Jotting and Journalling with Fatigue

Journalling can be a useful way to record thoughts, symptoms, reminders, achievements or everyday experiences. For people living with ongoing fatigue, journalling may help you to notice patterns in your energy and to understand how different activities affect you. These patterns may help you to make more informed choices about when to do activities, when to rest, and where it might be helpful to adapt your routine [2].

What does the research say?

Journalling may help with…	What the research suggests
Fatigue, mood and wellbeing	Expressive writing has been associated with improvements in fatigue, mood and aspects of quality of life in some long-term health conditions [1].
Processing emotions	Reflective and autobiographical writing may help people explore and process difficult emotions [3].
Coping and identity	Writing may support coping, resilience and a sense of identity that is not defined solely by illness [3].

When living with fatigue, the mental effort involved in thinking, remembering, concentrating, writing, typing or sitting in one position can sometimes make journalling feel like another task to complete – the aim is not to push yourself to keep the perfect, neat and polished journal. After all, journalling is still an activity, and every activity uses some energy. Let's explore how it can be adapted so that the effort involved is reduced to match the energy you have available.

Thinking about what the activity involves

Sometimes it can be difficult to figure out what exactly is making the activity challenging. Once you realise what is making the activity difficult, you can look at ways of modifying it.

It can help to ask yourself – what part of journalling is using the most energy? Occupational therapists often use ‘occupational analysis’ or ‘activity analysis’ to look at the different demands involved in an everyday activity.

Journalling might involve:

• Remembering what happened during the day

• Organising your thoughts

• Finding the right words

• Using physical energy while writing or typing

• Concentrating on a screen or page

• Sitting or holding a position

Fatigue can affect each of these areas differently. For example, you might have enough physical energy to write but find concentrating difficult because of brain fog. On another day, your thinking may feel clearer, but holding a pen or sitting upright may be tiring.

Modifying the activity:

An activity can be done differently, for example made shorter, simpler or less demanding. Journalling does not have to mean writing a page every day. You might move from writing a full page, to one paragraph, to three sentences, to three bullet points or to one word.

For example:

·       Energy: low

·       Activity: ten-minute call with a friend

·       What Helped: rested afterwards

This is still journalling.

Fatigue can fluctuate from one day to another. Having different options for journalling ready can help you respond to your energy level rather than feeling that you have to meet the same standard every day. On days when your symptoms are more noticeable, the aim may simply be to record one number, word or short voice note. Or some days you may decide to not do it at all which is also perfectly fine – journalling may not be a priority for you.

Also, it might be worth considering your positioning – there is no reason the activity has to be completed at a desk, especially for those who experience orthostatic intolerance symptoms. Sitting at a very upright angle can often worsen symptoms of fatigue such as brain fog, reaction times and processing speed [5]. The aim is to make the activity as comfortable as possible to participate in if you feel it is important to you.

You might find journaling easier in a supportive chair, reclined or lying down and reduce any overwhelming sensory stimuli by having the room quiet and dimly lit, or reducing screen brightness on your phone or laptop. It can help to choose a time of the day where your concentration is usually at its best also.

Reduce the mental effort

Mental fatigue and brain fog can make deciding and remembering what to write especially difficult. Using the same simple prompts or estimating your available energy levels can reduce the amount of planning and decision-making involved [4].

You could try prompts like:

·       How is my energy today?

·       What did I do today?

·       What went well? What was difficult?

·       What helped?

·       Did anything use more energy than expected?

·       Is there anything I want to remember?

You do not need to answer every question, and maybe one may be enough.

Another option is to use simple ratings.

For example:

Fatigue: 4/5

Concentration: 2/5

Overall day: 3/5

This bullet-pointing style can give you valuable and useful information without spending a lot of energy writing or typing full sentences.

Changing your journalling method

If handwriting is tiring, you might consider changing how you journal rather than side-lining the activity altogether.

You can use other methods like typing, speech-to-text, voice notes, use tick boxes, symbols or numbers, take photos to record and represent parts of the day, or using a prepared journal template.

There is no “best” method for everyone, just whichever method is the one that works for you while avoiding using up energy that you don’t want to spend.

Think about Pacing

Some people with ongoing fatigue can sometimes experience a boom–bust pattern, where more is done on a day where you feel more energised, followed by a worsening of symptoms or increased recovery time, or both.

Journalling does not need to become an activity that contributes to this. So, setting limits for yourself and sticking to them is vital. For example, rather than thinking “I need to finish this page”, you might decide “I’m going to spend two minutes journalling”. Stopping when you had planned is important in not pushing yourself over your energy threshold.

For people who experience post-exertional malaise (PEM) or post-exertional symptom exacerbation (PESE), it is particularly important that journalling does not become something you feel you need to push through - if it is something that is likely to add to your symptoms or use energy you need for more important activities, it is okay to leave it for another time when it feels more manageable.

Journalling can be whatever you want it to be. The important thing is making it something that works for you and fits around the energy you have. By using journalling as a flexible tool, it can offer a place to reflect and better understand your own patterns over time.

Happy journalling!

References:

1.       Abu-Odah H, Su JJ, Wang M, Sheffield D, Molassiotis A. Systematic review and meta-analysis of the effectiveness of expressive writing disclosure on cancer and palliative care patients’ health-related outcomes. Support Care Cancer. 2023;32(1). doi:10.1007/s00520-023-08255-8.

2.      Nottingham City Care. MOSAIC online ME/CFS management programme [Internet]. 2026 [cited 2026 Oct 2]. Available from: https://www.nottinghamcitycare.nhs.uk/msk-home/mecfs

3.      Olukayode F. Therapeutic applications of autobiographical writing for chronic illness management and self-reconstruction. Int J Engl Educ. 2025;14(3). doi:10.67050/ijee/v14i3/ijee253014.

4.      Sanal-Hayes NEM, McLaughlin M, Hayes LD, Mair JL, Ormerod J, Carless D, et al. A scoping review of ‘pacing’ for management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): lessons learned for the long COVID pandemic. J Transl Med. 2023;21(1). doi:10.1186/s12967-023-04587-5.

5.      Vernon SD, Funk S, Bateman L, Stoddard GJ, Hammer SK, Sullivan KA, et al. Orthostatic challenge causes distinctive symptomatic, hemodynamic and cognitive responses in long COVID and myalgic encephalomyelitis/chronic fatigue syndrome. Front Med. 2022;9. doi:10.3389/fmed.2022.917019.

Bibliography:

6.      Amira, F. and Vidyarini, E. (2026). Sitting posture and cognitive performance: A systematic literature review. Jurnal Arsitektur ARCADE, [online] 10(3), pp.379–386. doi:10.31848/arcade.v10i3.4601.

7.      Kim, S., Xu, Y., Dore, K., Gewurtz, R., Larivière, N. and Letts, L. (2021). Fatigue self-management led by occupational therapists and/or physiotherapists for chronic conditions: A systematic review and meta-analysis. Chronic Illness, [online] 18(3), p.174239532110397. doi:10.1177/17423953211039783.

8.      National Institute for Health and Care Excellence (NICE) (2021) Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management. NICE guideline [NG206]. Available at: https://www.nice.org.uk/guidance/ng206 

By Ruby, Occupational Therapy student at The Brí Clinic