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Best treatment of mental fatigue

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Please read below a proven and good method to combat and reduce mental fatigue. However, the cause of the fatigue discussed here is not a serious physical abnormality. It is of course important to get medical treatment first whenever the cause of fatigue is clearly physical.

This article is about the fatigue that is mainly caused mentally and that remains when a physical illness has been treated as optimally as possible from a medical point of view or is still being treated. Anyway, the tips discussed here are very useful for anyone dealing with fatigue. Especially if it has lasted longer than 3 months and can therefore in fact be called chronic.

On this page I want to summarize the basics of all fatigue tips and tricks. In my opinion, it makes no sense to spend hundreds of pages on the internet to search for all the tips and tricks that have ever been written about dealing with fatigue. That is why I only want to write down here what has actually been proven effective, scientifically spoken.

But… I especially want to emphasize the advices that have actually been shown to work in practice or in a clinic. Unfortunately, science is often unworldly and does not take everyday life and reality into account. I want to do that here. Backed by many patient and family experiences, which actually tested what the scientific world put forward as treatments.

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Mental fatigue seems to be variable

An important observation is that mental fatigue is variable, like everything in life (e.g. pain, itching, sadness, fear). This means that there are also times when fatigue is much less (experienced). And if so, treatment can focus on increasing those moments. If that succeeds, the ultimate net result will be that fatigue will generally be experienced as less stressful.

This sounds very simple and it is! I'll be very clear below in the knowledge we now have about successfully fighting fatigue. I will briefly describe the method so that everyone can learn to apply it in their daily life. Only then will I discuss the apparent difficulties of following the method. 

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Best treatment of mental fatigue ?

The biggest 'secret' formula for reducing fatigue can be assumed to be fairly well known by now and I have summarized all the ingredients in one sentence: do as much that you can to improve your condition and recover sufficiently from your efforts at the same time. This formula contains all proven factors that can reduce fatigue.

1. DO. Either way, you'll need to take action. You will have to learn to fight your fatigue by doing activities. No matter how bad or tired you feel, you'll have to do it. You won't get anywhere without doing: rest rusts. Our bodies are evolutionarily built to do, to move, to perform activities. But not only that. Only doing improves our condition, our mood, we learn, we move forward. If you remain passive on a bed or couch, your condition will only decrease, your self-confidence will not grow, you will not learn anything, your mood will certainly not improve, in short: you will actually only sink further into negativity. And you get even more tired.
2. IMPROVE YOUR CONDITION. This is also essential. Without an improvement in your condition, your heart-lung condition, your muscle condition, your joint condition, your blood vessel and organ condition, you will not feel fitter. Quite logical, because your entire body needs movement and exercise to function optimally.
3. RECOVER. Recover from your efforts. The downside of building fitness is that it takes energy and effort. So you will also have to refuel, something we neatly call 'recovery'. And this is where it usually goes wrong with fatigue: the vast majority of people who suffer from severe fatigue do not adjust their recovery moments correctly at the moments of doing, of exertion. Why not? Why don't they do that if people rationally know that a correct balance between effort and relaxation/recovery is essential for building up a good condition and reducing the fatigue experienced? More about that below.

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Biggest problems in treating fatigue

Someone with prolonged fatigue no longer has the right sensors when it comes to what is good for their fitness or body. The experienced fatigue is no longer correct, this experience has become disturbed or damaged. You can no longer rely on your own experiences!

A short explanation: Fatigue, just like pain, or fear or sadness, is a construction in the brain. The brain determines whether you feel tired or not. They do this by relying on signals they receive from the rest of your body. That could be your blood pressure, your heart rate, your breathing, your muscle pain. But also all kinds of hormones or other chemicals that are released during exercise.

It is now known that this interpretation of all these bodily signals can be influenced. The brain does not need to interpret these signals as "tired" in some circumstances. Just like with pain. For example, a footballer who is going through a game where they are 1-3 down may suddenly have a revival of fitness when it suddenly becomes 2-3 and there are still 10 minutes to play. That is not because there is suddenly more energy flowing into the body (with what? After all, he does not eat or drink). But that's because the brain suddenly starts interpreting things differently based on just a few ideas. Especially the idea that "it's still possible, we can still score an equalizer!".

The above is a clear example that signals from our body can be interpreted differently by the brain. In favor of fitness: you will feel less tired. However, this distorted interpretation is usually temporary. Because afterwards a footballer is really tired, even after the equalizer at 3-3. His body then screams for recovery, for relaxation, for refueling.

If that often does not happen, if the body repeatedly signals in vain that it is tired and that it needs to refuel, then the brain process that interprets body signals can become seriously disrupted. So serious that eventually there is no energy left and that the body actually suffers damage if you continue to work.

Suddenly the brain then gives up: the failure in correctly interpreting body signals that indicate fatigue is then complete. Then the smallest body signals that have something to do with fatigue are often blown up in one second. The dominant feeling then becomes: I can't do anything anymore. And that is exactly what is meant by burnout.

It is very important to realize that with a burnout both the body has become overloaded, so actually physically, and the brain has also become disturbed! And then specifically: the mechanism in the brain that correctly interprets body signals when it comes to fatigue signals. Exactly where this is is still unclear. Although…below some interesting links to recent research on fatigue (from Dutch soil!)

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Fatigue and dopamine

For people who think I am speculating too much in the above paragraph, read this article about fatigue and the chemical dopamine, one of the brain neuro-messengers. Maarten Boksem researched fatigue in his dissertation and guess what? Fatigue is physically detectable.

Now this is not news to me and neither is it to anyone who can think. Why? After all, all our experiences are something material, can be traced back to something physical, namely in our brain. Unless someone gives me evidence about our spirit, soul that floats somewhere and is immaterial. Because that would be world news.

But let's go back: Maarten explains in the article that a dopamine drop in the brain in particular is a sign of fatigue. So fatigue can be measured in the brain. And in particular that the brain always considers whether a task has positive or negative consequences. If the assessment is found to be negative, demotivation and fatigue will set in.

What he does not explain in the article as he cannot have researched all possible factors, is that not only dopamine plays a role in fatigue in the brain. Dopamine is one of the most common neurotransmitters (messenger substance) in the brain, but certainly not the only one. Estimates are that at least 100 substances serve as neurotransmitter in the brain! It would be quite a coincidence if only dopamine had anything to do with fatigue.

With a dopamine drop, several other substances will also decrease or increase in concentration, that is theoretically almost certain. Unfortunately, science works in such a way that not everything is measured in a limited study of no more than 2 years for a dissertation. So I guess that several substances will soon be found in the brain that have to do with fatigue as well.

But it's nice that Maarten has made such a difficult and subjective concept as fatigue more 'objective', so more physical. As he says himself: “Fatigue is now also taken seriously as a psychological complaint”. The fact that you wouldn't take a human complaint seriously at all, because it is a subjective complaint, is an argument that shows stupidity and reduced empathy.

The article about fatigue and dopamine and Maarten's research can be downloaded from his own website. There are also more interesting articles by him about fatigue. Click HERE for his website.

The above mechanism of a disruption of the brain process that can correctly interpret body signals probably also applies to other chronic conditions such as chronic pain, chronic high muscle tension, chronic sleep disorder, but probably also to an eating disorder such as anorexia nervosa.

In anorexia it is now known that there is a disturbance in the brain of body image and presumably also of the feeling of hunger. In other words: if you eat unhealthy for a long time and constantly see yourself in the mirror as too fat, the time may come when you get a disturbance of body signals. We know that we can adapt very quickly to a disturbed image of our body. If we do experiments in which we constantly see our body as too fat (or too thin) via a manipulated mirror, the brain also quickly learns to see this body in this way.

What I want to say above all is: our brains are a network that is dynamic. This makes them very easy to manipulate. Especially when that happens constantly, every day, every minute by feeding them wrong information. Obviously, this disturbance can eventually be traced through imaging techniques or MEG (special electroencephalography), but our techniques are not yet optimal. Moreover, we simply do not know whether what we see is actually normal or a malfunction. For that we have to study many healthy brains with these modern brain scanning techniques. Like Maarten, for example, did.

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The correct approach to fatigue

All that theory is nice but let's go back now to the proper treatment for fatigue.

To clearly explain this, I have made a graph that indicates the essence of a training program in case of fatigue (or pain). With this chart I want to explain what you should do to get out of your worst fatigue. Whether this fatigue has arisen after a brain injury, or after cancer, or after a long-term other illness. The approach remains universal.

An incorrect approach (black line) to fatigue is drawn in the graph, with a red line indicating the final average outcome. This trend is heading towards the abyss: you become and remain a victim of your fatigue and you cannot recover. That is mainly because you take too many big steps in doing things, in carrying out activities. So much that you have to pay for this with a strong relapse after which you have to take a lot of forced rest because your body really demands it.

Then, after a period of much rest, there comes a moment when you really feel better and well, then you go again.... going too far. A repetition of this 'yo-yo effect' occurs and eventually you will lose the battle. Fatigue overcomes, with harmful consequences for your body that burns out completely, running out of fuel.

The right approach is the one with the green line showing an upward trend. How is this? The main thing is that you become wiser and realize that if you feel better, you have to stick to a small effort, a small peak load. Even if you feel bad!

The essence is that you do something anyway, as long as it is measured and limited, within the limits of your actual possibilities. If you learn this, you will notice that you will experience a relapse after such a small effort, but this relapse is less severe and lasts less time than after a peak load.

This also means that you perform 2x more activities over the entire time (8 efforts in the graph) than during peak loads (which only occur 4x in the graph). So you actually do more! And you also feel better with it, plus that your condition also improves through more exercise / activities. It is striking that precisely by controlling yourself, you eventually get further with smaller steps and are even faster than if you suddenly take big steps!

Is it that simple? Of course! Wise people will quickly adopt this philosophy and achieve rapid success. As a psychologist, I spend most of my time convincing not-so-wise people of this approach. And clinical  practice compels me to say that some people will never learn: they are unable to follow this sensible approach. Usually because they are very stubborn, inflexible.

Fortunately, this is only a very small group. The largest group of people with fatigue consists of people who no longer feel correctly what is an effort and what is a peak load. They really don't know when they've gone too far, when they've done too much.

Occupational therapists have developed an activity meter for this purpose. Each conceivable activity receives a number of points. Just like with a diet: every dish gets points. A pastry gets more points than an apple. Following a fast paced action movie gets so many more points than reading a few pages, considering the energy consumption.

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What exactly are peak loads ?

The graph shows very clearly that you should try to avoid major peak loads. In practice, this most often goes wrong because people do not really know what a large peak load is.

Actually, these are activities that are both emotionally charged and require a lot of attention.

Emotionally charged activities evoke (strong) emotions. On my page about Stress I already explain that Stress is nothing but intense emotions. These put a lot of strain on your body, they are peak loads. See my page What is stress?

I often use a simple formula that emotions outweigh regular physical activities by a factor 6. For example, visiting a birthday party at a less loved sister or brother can cost just 30 points of energy, while doing a garden job within the same time only costs 15 points of energy. This is not just speculation, but it is based on newer insights in psycho-neuroimmunology, the science of the relationship between the brain and our immune system. Knowing that stress (heavy emotions) strongly negatively affects the immune system.

Within rehabilitation treatments we teach people to estimate what now costs more and less energy, and therefore when they should make small efforts and when they should rest. For example, ironing can be done in 2 hours in one day (peak load), but it can also be divided over 4 days in 30-minute chunks. Unfortunately, the impact of emotions is still insufficiently taken into account in such treatments. The emphasis remains too much on physical activities, so that optimal results are not achieved. People often learn that they should live very quietly and that is not entirely true. In this way they are often kept much more tired than necessary. This has enormous consequences for their ability to participate in society in a normal way.

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Examples of large peak loads

Despite the above explanation, I often notice in the treatment of fatigue that people still do not understand what really large and small peak loads are. Again: activities that require a lot of attention and that are also emotionally charged. Below I would like to give some concrete examples of such larger peak loads.

In this way you can learn to put together a weekly program with the right balance between efforts and rest/relaxation (rest does not mean that you just have to lie down!).

1. Shopping for 1 hour on a Saturday afternoon takes a lot of energy. That has to do with the crowds: there are many different people on the street, in the shops and you have to find the right shops between all these images, and look for and find the right articles. And also the stress of having to find the right things in time. The brain has a lot of work to do with this. The fact that there are quite a few women who love this does not mean that their brains did not have experienced a peak load. Only...they won't notice it themselves, after all it doesn't hurt and much more important...they have successfully shopped and feel wonderful. After all, they have found some new shoes or clothes and that gives a strong reward. They will feel satisfied and tired at home and for them that is certainly not unpleasant.
2. 1 hour of shopping on an early Saturday morning uses much less energy. There are far fewer people, you can get to the shops quickly, you can find products much faster. But… it may not be cosier for the seasoned shopper. For the brain, however, it is indeed a much lesser peak load, a normal effort, than when you go shopping during rush hour (Saturday afternoon).
3. Attending and co-arranging a birthday party for 8-year-olds for 1 hour, for example as a parent helper. This also costs considerably more energy than, for example, working for a few hours. How is that possible? Well, this is where emotions play an important role and the non-routine activities. At such a birthday party you have to keep an eye on many more things, whether everything is going safely and well, there is much more hectic, the children can ask you anything and everything, the sound volume is usually also on the high side, it often gets warm in a room where you are all together. In short, the brain receives a lot of information. They just have to deal with that. Someone who can shut himself off for that is lucky. He is much less tired afterwards. A few hours of regular work is much calmer: you know what you are going to do, there is little or no stress involved, no really unexpected things to watch out for, your attention system is not focused on this. 
4. Read for 1 hour or watch TV for 1 hour. Which is more tiring? That mainly depends on how difficult the material is. When you read and the text is quite complicated, your brain works much more than when you read a series of bouquets or the Vogue. If you watch a TV series, for example a soap, then it is relatively relaxing because a soap does not really excel in hard-to-follow storylines. Everything is often clear so your brain doesn't have to think much, or plan. In other words you don't have to concentrate much and you can let yourself be carried away by the images and the acting of the actors. But a documentary requires much more concentration to understand everything properly.
5. 1 hour driving on the highway in Norway or 1 hour driving in the heart of Amsterdam. Guess once. Of course driving in Amsterdam is much more tiring. It demands much more from your attention system than driving on the quiet roads in Norway, even if you are not very familiar there.
6. Following a conversation or lecture given by someone who is not to the point, who is very verbose, or who can tell very well in a well-organized and clear manner. In the first case, your brain, your attentional system, will have to make every effort to understand and follow the story. Such speakers are really tiring and often boring. Clear speakers hardly exhaust you and you often keep listening more captivated.

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Summary

Fatigue is of course something physical, but it mainly takes place in the head, in the brain. Maarten Boksem, among others, has demonstrated this beautifully. Dopamine in particular, but also other neurotransmitters such as serotonin, play an important role in the experience of fatigue.

The assumption is that fatigue is an evolutionary good thing: it is a warning signal for us to adjust our behavior or we will suffer damage. Constantly ignoring this warning signal for a very long time can lead to a biochemical disturbance in the brain, something I have called: a disturbance of the correct interpretation of body signals (namely that we are tired and need to rest).

That can lead to chronic fatigue and literally exhaust our body. Brain injury can also lead to increased fatigue. To learn to experience reduced fatigue after a brain injury or other injury, it is necessary to adjust your load capacity to your load and efforts.

The previously created chart can help you with that. Gradually and consistently building up activity, no matter how tired you feel, will ultimately lead to more activity and fitness and a reduced experience of fatigue. However, it does not mean that fatigue will disappear completely. Your body and brain may have been damaged too much, for example due to brain injury or constant long-term overload.

Do you want to know more about how much stress (=emotions) you have in your daily life? Then I recommend the S.O.M. (Stress Overview Meter). You will then get a good impression of your emotional burden. See my page about the S.O.M. HERE.

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DISCLAIMER

I will not take any responsibility for how the information on this website will affect you. It always remains your responsibility to handle all information with care and in case of medical or mental problems you should ALWAYS consult a professional in your neighbourhood!

Ik neem geen enkele verantwoordelijkheid voor hoe de informatie op deze site u zal beïnvloeden. Het blijft altijd uw verantwoordelijkheid om al deze informatie zorgvuldig te bekijken. In het geval van lichamelijke en/of mentale problemen dient u ALTIJD een professional in uw directe omgeving te waarschuwen!

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