Aggressive Rest Therapy (ART) and Aggressive Resting
What It Is And How To Use It
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What Is Aggressive Rest Therapy?
Aggressive Rest Therapy or ART is a behavioral therapy for Myalgic Encephalomyelitis (ME) originally designed by Gregg Fisher who describes
"The concept of ART is not just to rest when you feel horribly ill or even merely to eliminate "pushing." This is a program of aggressive rest. Even when you feel you have a little energy, you should rest."
ME is the only illness where exertion can lead to permanent decline. ART is promoted by the ME community to counterbalance the narrative that pushing is essential to recovery and establish the importance of rest to recovery. However, no large-scale studies have ever been conducted on ART.
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What Is Aggressive Resting
Aggressive resting may be used as a part of aggressive rest therapy but does not refer to a long-term therapy. Rather aggressive resting is a term used by the ME/CFS community to describe the act of resting deeply. Aggressive rest requires:
-Lying down to remove orthostatic stress
-The removal of as much physical stimuli as possible such a light and noise
-The removal of distractions such as screens, books, and crafts
-The removal of mental stressors such as overthinking or problem-solving
-The removal of emotional stressors such as worry about productivity, finances, and the trajectory of illness
Aggressive rest may be practiced for as little as 5 minutes a day or may be practiced for hours or even continuously. Practicing aggressive rest frequently can help aggressive rest therapy.
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How Is ART Different From Pacing
When pacing the goal is to prevent crashes. Activities are deemed safe and desirable as long as they do not cause post-exertional symptoms.
In contrast, the goal of aggressive rest therapy is to save as much of the body's energy as possible for healing. Therefore, any activity that is not essential to survival is deemed unhelpful. This hypothetically will allow the body to "recharge" its energy battery and use that energy to heal.
Pacing for ME is itself a form of radical rest and is supported by NICE, Mayo Clinic, CDC etc. However, ART takes this approach even further. Resting beyond an immediate visible benefit of days to weeks and instead attempting to receive benefits from more aggressive rest over months to years.
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Is ART A Cure For ME/CFS?
No large-scale studies have been conducted on ART and it is not recommended by any major medical association.
Anecdotally, ART is most likely to help patients recover early in their illness by preventing ME from developing permanently. This "convalescence" period following illness was once widely prescribed by doctors.
ART should likely be seen similar to pacing or as a form of strict pacing. Not a cure for the illness, but a potentially helpful intervention for symptom management and preventing progression of the disease. If a patient continues to decline after the implementation of pacing ART should be strongly considered.
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Key Things To Remember When Practicing ART
Feeling better doesn't mean the treatment is unnecessary, it means it is WORKING.
Mental and emotional stressors can use up just as much energy as physical.
Resting is HARD. This will be the most difficult mental task you will ever undergo.
Deconditioning is a likely consequence of ART. It should be monitored, but remember, it can be reversed. ME (to our knowledge) cannot. If deconditioning is a major concern, focus more heavily on mental and emotional rest.
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The Privilege Of Access To ART
While ART is a therapy that does not require a prescription or access to healthcare it is still one of the most difficult to access treatments for ME.
ART requires access to good caregiving (the level needed depending upon severity and going up to 24/7 caregiving) as well as the financial stability to not work for months on end without incurring financial or emotional stress. It also requires an emotionally safe as supportive environment to minimize emotional exertion as well as a high level of established mental health.
Access to pacing is already a privilege, without friends or family who understand ME well and will support you in ART or immense wealth this treatment simply is not possible to properly trial.
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The Importance Of Mental Discipline and ART
While the physical side of aggressive rest therapy is not too difficult to understand, the mental side requires intense discipline.
ART will not work if you spend the time stressing or doing mentally or emotionally demanding activity. This includes most exciting media and almost all socialization and all social media.
To avoid depression, ART must be done with intense dedication to the treatment, faith in its ability to help you, and self-compassion. You must fully decouple your worth from your productivity and devote yourself completely to rest and healing.
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Returning To Regular Life
While some people practice ART continuously, many simply trial it for a period of time.
In the best case scenario where ART leads to recovery, patients report first experiencing a complete remission of symptoms for an extended period of time (months), they are then able to rapidly increase movement without the development of post-exertional symptoms. It is generally recommended to first increase physical movement and undo deconditioning before allowing for mental and emotional stressors.
For most patients though, when increasing activity following ART symptoms that had been improved will increase. A slow and measured approach to increasing activity is best settling at a level where symptoms are manageable and activity levels do not spark large crashes. In other words, a transition from ART back to pacing is then possible.
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ART Summarized
ART stands for aggressive rest therapy
ART consists of resting as much as possible all the time even when you feel okay or good
Aggressive rest is a form of complete rest with no stimulation and is used as a part of ART but can also be used as a part of pacing
ART is not proven as a cure for ME
ART takes privilege and immense mental discipline to trial as a cure
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Agressive Rest Therapy or ART is a therapy developed for Myalgic Encephalomyelitis based on the idea that if exertion and pushing causes crashes Post Exertional Malaise (PEM) Post Exertional Neuroimmune Exhaustion (PENE) and decline of health than rest may be the way to restore health.
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ART goes beyond simply pacing, the single proven treatment for ME/CFS (As well as #LongCovid with post Exertional Symptoms). Rather than simply resting enough to prevent symptoms the goal is to rest as much as possible 24/7.
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Rest in ART is a form of Agressive Resting a strategy that can be used as part of many different recovery plans from MECFS and Long Covid.
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Agressive Rest means practicing
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Physical Rest - by lying down
Sensory Rest - by staying in a dark and quiet space
Mental Rest - by meditation or avoiding deep thinking
Emotional Rest - by avoid stress or exertion
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☆All forms of rest are essential to ART not just physical☆
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ART is not a cure for ME, a disease with no known cure and only a 5% recovery rate. It carries a high risk of deconditioning and had never been studied. However, annecdotally it may improve the chances of remission and is a powerful form of symptom management. Agressive rest therapy may be appropriate when attempts at pacing continually fail to reduce symptoms or crashing as ART is a stricter form of energy limitation than pacing.
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To practice ART you must deeply understand
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Symptom reduction does not mean the treatment is unnecessary, it means the treatment is working
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Your value is not your productivity. Healing is hard work that takes complete dedication.
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Deconditioning is a natural consequence of extreme resting. It can be reversed if you recover.
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ART requires priviledge to practice. Financial priviledge to be able to take time off work, social priviledge of access to caregiving, and mental health priviledge of being able to cope with the extreme boredom and sensory deprivation. ART is not possible for everyone and everyones practice of ART will look slightly different.
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So have you or would you try ART?
