BY CLARISSA G. HOOVER, MPH

If you're seriously bummed out over some bad news or some hard times, you may find that it is lack of energy, not lack of time, that keeps you from getting things done. If you're having trouble doing everything you need to do for your family (no matter how bad you want to), staring at a stack of dirty dishes thinking carryout sounds good tonight (too often), or struggling to build up your nerve to go to work in the morning (yes, I've been there), maybe you need to start thinking about energy management instead of time management.

When I was laid off a month after my daughter's third hospitalization, it hit me much harder than previous lay-offs that I'd gone through. (Yes, I consulted a lawyer – it didn't help me, but I'd like to think that we did enough to help others down the line.) We were less than a year out from my daughter's diagnosis with cystic fibrosis, and I wasn't exactly Miss Congeniality before the lay-off. However, the lay-off sparked a turn for the worse. Since I wasn't working, I had nothing but time, but I just didn't have the energy to put my life and my career back together again.

Around this time, I ran across one of the teaching tales that makes the rounds of the disability community: the Spoon Theory. A woman with lupus explains her life to a friend by handing her a fistful of spoons and translating the energy cost of each activity into its cost in spoons. Her friend starts the day with 12 spoons, and is staggered to learn that getting dressed will cost her two spoons – one to get dressed, and one to get ready to get dressed, which she hadn't even thought of as a task. I don't have lupus, so I was really surprised by how much this story resonated for me. When I thought about it, I realized there was one main difference between me and the Spoon Theory. I didn't start every day with 12 spoons – I could have a lot more (or less!) depending on the choices that I made. I didn't call it this at first, but I guess that I've been working on my own theory of energy management ever since that day.

My first rule of energy management is to invest energy to produce or save energy. My second rule is to treat myself as kindly as I would treat someone else I saw in a situation like mine. Everything else springs from these two rules and, really, the sec ond rule springs from the first – because it wastes a LOT of energy to be unkind to myself.

Let's pause a moment to be clear about this – what I'm talking about here is a prescription for depression and anxiety. I haven't used those words yet because I didn't think of myself that way at that time in my life. Didn't think of myself that way when I started therapy. Didn't think of myself that way (don't ask me how I got away with it) when I was on anti-depressant medication for six months. I didn't really start to think of myself that way until I started to get better. These days, when I'm feeling pretty good most of the time and depression or anxiety are occasional interludes, it's pretty obvious what they are. Because I know what I'm like when I'm feeling good, and anything that changes me that much deserves a name, a diagnosis, and (very important!) a wealth of resources available on the internet when I type the right keywords into my favorite search engine. 

Is energy like a pie, that's gone once it's cut and served? Or is it like a plant, that grows if it's cared for? (Don't throw any Laws of Thermodynamics at me here – they apply, but they aren't as helpful a way of thinking about life force, the energy that drives the human body.) Many people with disabilities, including the woman who authored the Spoon Theory, face tough limitations on the amount of physical energy they have to get through the day – every activity must be chosen with care, every priority carefully weighed. Even so, I believe that energy is more like the plant than the pie.

Below are some of my suggestions for how to grow your energy by investing limited energy in ways that produce or save energy down the line.

FUEL THE BODY

Like all energy, your body's energy starts with fuel, mainly oxygen and food. This is especially important if you (like my daughter) can't take breathing or digestion for granted – but really, should any of us be taking them for granted? You can't grow your energy if you don't have it to begin with, so breathing well and eating well are top priorities for energy management. Exercise is also important, to keep your heart and lungs in good shape to supply you with energy, and your muscles in good shape to use it.

SLEEP

Depression and anxiety can wreak merry havoc with sleep patterns – sleeping all the time when you're not tired; can't sleep no matter how tired you are; sleeping all day and can't sleep at night. So, without being too glib about the size of the challenge, I have to mention the importance of getting a good amount of sleep (probably around eight hours) every night. It seems kind of silly, but it was actually my phone that finally got through to me on this, when it prompted me to set a bedtime based on when I was getting up in the morning. I haven't got this one completely nailed down yet, but I've gotten close enough that I know it's going to be good for me, and I'll keep after it until I get there.

LINE 'EM UP AND KNOCK 'EM DOWN

Did you see how I did that, just then? I'm not there yet, but I'll get there. This is part of "line 'em up and knock 'em down," which has been one of my favorite mottos since shortly after my daughter's diagnosis. It's gotten me farther than I ever imagined back when the next big challenge was eating off of real plates instead of paper. The point of this is to keep focused on one challenge at a time, rather than looking at everything that needs to change and getting overwhelmed into a state of emotional paralysis. It would fit in nicely with my overall message if I claimed that I always focus first on the things that would increase my energy reserves most, but that's just not true. It almost doesn't matter how I decide what to focus on as long as I have a focus. As long as I am making progress, it helps my energy levels and helps me feel better about myself and about my situation.

EXERCISE, AGAIN

Exercise is so effective against anxiety and depression that it is worth a double mention here. I was once privileged to interview a number of breast cancer survivors who had been cancer-free for up to ten years, and I learned a lot from what they told me when I asked about exercise: "I dance"; "I walk with my mom"; "I work in the yard every day." These women did not limit themselves to jogging and gym memberships – they understood that the essential feature of exercise is movement, and celebrated opportunities to blend exercise with other things that they enjoyed.

DO SOMETHING THAT SEEMS OUT OF REACH

Sometimes the things that we think are impossible or not worth the effort turn out to be the best, most worthwhile things that we can do. This can include day-today things like taking the kids to the playground, or more adventurous activities, like going to an amusement park. Maybe it can't happen often, maybe it takes extra preparation or extra time, maybe you'll need special equipment - whatever it takes, it may be worth the energy tradeoff, because nothing recharges those energy stores like VICTORY.

POWERED UP: Exercise keeps your heart and lungs in good shape to supply you with energy and your muscles in good shape to use it. Don't limit yourself to jogging and gym memberships – the essential feature of exercise is movement, Celebrate opportunities to blend exercise with other things that you enjoy.

IS ANGER GETTING THE JOB DONE, OR IS IT DRIVING YOU INTO THE GROUND?

It isn't recognized in depression stereotypes, but depression often takes the form of anger rather than malaise. This kind of anger tends to find targets that have nothing to do with where the anger is really coming from, and it is a huge energy drain for you and other people around you. If you're struggling with anger that seems out of proportion to whatever the immediate triggers are, try to let go of it rather than letting it drive you. As with malaisetype depression, you may find some relief from some of the other suggestions on this list, particularly the quiet powerhouse in the anchor position, "Get Grounded."

IS REST RESTORING YOUR ENERGY RESERVES, OR DRAINING THEM?

This is an issue with depression and anxiety that can be tricky, particularly if it's combined with physical problems that limit energy reserves and truly require increased rest. You feel exhausted, so you watch TV, mess around on the computer, or take a nap… and when you get up, you feel worse than ever. So, if rest doesn't help you when you're tired, what will? The answer is, anything else on this list, anything else you can think of, text a friend, exercise (did I mention exercise?), but first and foremost, recognize that if rest isn't helping you, rest isn't what you need – or in any case, it isn't all that you need.

GET HELP REFRAMING YOUR PROBLEMS

This is the point where a lot of people would talk about the importance of a good therapist, but since I know that isn't an option for everyone, I want to back up a step and talk about what that means. A good therapist (or friend, or cleric, or whatever) isn't going to solve your problems for you, and they aren't (God forbid) going to create new ones out of thin air. What they will do is help you reframe problems so that they are easier to solve (which is where the energy savings come in). "What would happen if you had that conversation?" "What was it about that that you liked?" "What do you want to see happen next with this?" Everyone gets stuck sometimes, but when you're depressed or anxious, being stuck may cost more energy than you can afford. It can be a huge help to have someone else pointing out things that you're making harder than they have to be.

GET GROUNDED

Getting grounded is about getting more connected with yourself. Journaling, making art, making music, meditating, and (surprise, surprise) exercise are all strategies that can help you get grounded. It's surprisingly common, even encouraged in our society, to spend large amounts of energy trying to escape ourselves. It's a little challenging to explain the energy savings from getting grounded until you've experienced them yourself, but they can be profound. Whether you're trying to block out past trauma or current pain, or simply never really had a strong sense of yourself in the first place, grounding activities help you create a safe space to come to terms with things that you've been trying to avoid.

I don't know how well the energy management strategies that worked for me will work for you, but I hope that they at least give you some ideas. I also hope that this is a chance to think about the value of activities that invest your energy to end up with more energy, and the value of investing in yourself. •

ABOUT THE AUTHOR: clarissa g. hoover, MPh, started advocating for patients, families, and quality healthcare shortly after her daughter's diagnosis with cystic fibrosis in 2005. she is currently a project director for Family voices ( familyvoices.org), a national, nonprofit, family-led organization promoting quality health care for all children and youth, particularly those with special health care needs.