Avoid or engage? That is the question

Okay, so I have gotten a number of calls from recruiters with jobs that sound promising to me. At the same time, the people I’m working with at the moment are offering me some good opportunities to grow. And at the same time, I’m so sick and tired of the commute and the working arrangement, that I can’t wait to leave.

I’m stymied. Stuck. I want to move forward, and I have formulated a number of different plans, but I can’t seem to A) stick with any one course of action for long, or B) stay true to my original intention I had, a couple of months ago. Rather than taking the bull by the horns and taking steps in the right direction, I find myself avoiding the issues entirely, doing a million other things besides what I should be doing.

This is no good. Not only is it terrible for my work life, it’s really hard on my spirit. It’s doing a job on my self-image and self-confidence, because each day I feel less and less capable of getting things done the way they should be. It’s as true for my daily work, as it is for my future plans. It’s just not good. I want to engage… but I end up running in the opposite direction, time and time again.

I need some answers and I need some new ideas. So, I’m looking to recent research to see if anyone can explain the mechanics of this to me, so I can formulate a new approach.

I’ve been studying an interesting piece of research, entitled “Coping behaviour following traumatic brain injury: What makes a planner plan and an avoider avoid?” (Brain Injury, September 2011; 25(10): 989–996 by Krpan, Stuss & Anderson). It talks about how, after TBI, executive dysfunction can be related to whether you plan ahead and engage with the tasks / events of your life, or whether you avoid those tasks / events. The paper suffers a bit from a lot of other scientific research I’ve read, in that it focuses so intently on the validity of its data, and it goes to such great lengths to explain and defend the methodology, that the actual point of the research is lost in the shuffle.

And ultimately, the paper doesn’t actually seem to answer the question it poses – “What makes a planner plan and an avoider avoid?”

I do think this is a valid question, and now I’ll explain what I got out of it, and I’ll also attempt to answer the question a little better than they did.

Basically, the point they’re starting from is that after TBI, survivors who avoid issues tend to have negative outcomes. I believe that means that those of us who avoid challenges rather than facing them directly have more trouble with job loss, relationship troubles, money problems… we know how it goes… all these troubles come up, and our means of “coping” is to avoid them, rather than engaging, and we end up with more trouble than we started with.

On the other hand, people who are better at planning things and taking steps to engage with their lives end up with better outcomes.

This study was to “evaluate the neuropsychological, physiological and psychological differences between planners and avoiders with TBI.”

They collected 18 people with moderate-to-severe TBI and ran them through a battery of tests that evaluated them neuropsychologically and physically. The people who did best on the tests and performed best in a staged evaluation were people who planned, whereas people who avoided (didn’t prepare for) the staged evaluation, did worse.

The short answer to their question seems to be that people who avoid score lower on executive function tests, while people who plan score lower. So, the thing that makes people avoid, is diminished executive function. That seems to be what makes a person avoid or engage with the challenges of their life.

Now, I do think that this study has a lot of merit. It’s a great starting point for this line of inquiry. It is one of the first studies of its kind with regard to coping and outcomes after TBI, since not that many people have actually objectively studied the functionality of TBI survivors. Apparently (and I never would have guessed this) clinicians and experts have been relying on our self-reporting to see “how we’re doing” — which even to me seems like it’s not that bright, because we who struggle with brain injury all know how TBI can screw with your perception of self and your ability to assess how you’re really doing. So, kudos to the team that put this study together.

At the same time, however, I think that the conclusions they draw — that faulty executive function is the source of planful/avoidant coping — needs closer scrutiny. Based on my own experience, I would say that, as they say, “Dysfunction on tests assessing executive abilities was the best predictor of avoidant coping,” but it’s not the sole cause of that kind of behavior.

I’ve talked about this in years past, and I’ll say it again — it’s actually an amped-up and poorly managed fight-flight-freeze response that makes us engage or avoid. Because no matter how well your executive function may be, no matter how capable you may be under normal conditions, if the fight-flight-freeze sympathetic response gets the upper hand, it short-circuits our ability to think clearly, to plan, to learn… to make the most of whatever resources you have available to you. Even if you’re normally “with it” and able to deal with most of the complexities that life sends your way, if that sympathetic overdrive kicks in, chances are good that you’re going to run in another direction than straight into the oncoming challenge.

I’ve seen this myself, countless times — a challenge comes up that I know intellectually that I’m able to handle. And I engage with it. Then for some reason, I just can’t. I just can’t deal. I know in my head that I can do it — of course I can. But there’s a big part of me that avoids dealing with it, as though it were a fire-breathing dragon. And it makes no sense.

Unless you consider that the fight-flight-freeze response kicks in prior to the executive function, hijacks the thinking process, and it takes the upper hand quickly and willingly to keep any “danger” from becoming life-threatening. It takes its clues from a million little stimuli, and it doesn’t negotiate. It just takes over — all in a split second before your higher reasoning can kick in.

This being the case — and there is research to support it in the trauma studies “wing” of academia — I believe that even if you do have superior executive function, if you’ve also got a sympathetic bias going on with you, then you can periodically end up with executive dysfunction that keeps you from really developing and honing your higher reasoning abilities.

And this, I think, is where the troubles set in — because our brains are plastic — they respond to conditions and they change and morph over time. And when we have a dominant, poorly regulated sympathetic nervous system that puts us into fight-flight at a moment’s notice, our brains are shaped in that direction — towards the most basic reactions, not higher reasoning. And our executive function doesn’t get the “workouts” it needs to develop over time.

Ideally, it might have been really helpful in the assessment of the subjects in the coping study, if they had looked at their cumulative stress hormone levels over time, to objectively assess the degree to which their sympathetic nervous systems had the upper hand. Come to think of it, that could make a really interesting epidemiology study — look at a broad population of TBI survivors and measure their stress hormones and the outcomes of their lives over an extended period of time, to see if there are correlations — any cause-effect relationships — that can be detected. Or maybe there is a study like that out there, and I just haven’t found it yet.

But I think I’m wandering afield… back to my original theme: According to the study, “planful” coping and “avoidant” coping appear to be connected with executive function in TBI survivors, with people who have more executive function doing more planning, and people who avoid issues having less.

On the other hand, I believe that executive function — rather than being a cause of good outcomes, is an indicator of autonomic function — it is a by-product of not letting your fight-flight-freeze sympathetic nervous system get the upper hand. Whether that is due to conscious choice or instinct or practice, is another question, but based on my own experience and observations of the behavior of others, if you can keep that biochemical cascade in check, so much the better for your executive functioning. And over time, given practice, you’ll be able to strengthen those abilities, and do a better and better job of planning and meeting your life’s challenges head-on, instead of running the other way.

So, I think that rather than being a cause of planful or avoidant coping, executive function is an indicator of how well modulated the autonomic nervous system is, and how adept an individual is at suppressing/resisting fight-flight-freeze responses so they can keep a clear head and actually process all the stimuli that are coming at them on a higher level.

Kudos to the team that did the study. It’s a good start. And like so many other examples of research, it does a great job of posing more questions. I think we have a ways to go before we can come up with anything definitive, academically speaking, but in reading and re-reading this paper, I am coming up with some pretty good ideas about how I get myself over the “hump” of progress I seem to have hit.

I want to move forward, but I feel frozen in place. Now I think I have some ideas about what my next steps can be, so I can move on.

Author: brokenbrilliant

I am a long-term multiple (mild) Traumatic Brain Injury (mTBI or TBI) survivor who experienced assaults, falls, car accidents, sports-related injuries in the 1960s, '70s, '80s, and '90s. My last mild TBI was in 2004, but it was definitely the worst of the lot. I never received medical treatment for my injuries, some of which were sports injuries (and you have to get back in the game!), but I have been living very successfully with cognitive/behavioral (social, emotional, functional) symptoms and complications since I was a young kid. I’ve done it so well, in fact, that virtually nobody knows that I sustained those injuries… and the folks who do know, haven’t fully realized just how it’s impacted my life. It has impacted my life, however. In serious and debilitating ways. I’m coming out from behind the shields I’ve put up, in hopes of successfully addressing my own (invisible) challenges and helping others to see that sustaining a TBI is not the end of the world, and they can, in fact, live happy, fulfilled, productive lives in spite of it all.

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