I came across this the other day:
Development and Evaluation of an Ecological Task to Assess Executive Functioning Post Childhood TBI: The Children’s Cooking Task,which talks about how kids with TBI made more errors in cooking, than kids without.
Results: . . . Children with moderate-to-severe TBI, as well as children with mild TBI made significantly more errors in a Children’s Cooking Task (CCT) in comparison to controls (those without TBI).
What I’m going to use is the idea that cooking success (or lack thereof) can be a good an indicator of how well I do with basic executive functioning stuff like attention, comprehension, staying on-target, etc. The results (I’m sure) don’t just apply to kids. I’m sure they could apply to grown-ups as well.
Given that I believe that I can strengthen the areas where I have issues, cooking seems like a great thing to dive into more. In fact, how well I handle cooking (when I have the time to do it) is a pretty good indicator of where I’m at.
PLUS, it really appeals to the side of me that craves sensory input. It can be an excellent way to experience my life more deeply, charge up my senses, and infuse a deeper and more thorough quality into my life.
After all, I have to eat, so I’d rather eat the good stuff — stuff I make myself. And since I’m the one who’s going to be consuming what I make, it gives me more leeway to experiment – my picky spouse notwithstanding ;).
I used to cook a lot more than I have been, lately. And when I cooked before, it was not very varied or adventurous. When I did try new things, I often messed them up. But I probably wasn’t actively managing my issues well enough. Now, though, I am aware of my issues, so I can actively keep an eye on them. And with this new job, I will have more time in my days to make things I can take with me to lunch, and maybe I can coax my spouse into trying a new thing or two. Less tired is a good thing. Especially for cooking.
As always, moderation is the ticket. Take it slow and be systematic and smart about it. But do it.
Broken Brain - Brilliant Mind 
BB –
Hope your first day went well!! I am sure that you will do amazingly well.
Wanting to answer thoughtfully I have spent a little time considering your question about how I see the difference between post TBI hyper vigilance and the practice of mindfulness. While these approaches seem very similar in purpose; that is to enable a tbi survivor (can someone please please come up with a better nomenclature than that?) to consciously direct themselves so that they are not making gaffes, social miscues and having other various tbi moments I felt, on a gut level, that there was a fundamental difference. To substantiate this I considered how I viewed both hypervigilance and mindfulness and how that related to the neurological functioning of the brain. While some of my reasoning is pretty established ‘fact’ , some of it is simply what I suspect to be true or what some research suggests. Worst case there is a least a thread of validity – and so here it is…
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As I have said many times before cognitive tests and neuropsych exams don’t really illuminate certain key issues (such as these skipped tracks in the record of our lives) and yet among mTBI folks these are often the most difficult obstacles to overcome – particularly because they appear as moral or self-discipline failings and not as cognitive mis-fires. The answer on how to tame these errant neurons – or manage around them – is perhaps one of the greatest challenges people such as you (and I) face. On one hand we want to be who we are (which is pretty capable), able to see ourselves and our lives as filled with possibilities and eager for challenges; on the other hand we climb 2 steps up the ladder and then go sliding down three often enough to get very frustrated – all of which has its own set of consequences. We want to just be, we want to trust ourselves, we want to fulfill our desires but we also know we need to acknowledge that we have been injured in some way and that injury may impact our self-perception and perhaps make us unreliable judges of ourselves. All too often, when we turn to the ‘experts’ , what they say feels limiting, narrow, a reduction of self, a denial of self and not a healing. An almost obsessive focus on our interaction with the world results; yet even this, at times, feels synthetic – how can we just live. Where is the balance, how does one overcome a neurological system that has glitches in self-monitoring? How does one rebuild the capacity for smoothly and simply interacting with the world without constant fear of tripping oneself up? How can we learn to monitor ourselves, to weigh ourselves, to track ourselves in a way that becomes part of us and produces a meaningful change but doesn’t make us feel like we are ditzy flakes?
The art of hypervigilance is often what results from rehab, from the books on TBI and from the ‘experts’ in the system. This is not necessarily a wrong approach. Hypervigilance is about paying attention to what you do, developing routines and processes that can prevent many of the problems that are common (using a planner, getting rest etc). It is about having respect for your injury. Yet many TBI folks find it difficult to remain hypervigilant, they resist the artificial feeling of these external structures and tire of the need for constant self-observation and even more self-evaluation. At some point we want to shout ‘sometimes a cigar is just a cigar’. Furthermore the training process to incorporate these mannerisms into ones lifestyle is awkward and cumbersome – and even worse our tricky brains can distort our effectiveness leading us to believe we are masters of our universes when we are not. If you have to question your very perceptions of self you start to lose self-esteem and you tumble in other ways. Our cognitive skills may outstrip our I/O processing abilities making us feel like we have a brand new Porsche engine in a 20 year old Lada. Or we may feel constrained, as though we cannot simply charge ahead and immerse ourselves in anything because that’s when we are most likely to make the mistakes that hurt us – so we tread carefully and watch ourselves.
Is mindfulness an alternative? Or is it the same thing packaged differently? Can mindfulness – being fully present to the moment – achieve the same degree of awareness and prevention of hypervigilance without the feeling of constraint?
The ‘technique’ of mindfulness is simply about paying attention – just like hypervigilance. So what, if anything is different? On a simle level I think of hypervigilance as a narrow focus, like driving a car down a very narrow and dark road with lots of ruts, you are peering carefully at the ground ahead and trying to keep the car straight. Mindfulness is less goal oriented, it’s a way of stopping and looking around, a broadening of the view which allows you to see the whole more completely.
They each offer something and in part because I think they activate and respond to different neurological basis. Lets start with how our brains function and the possible root for these executive dysfunctions…..
1. A key concept in understanding brains is that they work on patterns. ‘We are as we repeatedly do’ said Aristotle and he was absolutely correct. Our brains seek repetition in form, in action, in input data, in functioning. It has even been suggested that humans have an affinity for symmetry (which is a pattern) in defining beauty. Do something twice and your brain looks for an underlying pattern – or even more it matches it to any pre-existing patterns as a template for how to act.
The use of pattern in cognition is essential to much of what we do – it extends our deeper instinctive behaviors (which are biologically patterned) to other cognitive functions, provides faster (instantaneous) processing, and gives us the ability to learn. Utilizing patterns we can react in both novel and familiar circumstances by deducing that situation B resembles situation A. If we know what to do in situation A we can assume it (with a high degree of accuracy) for situation B. This forms that basis of acquiring knowledge – we don’t have to rework every moment or fundamental concept of our lives over and over – we can extrapolate and predict – an extremely valuable skill.
This ability is probably rooted in our evolutionary development – when faced with a saber toothed tiger we do not have the luxury to think every tiime ‘4 legs, tawny skin, long tail, big teeth – tiger. Looking at me, running at me, stronger than me – danger. Best solution? Fight or run? – RUN’. We need to be able to see tiger – or for that matter any animal that looks threatening – and run – in a split second. And we don’t even have to learn it directly – we can see someone else getting eaten by a tiger and say ‘hmmm, could be me if I don’t run’. That’s a really brilliant concept when applied at a higher level – because it enables invention and metaphor and other nifty things.
Another benefit of this pattern processing system is that it allows us to perform a kind of multi-tasking (though in fact while we may perceive it as multi-tasking it is not quite – however it is close). Once we establish a pattern we can act ‘automatically’ and then turn our thinking to other activities. For example when we first learn to drive it requires all our attention, after a short period of time we get to the point where driving is so automatic that we read, text , talk, eat while driving because the act of driving the car is so ingrained. So having the pattern set up means that we just have to initiate it and we don’t have to dedicate all our cognitive functioning to execution. This in turn means we can do a lot of the stuff of life that is routine and still mentally meander, create, attend, etc .
Pattern processing is also fundamental to many other aspects of our lives – including our ability to ‘time travel’ – that is to reflect back on the past or to imagine what the future is like, or to assume what an unknown situation will be like (I know my spouse will be unhappy about my denting the car because he was unhappy the last time I dented the car so I better start preparing excuses). Or we can visual things like what our new job will be like and how good it will be to do such and such – or how difficult it will be.
2. So this pattern making is essential to learning and creation. While many patterns are inherently neutral – that is learning how to read is a form of pattern recognition – we do attach a lot of emotional context to patterns so that even neutral things can convey feelings , eg. Reading is fun. Similarly we can learn negative patterns – such as poor self image.
Patterns are not inherently correct or right; there are not absolute ‘true’ patterns in all circumstances – patterns are own self perceptions. We train ourselves to recognize patterns based on sensory cues and the way our individual brains are devised and on previous patterns. Some folks get patterned into seeing negative aspects, some into positive. A few folks have very unusual patterning; Daniel Tammet – who is an autistic savant and a synthesiac- sees numbers as associated with color and shape which allows him to perform complex calculations very rapidly. While there are many consistent and established patterns in a culture (saber tooth tiger – run) we all also have our own unique pattern recognition systems that help us define who we are. It may be that the patterns that each of us uses is what we refer to as ‘self’.
3. Patterns alone – even when given emotional content -are not, in of themselves, the distinguishing feature of humans (animals of all sorts develop cognitive learned behaviors). What gives human pattern cognition that extra punch is our highly developed frontal cortex. Indeed our frontal cortex is both our gift and our curse. This part of our brain provides us with our ‘executive functions’. These functions are what allow us to utilize those patterns for planning, rapid decision making, behavioral self-regulation, understanding /making metaphors, extrapolating information and projecting across time (imagining future and past) and other very handy and cool things. While these executive functions are not the actual source of what enables a person to write novels (or software), build airplanes, make chicken cordon bleu or plan a wedding – without our executive functions we would have a difficult time doing those things because damage here would impact attention, motivation, impulse control, self-awareness and coordination of thought processes. Thus, while we might have the intellectual capacity in other parts of our brain to design a building or derive a mathematical proof without our frontal lobes we might not be able to stay on task, begin or end the task, derive a new concept from previous models, keep our mood stabile, or recognize our own mistakes. It is our executive functioning in many ways that allows us to apply our intellectual abilities successfully.
The motivation that our frontal lobes provide is abstract – thus we can motivate a dog to do certain things for food or even for affection or to avoid pain – but it is not often motivated because it wants to achieve, because it is a cultural value. Thus this type of motivation involves things like self-regulation, making yourself do something for a reward that may have little direct relationship to survival. Furthermore our culture sees the capacity to act in this way (self-regulate, motivate, be organized) as an ethical or value function and not a cognitive by-product. Thus a failure to get something done is a lack of effort or discipline, a choice.
4. In TBI survivors who have lasting sequelae the frontal lobes seem to take the hardest hit – often producing what they call executive dysfunction. Perhaps it is just very susceptible, perhaps it is the location or the circuits here are more fragile, or that it is more evolutionarily recent and so redundancy here is harder to achieve. But lasting issues in TBI all seem to point back to this part of the brain. This may be why many mTBI folks struggle so – the intellectual capacity to do things is fine or at least one is able to re-map them, but the underlying ‘self-will’ capacity has glitches.
5. Self-regulation is a key role of the frontal lobes. Remember that we use patterns to act – the frontal lobes then are our last minute security system for our patterned responses and they can nix the execution of a patterned response that may be incorrect. We move to act before we are even aware that the decision has been made – pattern behavior is very close to instinct in speed – but sometimes Situation B is NOT the same as situation A – sometimes we have extrapolated too much or filled in the gaps of information incorrectly. The frontal lobe is thus essential in saying things like ‘Do not hit your boss just because you feel threatened’ – and it can put the brakes on that thought and leave it as a thought and not make it an action. In less dramatic scenarios the frontal lobe can do things like scan the environment and tell you to stop talking so much so others can speak because they look restless, or make you aware of the fact that this stranger is odd and you should not give them your phone number .
Your frontal lobe is what distinguishes between the need to fight in a case of physical threat and the need to inhibit because of an emotional perception (pattern) of being threatened. It’s what says ‘whoa, wait a minute’. This, as you can see, is a very helpful function. Thus the frontal lobe, in the briefest of milliseconds applies historical memory, analysis, lessons on social behavior and organizational structure etc etc – and helps you keep that urge (and others) in check or conversely tells you when to act. .
6. The frontal lobe monitors/manages many functions in this way, things like planning, reward, attention, drive, etc. It is of course not only about inhibiting inappropriate responses or actions it is also about initiating actions, about determining what is relevant and what is not, the priority of demands and stuff like that – all of which is a big part of every day. How and when and why to do those things also requires decisions, data, etc.
We often do not realize how much emotion plays a role in this process. People who think they are logical and can avoid emotional entanglements are deceiving themselves – they still have emotional tags about reward, punishment, etc that influence their decisions making. For example they do not want to lose their home so they pay their mortage every month – this is logical yes, but also because they associate loss of their home with negative and fearful things. Damaasio has demonstrated that emotions are very critical for human thought and are in fact essential for optimal functioning in our world. Decisions and behavior are influenced by previous actions, imagined consequences, and degree of importance. Thus, even if you have the money for the tickets, recognizing the potential consequences of driving 120 mph (injury, loss of license, and social inappropriateness) can act to inhibit you. Emotions give weight and significance to actions, they may be the match to the flame of motivation, they may support attention and memory, they may pull up past events or actions in order to make decisions on how to act now or they may act as detection systems, warning us to slow down because we are feeling pressured and moving too fast. So the frontal lobe management process is very tied to the emotional content we give thoughts and patterns.
7. One result of our hectic, multi-tasking world is that the frontal lobes are very busy. They get feedback and data from everywhere and are constantly evaluating, assessing, correcting. All of this – memory, sensory data, reasoning, and emotion forms a kind of constant background of ‘self-talk’ or mind chatter n the frontal lobe – often without conscious awareness. There is also a lot of stress in our environment – also whether we are aware of it or not. Stress is a form of emotional context (fear) and that drives our frontal lobes too. All this self-talk is part of what many types of psychology attempt to parse out and re-shape because it informs the executive functions (and patterns) of the frontal lobe (and those decisions and actions of the frontal lobe in turn inform the emotional coloring of experience).
We create complex webs of thought, behavior and feeling as a result. And the increasing speed and complexity of our environment adds to the patterns of our executive function as well. Our society – and the various emotional constructs we have – probably makes for a great deal of mind chatter for most folks today. And, for those who have very acute sensory systems (or inability to filter), or who have lots of data in their heads or who think in parallel models or who have strong emotional overlay, the mind chatter may be even more intense.
8. The frontal lobe is also one of the last parts of our brain to get developed – this explains, in part why teens are impulsive and may make poor decisions – they do not have the finely tuned circuitry yet developed to make choices and self-regulate, to double check an action. Ditto for those who are very depressed or have emotional issues. Anything that interferes with the frontal lobe will impact these executive functions. However, the big plus for teens it that their brains have a lot of complex and richly developed neuronal pathways– so learning and absorbing data is easier . They have fewer established patterns (so less ingrained responses, though more impulsive) and they have less capacity in the frontal lobe to check and regulate the formation of action – response (or the validity of a pattern that is executed). The lack of highly organized circuitry at this age may be a good thing because it means they have greater flexibility in establishing new patterns of behavior – so if they execute a pattern that is repeatedly unsuccessful they can ditch it and start anew more easily. The executive function of the frontal lobe is not really in high gear until mid to late 20’s, but it is developing it skills at this time. Later on in life we have less circuitry and more established (and tested) patterns, we need to rely even more on our frontal lobes however for management to insure that the right response has been selected. We also must account for our interpretation and valuation of abstract concepts such as morality, ethics, social mores etc that we have acquired. What busy frontal lobes we have!
9. One of the most effective and rapid associations is emotional – high emotional content has a powerful affect on memory and speed of processing. A man sees a pretty girl – if he has had happy relationships with women his frontal lobe will weigh that positive (along with other factors such as time, place, age, etc) and determine if it is okay to approach her because he will predict his likelihood of a yes is high. On the other hand if he has had his heart broken he may feel fearful of loves snare and say nothing because he believes that he is likely to get rejected. The emotional tag for previous experience will frequently outweigh the fact that logically past relationships will have NO BEARING on whether this girl will say yes or no. But emotion is influential.
Emotion is also quicker to the scene than semantic thinking – after all the need to respond to that tiger with alacrity is more pressing than the need to answer 100 minus 7. So fear (and to a lesser degree pleasure and disgust) are going to be the first ones to arrive at the frontal lobe decision making party.
10. Now realize that your frontal lobe is constantly making decisions, large and small to keep the cognitive machinery moving along. Some things are more clear – don’t hit the boss might be so ingrained that it doesn’t require much cognitive effort to enforce it – but other things might not be – such as talking too much in a situation. Or it could be that there are two opposing valuations of a situation but the more emotive one rules out (pressure to get a reference for the new job over picking the best reference), or that there is too much activity, too many demands – in stressful situations we might have to rely on unchecked patterned responses to save our lives, so when there is high stress the frontal lobe may let a patterned response get by. Yet remember – what we perceive to be stressful is also rooted in patterns and tagged this way by our emotional center. Much of the stress we feel in our lives is not life or death (at least not immediate).
The influence of emotional overlays can be subtle – they can be the voice that shouts hurry up get it done, or they can be worrying about something else so we are listening to worry and not paying attention to routine tasks – they can distract, chew up cognitive fuel and misdirect because they are based on perception and emotional history.
11. Emotional tags and feedback come from our limbic system. Some of this is ‘flight or fight’ stuff – tiger-run behavior. But much of our decision making is not that basic. The limbic system big three are the amygdala, hypothalamus and thalamus. Of these there is a lot emphasis on the amygdala. Interestingly the other part of the limibic system is the hippocampus – which is key in memory – the amygdale has a lot of influence over what the hippocampus retains for memory – and this same memory is used for establishing patterns and the executive decision making processes of the frontal lobes. One might say that the frontal lobes and the limbic system are kissing cousins.
The amygdala plays many roles; for example – mediating ‘gut’ reactions needed for the fight or flight answer, tagging and consolidating memory, supporting the learning process and enabling social cognition. The amygdala decides what matters and gives experience emotional tags. While long thought of as a fear center more recent studies have indicated that it also is activated for pleasure and disgust. Perhaps fear is a more lasting emotion or a more prevalent one than pleasure, or perhaps fear can initiate action more quickly but regardless fear seems to predominate. Certainly in many group and individual studies of psychodynamics and behavior fear plays a major role; fear of loss, fear of failure, fear of making a mistake, fear of death – these all act as powerful driving forces. Whether we are programmed for it or not, culturally our world has traditionally focused on fear as a driver for much human action. Some research suggests that many people (the majority?) do not commit crimes simply because of the fear of being caught (not because it is wrong)– so fear works.
Again, from an evolutionary perspective this makes sense – while pleasure is enjoyable and compelling fear keeps us alive.
However fear, especially in our complex social world, can easily become shame, guilt, self-hatred, despair, anxiety. Thus the amygdala’s reading and determination of the fear content of a situation makes it the 300 lb gorilla in our brains; bossy, controlling, putting negative p-touch labels on everything in memory – it can get out of hand. The determination of what is labeled with what is born from genetics and environment. Living in physical danger, having painful experiences etc. will encourage the amydala to put fearful labels on more things, more memories because that’s the pattern. These memories will then be used by the frontal cortex in the decision making process and for future pattern recognition. Fear breeds fear.
12. So now you have this frontal lobe that is performing these sophisticated executive functions, interpreting data, choreographing the dance, looking at how to get behavior and cognition to coordinate for the big picture. It is influenced by the amygdale which is supplying memory tags and providing a lot emotional internal chatter.
13. If our frontal lobes have any injury this can skew everything – the frontal lobe provides the regulatory response to the amygdala, and conversely it needs the amygdala to make decisions, motivate, conceptualize etc. When this connection loop is out of synch the amygdala can up the emotional chatter because it doesn’ t get the message and the resulting chatter overwhelms and interferes with decision making (or judgement or motivaton). The amygdala can call out danger danger when there is none – or focus on the wrong kind of danger (the pressure to do something rather than to do the right something). Or maybe the emotional chatter gets too loud, too confusing the frontal lobes over-react, looking for a quick resolution even at risk of a mistaken pattern. Or, because in the brain injured person processing is slowed down when there is a need to act speedily emotional circuitry is the more rapid response so the brain doesn’t double check – and it allows more incorrect pattern responses out the door.
It may even be that the miscue is from pleasure – and that without regulation the amygdala rides a wave of pleasurable responses and ignores the reflective double checking of the frontal lobes – hey, it feels goooooood to drive fast and so we are not going to self regulate this behavior and look at the pattern – drive fast traffic ticket. The chatter about feeling good is loud.
In the simplest view this loop of emotion and executive function is not optimized due to a change and so more processing errors slip through – those wonderful gaffes, miscues etc.
Okay so that is sort of a crude and simplistic neuro view of behavior. …now as to how hypervigilance and mindfulness fit in…
14. Hypervigilance, to me, is an attempt to utilize the amygdale to manage executive function better. It makes sense in that fear of losing your job can and does encourage you to perform better. But for the BI person there already an overload – lots of sensory chatter, perhaps random memories, perhaps a faulty feedback to the amygdale about the situation, slowed processing that makes it difficult to accurately self-assess, loss of inhibitory controls to rein in the fear and keep it from turning to anxiety, guilt, shame or worse. So amping up the amygdala is like letting a zillion ladybugs loose in a small room with no aphids to eat. Soon you have all these bugs buzzing about and they interfere with everything – even if they are benign. Its not that emotions are bad, they are needed but they also create chatter and can go to excess. While fear and even pleasure can provide you with more focus and attention to things in TBI they are easily out of control. The extra demand actually may make things worse.
15. Mindfulness, like hypervigilance, tries to have one ‘pay attention’. The intent – if you can say that – of mindfulness is the following: stop habitual responses, prevent future and past thinking, observe and identify emotional tags and responses of a situation apart from the data and reduce brain chatter. In other words mindfulness seeks to calm the amygdala and get it to chill a bit.
This can enable a person to reframe a situation, slow down their responses so that they are planned and conscious and aligned with their data processing speeds, and utilize data and sensory cues that might be missed. A calm amygdala may give the frontal lobes a chance to assimilate ALL data, act with more information and recognize incorrect or faulty patterns that might have gotten missed amid the chatter and demand from the amygdala for an immediate response. It may even be that the calm amygdala gives a more accurate reading of the emotional tag for any given situation – the real danger, the reason for fear, and thus provides better insight into how to actually respond.
It may be that the neutrality of focusing on breath (breathing is usually not an emotive response by itself but it is altered by emotions) can mitigate the emotional onslaught of the amygdala. Furthermore, through mindful practices we can examine the emotional content we bring to a situation since emotional impulses will impose themselves even as we attempt to empty our thoughts. Mindfulness does not seek to control thought or responses but to free ourselves of them so that we can choose the ones that help. If we attempt to control emotions we are still caught in the battle of amygdala-frontal lobe and we end up in a behavioral loop.
There are also some studies which suggest that these practices give our front lobes a breather, a chance to re-energize. I do not know the validity of that but I will tell you that for a time period after my accident I had no internal chatter; my mind was quiet, there were no thoughts unless they were bidden – and even those were very slow to come forth. I had a kind of natural ‘mindfulness’ – I was constantly in the present moment. Perhaps my brains repair effort required this disconnect in order to make immediate repairs. I do not recall what my temperament was though it seems I had a somewhat flat affect. I do suspect that this form of natural mindfulness was needed – like a coma perhaps – to help initial recovery.
These circuit issues between the amygdala and the frontal lobes may not be major – they can be small miscues, or the amygdala mislabeling things with fearful responses, or getting stuck in the immediate pleasure response without regard to future – any number of things.
I have found for myself that, since my injury, I have had to disengage my emotions a great deal; perhaps because my amygdala was overly active in a fear response. After my accident my anxiety and worry would be so great that it would interfere with my executive functioning – and of course my life situation was very difficult so there were real things to worry about – but no way to regulate them. I literally would get so overwhelmed by the sense of panic that I NEEDED to DO SOMETHING NOW that I could do nothing – I paralyzed my executive functions – which we already suffering from injury.
Having said that I also know that I need to not constantly think everything is a TBI moment or a result of TBI, sometimes I could do more to improve my situation – my life was not perfect before TBI (a great myth of TBI is that perfect people were turned into ruined souls; not quite true). So I do have to practice the art of self-discipline and sometimes let go of the TBI label and just move on.
This relationship between emotion, recovery and executive function is constantly being built and rebuilt. This is one of the reasons why I think that the early stages of recovery and rebuild are so important – the emotive patterns that are being reformed are critical to future functioning.
Thus, for me, mindfulness is a critical way to continue to heal, rebuild, recover. Mindfulness, unlike hypervigilance works to recover that self-regulation ,self-awareness in a way that makes it intuitive, a part of who I am and not an outside presence looming over me checking me for failures, faults and mistakes. Mindfulness does not seek to self-judge and because it does not engage in the amydala’s self-talk, it does not act to motivate or inhibit.
However mindfulness intentionally works to not predict, imagine the future or ruminate about the past. Those functions are not necessarily good or bad but they can be like a group of loud children clamoring for attention, they are part of our human capacity to have imagination – mindfulness is about what is. So we do want to engage the amygdala, we do want to use hypervigilance at times – it IS effective – but we want to choose those actions, we want to create the patterns that enable and empower us, that help us be us.
I also think a powerful benefit of mindfulness is that it allows us to select pleasure and the positive to reinforce behavior. On a philosophical note I believe that many of our inhumanities come from our fear based thinking.
Unfortunately mindfulness does not come easily nor quickly – , it requires patience and continued practice – and like many who attempt this I often fall out of practice. It also needs to be integrated into the art of living – and so I try to find ways to use mindful practice. One of the ironies of life is that it works to discourage such a practice; many folks complain that they have no time for meditation – which is exactly the point.
Beyond the time after my accident I believe I have had moment of being mindful – particularly during certain kinds of exercise. I do/did a lot of endurance sports and that brings out a similar focus and awareness, especially as one ‘hits the wall’. To train during very hot or cold situations requires a complete awareness of how your body is responding in order to prevent injury, like focusing on the breath this becomes a kind of expansive awareness. Similarly swimming laps in a pool will also do it- the counting of laps and the regularity of breathing focuses your thoughts, you cannot meander, plan your day or ruminate while counting laps – and so I often found myself very peaceful after a long swim.
Running on the other hand is about time and distance and so for short distances, I am able to let my thoughts ramble, to think about things, to mull and experience chatter. I work to trying to train myself to not do this but it is hard. Many people I know complain that running is boring and I think this is why – they don’t know what to do with their minds. I understand that, I often find indoor running (and biking) boring. But, because of my injuries I must often use a gym to exercise (the hard pavement surface is too much for my spine and legs). To motivate myself I would, like many folks, bring a book to read on a treadmill or bike. . But I have realized that this is not necessarily in my best interest – it is just more busywork for my mind. I need to learn to be mindful, to pay attention to the experience of the present – and this is a good time to do it.
I certainly feel a time crunch, I have so much to read, and I am a slow reader now and I want to multi-task in the bigger picture I need to learn how to focus even more. So I compromise – for every 20 minutes of reading on the indoor bike or treadmill I must be mindful for 20 minutes.
Of course this frontal lobe-amygdala connection is not quite a simple – and different aspects of the frontal lobe focus more on certain emotional content. So various injuries will alter how the connection works – or misfires. For example, tThe left frontal lobe is associated with pleasure and motivation, and, unfortunately for me, that was the source of significant injury.
Your distinction between anxiety and fear is similar to the role of hypervigilance – in the right way it can enable, in the wrong way it can cripple. The emotional content of our experience can teach us but also weigh us down. Mindfulness is one route towards understanding that – but it takes much time and patience. For all my efforts I feel that I have progressed only inches.
So far I have traveled, so much lost, and so far to go.
Hope you had a great day !
M
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Wow – awesome comment(s). I’m pretty bushed after my first day of work, so I can’t even begin to read through it all and make immediate sense of it, but I’ll get to it.
First day of work was great. Now I need to go to bed so I don’t sabotage myself with all sorts of thoughts about the ways it wasn’t 100% perfect, and start thinking I was a disaster 😉
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I am sure you did just fine and probably even better than that – think in the big picture, pay attention to the story you tell yourself and what exists behind it, breath deeply and know that they hired you – they went through a process and selected you and they didn’t do that to amuse themselves – they saw your talent and abilities – those things exist. One step at a time.
Congrats.
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Thanks – yes, I have to focus on the fact that they keep telling me they’re glad I’m on board.
Thanks for the reminder.
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Ah – just got through to the end of your comments — great stuff. Much food for much contemplation.
Thank you
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BB –
Here is the one issue I have with Mindsight or any other program that talks about the awesome ability to remap/rebuild one’s brain in some incredible way – the single biggest comment I have to ANYONE with a TBI is this – think in years – not days, not weeks or months, but years – because recovery or anything that resembles recovery takes years.
By many accounts I was most fortunate in my accident – no coma, no broken anything, no blood or stitches – two black eyes, a lump on my forehead, some bruises and a sore ankle; I didn’t feel so good, had a bad headache, was a little confused (but afterall I was in a serious accident), a little wobbly – but hey, I walked out of the hospital a few hours later and went home under my own power.
Two months later I couldn’t complete a neuropsych test because it was too difficult to finish.
Six months later I was still so deficient in some areas that I was still considered borderline (that is borderline mentally deficient) in those functions
During much of that time however I still struggled to believe that I really had a brain injury
At 18 months I began to recover my sensory integration (I believe the I damaged the portion – the angular gyrus – of my parietal lobe that integrates certain sensory functions) and slowly was able to manage sound, vision and touch better. It would take another 6 months to a year for me to develop stronger filters – though even 5 years later I am still sensitive to sound and to a lesser degree busy visual fields.
It took 2-3 years for my emotional status to settle down and be normalized.
It took 2-3 years for me to rebuild – under INTENSE effort – my working and short term memory skills. I would not have done this except I was forced to by what I did. I had huge problems professionally because of this.
It took my 3 years to hold a visual image in my head and 3 plus years to create or manipulate a visual image in my head. This used to be one of my major strengths and even today it is a lot of effort for me to do this – it was a huge loss of ‘self’ since I was literally gifted in this skill
It took 4 years before I was able to plan and organize my personal effects – and only after I had to move. The moving out process was a nightmare; I simply couldn’t conceive of how to pack things properly and it took me forever – in the end a lot of stuff was lost, trashed, etc. But it may have forced that part of my brain to get moving because a few months later I was able to unpack and organize in a way I had not been able to in years. This too was one of my great skills and so it was very wonderful to do this again.
I had major attention issues the first year – took prescription meds to help but ultimately developed (as most folks do) a tolerance after another year. The dosage was upped which helped but it made me too ‘speedy’ and I already struggled with self-regulation. So I just stopped after about 2.5 years. I have noticed a decrement in my attentional abilities but I continue to work hard at attention since it is so crucial – I believe that mindfulness can help (see below as to how).
My social skills and interaction with others has remained quirky despite a great deal of effort. Some of this is because my situation has been somewhat isolated; I have taken classes in order to improve this and it has been helpful – but regular working conditions would have been good since that would have forced me to address these issues. Sometimes dire necessity is the only way to make the change.
Five years now – two stints in rehab programs (a year each) and a lot of work on my own. During all this time almost no one would have suspected from meeting and talking to me that I was a BI person. They might think I was a bit odd, self-centered, impulsive, pushy, forgetful, confusing, unmotivated , emotionally labile – but they would have all also said I was extremely smart.
I still suffer from significant balance issues, visual co-ordination and subtle but significant executive function problems. I am aware of them but find them difficult to control, but I work at them. A lot of it is tied into self-regulation – and that may be due to lack of exposure to certain circumstances.
I have light years to go and I have been working on the processes that programs such as Mindsight suggest all this time.
If you don’t think years then you keep trying for new answers, you keep running around from one approach to another, you get frustrated and angry and embittered. It’s years – be kind to yourself – you make more progress than you can know.
Having said that though I will also say this –
One of the other big problems about TBI is that the subject of your brain, your behaviors, how you cognate etc. becomes the central theme of your life. You end up both feeling you have something to prove and fearful/shameful of your ‘secret’ deficits that you struggle to hide under a bushel basket.
And sometimes that works against you.
For example; your new boss calls you in after a month on the job and says ‘I would like you to take charge more, to assume responsibility and ownership of things on your own’.
The TBI person thinks – Oh jeez, I am screwing up, I am so careful to not be too assertive or imposing, to listen and not talk all the time, or I just don’t see the next thing I am supposed to do so I just wait to see what is expected or I lack motivation or whatever – and now I am being identified as a loser. ‘ In some cases the BI person may get so paranoid that they say ‘I am sorry , I have a brain injury and I don’t always have the greatest focus but I am working on it’.
The non TBI person thinks (and says) – Great, I am glad you mentioned this. I have been careful to watch and observe so that I can learn more about what the organizational culture is and how you like to have things done. I respect that management here is very smart and has a reason for things. I am eager to assume a more pro-active role. Do you have any suggestions as to where and how you would like me to start?
There a innumerable scenarios such as this where the BI person sees the scenario in light of their ‘deficits’ and feels embarrassed, ashamed, guilty, a failure or screw-up, etc etc. Sometimes they try TOO HARD – they over exert, expect too much, don’t recognize what they do bring to the table and focus obsessively on what they have missed. Since you are aware, far more than most people, of every little quirk, kink and crease in your cognitive roadmap you are driven to demonstrate that you can be just like anyone else. But the person you are demonstrating this to is not really your boss or you colleagues but yourself. Why – because you have imposed on the scenario a variety of templates – emotionally templates that color the picture.
And that is one of the ways that mindfulness makes a difference. When you focus on your breath for any extended period of time you are working on not doing, on not thinking. What happens however is that thought inevitably tries to start up, emotions start to knock on the door. During a formal meditation they may seem unrelated but you may discover that they are very related. During the meditation process you learn to say ‘thank you emotion for showing up, I promise you I will attend to you but I am going to put you in the corner over there for now and just be’ – in the being process you can see the experience and the emotion are separate things. In time you can ‘see’ that paying attention the emotions that certain situations attract can distract you from the actual experience and even worse color that experience a certain way. Many of those emotions are rooted in fear – but sometimes pleasure can distract as well (see my previous note). The emotional content that you bring may be because the situation evokes something in your mental database of memory that is tagged with that same emotion – a similar pattern. So you see what you want to see – not necessarily what IS.
When your boss calls you in it makes you nervous, you want to do a good job, you are afraid that your bi behaviors will hurt your ability to succeed or be rewarded/liked/etc. So you don’t hear what your boss is saying you hear what you are afraid of. They may not be criticizing you at all – but that is what you hear. Or they may see you as such a high potential person that they feel it is important for you to get extra feedback so that you will succeed and will stick around.
These mis-reads are common among ALL people – tbi or no tbi – but in TBI that are worse because a) there really are issues that may need to be addressed (though any shame or guilt is one of those intrusive thoughts that should sit in the corner quietly and be ignored) and b) you are so quick to see your world in a light of tbi that you jump to conclusions and make it worse when what you really need to do is learn how to get that amygdala and that frontal lobe dancing together nicely ; no brain bullies allowed !
And of course this impacts self-esteem, leads to depression and all of that can exascerbate the problems and functional skills of a person worse; so they ruminate and get stuck and the cycle continues.
Mindfulness discourages future projection that are built on emotional modeling. How many times do we assume we know what another person is thinking or feeling or how they will react or what they REALLY want. It also discourages dredging up the past endlessly; how many times do we say, ‘see, this proves I really am a loser, I have done it again, I cannot work well with teams’. Mindfulness grounds us in awareness of the whole of experience – so we hear the positive and not just the negative, so we see the good and not just the bad, so we look at a persons face and don’t rush to judge or interpet but simply note it – and perhaps later reflect or recognize from within ourselves the feelings and experiences of the other (my friend who brags so much is really seeking my recognition , I resent their bragging so I don’t give it to them, perhaps if I acknowledged them they would reduce the bragging – and what is so hard about giving them HONEST acknowledgement?). Mindfulness makes us aware of how we habitually respond (our pattern) and allows us to choose that pattern or another one if that is better. It slows down the situation so that we can use those frontal lobes consciously. Mindfulness works to minimize brain chatter, to build up the ‘muscle’ of focus and attention to task by calmly putting all extraneous tags and noisemakers to the side and addressing them when we are able and ready. It allows our mind to rest a moment. And mindfulness allows us to learn how to observe ourselves, observe our thoughts and feelings honestly – not to pretend that things don’t matter or that we aren’t feeling pain or sadness – but to give due to those feelings – without saying they are right or wrong – and understand that we feel what we feel – but we also can decide to accept those feelings or let them go.
BI is a real issue – I have spent 5 years endlessly working to recover, rebuild, whatever you want to call it. The gross issues (aphasia, severe memory problems, confusion) ebbed pretty quickly. The deeper neurophsych test functions took longer and were more erratic. Some of the healing came from things that no one recommended but I did anyway (exercise, types of work, playing games, school). It was slow and difficult and very very very few folks, including many who said they loved me, were willing to sit it out. What remains are very subtle and deep issues – but also very important ones. There are no tests to tease what these issues out to qualify them – the organize your box test does not correlate to the Wisconsin card test truly. Yet these issues can be what makes it or breaks it for me, especially because with no support for the past 5 years, no real meaningful rehab for the past 4 years I have been teetering on the edge of destruction and so I still walk a very thin line. I know that I need to be healed NOW and I wish that there was a quicker way home but there isn’t.
And I also know that I can paint this picture with every bitter memory and moment and angry thought – there is a lot of that – I can be defensive, embarrassed, self-hating, and despaired – and I often am. But I can also, on a good day, look at the ‘gaffes’ and say – learn from this and know that if they didn’t point it out to you it would mean that they didn’t think your were worth it. So listen, consider, weigh and if you think they are right work on it, if you think they are wrong show what you really are – but in any case don’t condemn yourself, don’t judge yourself, don’t quit on yourself.
Have a great day tomorrow – and good for you for seeking new adventures
M
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Here is an interesting example of mindfulness – I went on day long meditation retreat. After a while of sitting there I began to feel pain – I have some spinal injuries and they flare up now and then. I was however meditating and so I believed I could ‘conquer’ the pain through mediation. I squirmed and struggled and found it impossible to just be because I had a searing pain in my spine and I was a novice meditator AND I was forcing myself to sit in the upright position. I finally decided I would try to find the aspirin I had put in my bag – and so I tried to sneak my hand in my bag to get the foil wrapped aspirin. I contorted myself further tying to do this silently. I somehow could never find the where I had put the aspirin so there was more squirming. I was starting to get embarrassed by my excessive movement. Then, there was a break called and people went to the bathroom – and I took my purse to the bathroom and found the aspirin and took it. The next session of meditation was lying down (or walking) and it felt better on my back. Soon the aspirin kicked in. Later, trying to not think I realized what I had brought to the mediation –
1. Such exteme pridefulness that I was willing to suffer and sit in an upright position even though no one told me I HAD to do this, in fact many people did lay down when it was too much on their backs or knees. But I held on to the ‘idea’ that I would be a better person if I could hold posture. So I suffered and was unable to let my mind be calm.
2. I also could not allow myself the grace of getting up and going to the bathroom to look for the aspirin before the signaled time. Again, there was no rule that forbade this – I just made that up in my head and so I chose to suffer.
3. My embarrassment was only mine- after all no one was really paying attention to me since they were all mediating but I let embarrassment color my thoughts
4. I was unable to use several hours of time for meditation because I brought these thoughts to the process
5. My notions of being tough and conquering pain were not successful – perhaps because I was trying to deny that I was feeling them rather than seeing that they were part of the whole situation. Consequently I let pain direct the situation and allowed myself to be its victim.
All of these patterns are repeated in my life in many ways.
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What is particularly important to understand about that retreat is that I did all those things with good intentions – I wanted to be a ‘good’ meditation student, I wanted to follow the rules and show that I had been practicing and working at this. So I was trying to show I could conquer pain – which is NOT what meditation is all about anyway. I brought a whole lot of assumptions with me – they said that it was good to try to hold the posture and to keep quiet and still until a break but they NEVER said I MUST keep a single posture or that I would ‘lose’ if I went to the bathroom. That was just what I heard, what I brought to this experience but it was not a ‘real’ part of the experience. I was the one who was embarrassed – no one else noticed, and as for the pain – well, I am not the Dalai Lama and perhaps even he would not have said suffer unnecessarily
The good thing is that I came to recognize some of this from my later meditations in the day – I came to see that those emotions (and actions inspired by emotions) were MY perceptions and not absolute – and that indeed I bring those kinds of response to many situations – including BI. This one of the ways meditation can be helpful – because you can see what is your thinking and what is as separate experiences.
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m –
Man, you really hit the nail on the head. So much of what you said is so true. It really is about years, isn’t it? I keep finding myself slipping back into this numbed-out avoidance of what goes on with me. Then I meet with my neuropsych, and they remind me that the choices I’m making and the things I’m doing are not always that bright. But they also point out when I’ve done really, really well – which I have, lately.
I feel in many ways like I’m walking a very thin line — like a Flying Wallenda walking a tightrope above the streets of New York. I’ve been doing well, these past few days, but there have been some interpersonal glitches, some of which I haven’t the faintest idea how to decode. I can’t worry about it, thought. I am keeping my focus on the rope and the end of the thin line — Friday and the long weekend — and I’m not allowing myself to dwell on some of my confusion. It will clear up, I’m sure, as I get to know others and they get to know me.
The main thing is, to keep my act together, not give in to the chatter in the back of my head bitching about me “doing it wrong!” and just keep on keepin’ on.
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m –
I know exactly what you mean. This sounds like the sort of thing I would do. I had a similar situation recently… I’m not sure I can remember it, but it was exactly like that — deciding I was going to do something, making rules in my head about how I was going to do it, and then getting stuck on a proverbial meat-hook while I was trying to force it to work.
I get incredibly invested in doing things THE way I decide I’m going to, without considering all the options, or considering that another option might even exist. I just get jammed in second gear, and the accelerator gets stuck, too.
Huh.
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Isn’t it funny, how we get these ideas in our heads, and we just latch onto them, like they’re gods-truth?
One of my favorite figures in Buddhism is Ji Gong, the Mad Monk. He did everything wrong. He drank wine, ate meat, broke a lot of monastic rules, and was kicked out of his order. So, he went around and helped people as best he could.
I find that I am often at my best, when I am trying the least. But that tends to be rare, as I’m often so intent on doing the right thing, that I can’t possibly let go.
What I take away from it all is that I have a good heart, good intentions, and I’m willing to try.
Nothing wrong with that. We just keep learning.
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