see God as “endlessly faithful”. This is also reflected in the beautiful Gospel music sung by Elvis Presley, one of my favorite singers. Presley’s deep, gorgeous voice singing with strong emotions the songs, “Take my Hand, Precious Lord” and “You will Never Walk Alone”, is truly an inspirational experience for me. Creating a religion of one’s own does not mean discarding traditional beliefs but personalizing  our philosophy of life, developing our relationship with the Divine Source or ALL.. I also love Moore’s discussion of watching and immersing in Nature, which generates feelings of awe, majesty and wonder. This resonated with me as one of my coping mechanisms in this pandemic has been long walks and observation of nature. I never studied nature as closely as since pandemic started. The majesty of nature is stunning. Another spiritual experience is hugging loved ones.  Such spiritual experiences  strengthen our connection to our Higher Power. One of my clients described a powerful experience of unconditional love when she was feeling sad and her little dog leapt her in her lap and placed his head on her heart. It is what one of the women in my positive psychology classes called the “God Shot”. She said that without the “God shots” in her life, she would not have survived the difficulties in her life.

Concluding Thoughts

The duality of building strength and endurance (action)versus rest (nonaction) is best captured by the saying Keep Calm and Carry on.   This poster was printed by the British government to boost morale of the public during World War II, where British population faced air attacks. Building strength and endurance is not just physical, but also psychological and spiritual. It is carry on, mind. body and soul. Rest is also critical to strength and endurance building. Rest and calmness is needed at all levels: physical, psychological and spiritual.