I blame the space weather

Coronal Mass Ejection
Coronal Mass Ejection

I just checked online, and apparently we’re having pretty intense “space weather”. Coronal mass ejections (CMEs) that are pretty intense.  According to spaceweather.com,

Sunspot AR2671 has developed a ‘delta-class’ magnetic field that harbors energy for X-class solar flares. Credit: SDO/HMI

Awesome. Just what I need.

Solar flares, CMEs, and geomagnetic storms can affect radio transmissions and have also been tied to migraines and cluster headaches. It’s hard to prove, but if you consider that we’re very “magnetic”, ourselves — our nerves transmit their information as electricity (and lots of chemicals), so if electricity is affected in general, chances are, we’re also going to be affected.

Well, whatever. I’m just getting through the week, trying to be smart about things. Keeping myself on a schedule and focusing on the things I can control, versus… everything else.

Onward.

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FYI – Stress and cell phone addiction

child with smartphone sitting on a benchSmartphone addiction is real.

And it can also make TBI recovery more difficult by affecting your sleep and getting you cranked up into a constant fight-flight state. Not having a lot of “screen time” after a concussion is a good idea for a lot of reasons. This is one of them.

Thanks to Ken Collins for sending along this great research paper:

Exercise rehabilitation for smartphone addiction

Hyunna Kim*

Abstract

Internet addiction after launching smartphone is becoming serious. Therefore this paper has attempted to sketch out the diverse addiction treatment and then check the feasibility of exercise rehabilitation. The reason to addict the internet or smartphone is personalized individual characters related personal psychological and emotional factors and social environmental factors around them. We have shown that 2 discernible approaches due to 2 different addiction causes: that is behavioral treatment and complementary treatment. In the behavioral treatment, cognitive behavioral approach (CBT) is representative methods for changing additive thoughts and behaviors. Motivational interviewing (MI) is also the brief approach for persons not ready to change their behavior. Mindfulness behavioral cognitive treatment (MBCT) also the adapted treatment based on CBT. There are different types following the emphatic point, mindfulness-based relapse prevention (MBRP) or mindfulness oriented recovery enhancement (MORE). It is apparent that therapeutic recreation, music therapy using drumming activity, and art therapy are useful complementary treatment. Exercise rehabilitation contained the systematic procedures and comprehensive activities compared to previous addiction treatments by contents and techniques. Exercise rehabilitation can treat both physical symptoms at first and mental problems in the next step. So more evidence-based exercise rehabilitation researches need to do, but it is highly probable that exercise rehab can apply for smartphone addiction.

Keywords: Smartphone addiction, Exercise rehabilitation, Cognitive behavioral therapy, Complementary treatment

INTRODUCTION

The penetration rate of smart phones in Korea was recorded 67.6% as the world’s #1 in June, 2013. This is 4.6 times of the world average penetration rate, 14.8% and 10% higher than Norway ranked to second higher penetration rate (55.0%). In the case of 2012, the “Anypang game” craze was exploding in Korea. The daily number of that game was 10milion. It means almost every people using smart phone played the Anypang (Jung, 2012).

According to the “2011 Internet Addiction Survey” by Korea Internet Development Agency and Communications Commission, 8.4% of Korean people were heavily addicted to the smartphone. Smartphone addiction ratio is higher than the entire internet addiction. Problem is that 11.4% of 10 generation 10.4% of 20 generation was addicted to the smartphone.

The cause of addiction is enormous convenient mobile computing function of smartphone such as portable media player, high speed Wi-Fi mobile system. Smartphone carrying in the hand can access the internet more easily and conveniently than PC. Great variety of apps and games for smartphone are being made.

The general form of internet addiction can be divided into a game, chat, pornography, but the smartphone addiction can create a new addition category such as SNS or app addition. In addition to, in comparison with other media, smartphone require more intervention and activity by subject, immediate connectivity and social interaction as a game affect to the game immersion and addiction.

Seoul Metropolitan Office of Education surveyed the habit of using internet of middle school and high school students in March, 2013. As the results, 6.51% of the total number of smartphone users used the phone excessively. Among them, 4,585 students (1.81%) were risky users; they cannot done properly school work, interpersonal relationship and feel psychological anxiety and loneliness without using smartphone (Online news, 2013).

Smartphone addiction is not a personal problem. Addiction to smartphone has induced serious abuses problems more and more, especially to young students. This is the time to find the way to rehabilitate from the smartphone addiction at the national level. As reviewing the previous study about internet addiction, the addition research for rehab is relatively young is still establishing its basic treatment. In the case of addiction, except the pharmacotherapy, the behavioral approach to stimulate cognition and behavior has been applied typically. One of outstanding features employed in this device is that various treatments have been approved to help addicted individuals.

The commission on youth protection in Korea developed internet addiction treatment and addiction model in 2004. After 2005 they accomplished youth family camp for internet addiction and natural cure programs with Korea green culture foundation in 2007 (the Commission on youth protection, 2008). Analyzed the camp and other addiction program, there is growing body of attempts to cure the addiction not just focusing on the classical treatment.

Therefore this paper attempts to review the addiction treatments concerning general addiction and smartphone addiction from previous researches and offer the possibility of exercise rehabilitation for smartphone addiction.

INTERNET AND SMARTPHONE ADDICTION

What is smartphone addiction?

There are 2 types of addiction, one is drug addiction such as drug, alcohol and the other is action behaviors such as game, internet, even smartphone. Unfortunately, internet addiction is resistant to treatment, entails significant risks and has high relapse rates (Block, 2008). In case of smartphone, there are little research has been conducted. Smartphone addiction has many aspects that are similar to those of internet addiction and as such the internet addiction criteria must be considered when developing smartphone addiction criteria. So this study searched internet addiction treatment program for curing the smartphone addiction.

The terms Internet addiction were identified based on the Diagnostic and Statistical Manual, VI-TR definition of substance abuse and pathological gambling (America Psychiatric Association, 2000), but currently it described under the category of impulse control disorder, not otherwise specified.

Dr. Ivan Goldberg first coined the term internet addiction disorder (IAD) for pathological, compulsive internet use (Brenner, 1997). Internet addiction is an overarching term characterizing five problematic Internet-related issues: cyber sexual addiction, cyber relationship addiction, net compulsions, information overload, and addiction to interactive computer games (Young et al., 1999). Symptoms of internet addiction include social isolation, family discord, divorce, academic failure, job loss and debt (Young et al., 1999).

Causes and symptoms

Approached form the early previous studies, the research has offered the reason why people are addicted to the internet. Internet addiction have relevance to 3 factors, that is specific characteristics of the internet, personal psychological and emotional characteristics and social-environmental characteristics (Choi and Han, 2006; Kim et al., 2006).

Generally people who have psychological and emotional characteristics such as depression, loneliness, social anxiety, impulsivity, distraction (Kim, 2001) easily to addict the internet. The place where internet access, the degree of time to use internet, peer relationships parenting types are also associated the addiction.

Internet addition shakes physical and psychological problems. It provokes physical symptoms such as dry eves, carpal tunnel syndrome, repetitive motion injuries, wrists, neck, back and shoulders, migraine headaches and numbness and pain in the thumb and the index and middle fingers. As Young’s research (1999), fifty-four percent of Internet addicts report a prior history of depression; 34% with anxiety disorder; and 52% with a history of alcohol and drug abuse.

ADDICTION TREATMENTS

Behavioral treatments

Following the previous studies, personal factors may play a key role in internet use and the development of internet addiction. Adolescent personality traits that correlated positively with internet addiction included high harm-avoidance, reward dependence, low self-esteem, and low cooperation (Weinstein and Lejoyeau, 2010). Poor academic achievement might be associated with low self-esteem and with behavioral problems such as sleep disorders, aggressive or depressive symptoms, dropping out of school, antisocial personality disorder and alcohol abuse (Valdez et al., 2011). Adolescents with poor academic achievements usually received less respect from surrounding people, and poor academic achievement might be associated with low self-esteem and with behavioral problems such as sleep disorders, aggressive or depressive symptoms, dropping out of school, antisocial personality disorder and alcohol abuse. Those kinds of feelings and isolation would make these adolescents to go online in a search for sense of belonging and self-satisfaction.

Most studies have focused on the relationships between psychological characteristics and internet addiction (Choi et al., 2006). Classical treatment had focused on individual factors such as low self-esteem and aggressive and depressive symptoms. The main issue of classic treatment is how to change personal feeling and thoughts.

Cognitive behavioral approach (CBT)

CBT is the typical mental health care for develop psychological symptoms such as obsessive-compulsive disorder. CBT can assist the individual with internet addiction disorder to recognize thoughts and feelings causing person to inappropriately use the computer to meet personal needs (Orzack, 1999).

Generally, CBT is an efficacious method of treating substance abuse, depression and anxiety to substance abuse issues and drug addiction. .Further to this, there is evidence to suggest that the use of integrated approaches in dealing with depression and alcohol abuse have a higher rate of success (Baker et al., 2010; Magil and Ray, 2009).

The term of CBT first appeared in scientific literature in the 1970s based on Beck’s theory and has since become the treatment of choice for a broad spectrum of behavioral, emotional and psychiatric problems. To date it has been empirically tested for a range of issues including anxiety disorders, depression, obsessive-compulsive disorders, eating disorders and addiction (Frank, 2004).

CBT is a fusion of 2 distinct traditions in psychology. CBT addresses the interaction of thoughts, emotions, physical sensations and behaviors. It uses cognitive processing helps clients to recognize negative thoughts and behavioral strategies help them identify helpful and unhelpful behavior.

The role of CBT is to carefully identify the biased cognitive processes that influence behavior and decision making and to shed light on both the process of relapse and the states of mind and reaction that leave a person vulnerable to old solutions. There are 5 stages to change behavior overtime. That is pre-contemplation, contemplation, preparation, maintenance and termination. In the pre-contemplation stage, therapist focus to break the denial that a serious problem with computer uses exists. In the contemplation stage, individual recognize the need for change, but the desire to change may not be substantial and feeling or being overwhelmed may exist. In the preparation stage, the individual is ready to establish a plan to address the problem. The maintenance sate begins when the individual feels he or she has control over computer use and is putting less energy into the behavioral change. The final stage, termination has the goal to prevent relapse.

CBT is not only about making specific and identified changes to thoughts and behaviors but also making clients their own therapists. This will enable them to apply the learning developed in and between sessions to life in general.

Motivational interviewing (MI)

MI is a brief, patient-centered, directive approach that emphasized personal choice and responsibility. Generally, MI is the greatest challenges facing substance use disorders treatment agencies. Mostly person who are addicted to something, they deny the problem and do not seek rehabilitate. So for persons who not ready to change their behavior on their own, MI may help (Merlo and Gold, 2008).

Mindfulness behavioral cognitive treatment (MBCT)

Zindel Segal and colleagues found a possible solution in practice of ‘mindfulness’– a type of meditation that helps people decenter from negative thoughts and associated sad moods (Segal, Williams and Teasdale, 2011). MBCT appeared to prevent relapse in patients who had experienced three and more episodes of depression. Addiction is in essence a habit. The addicted person is believed to act automatically or ‘mindlessly’ with little real awareness of the cues and that trigger substance misuse. The idea of promoting mindfulness could thus prove to importance in tackling addictions (Frank, 2004).

Mindfulness-based relapse prevention (MBRP) is another name of MBCT. MBRP is psych educational intervention that combines tradition cognitive-behavioral relapse prevention strategies with meditation training and mindful movement. The primary of goal of MBRP is to help patients tolerate uncomfortable states, like craving and to experience difficult emotions. Mindful movement includes light stretching and other basic gentle movement.

Mindfulness oriented recovery enhancement (MORE) is adapted from MBCT for depression treatment manual. MBRP and MORE is also the program focusing on meditative approaches to coping with cravings, as well as education and training about how to identify and skillfully change or mindfully let be, mental processes like thought suppression, aversion, and attachment (Garlandet al., 2011).

Complementary treatment

Previous studies have documented that an adolescent’s family environment is highly predictive for adolescent internet addiction (Nam, 2008). Moreover, a number of studies in South Korea have found family factors that influence internet addiction among adolescents. There are many researches about the relationships between protective factors such as parenting attitude, communication, and cohesion within families and internet addiction among adolescents (Hwang, 2000; Kim, 2001; Nam, 2008).

Complementary treatments have more focused on the environmental factors and use diverse activity for cure the internet addiction. There are many studies for finding the specific effective activities like music, art and even exercise for decreasing the rate of smartphone addition.

Therapeutic recreation

Therapeutic recreation is the professional intervention for leisure life. Therapeutic recreation is the purposeful and careful facilitation of quality leisure experiences and the development of personal and environmental strengths, which lead to greater well-being for people who, due to challenges they may experience in relation to illness, disability, or other life circumstances, need individualized assistance to achieve their goals and dreams (Anderson and Heyne, 2012). There are many facilitation techniques for gaining the goal.

Few studies have examined the effect that a resource such as leisure activities might have on the relationship between stress and health among elderly men. Data from the Normative Aging Study (NAS) were used to examine whether specific groups of leisure activities (social, solitary, and mixed activities; activities performed either alone or with others) moderated the effect of stress on the health of elderly men and whether there were differences in this effect between bereaved and non-bereaved men. The sample of 799 men was divided into two groups: a group bereaved of family and friends and a group of non-bereaved. Hierarchical regression analyses compared an initial model, a direct effect model, and a moderating model. The results indicate that for both groups of men, mixed leisure activities moderated the effect of stress on physical but not mental health. Additionally, for the bereaved group, social activities moderated the effects of stress on physical health. The negative effects of life stressors (other than bereavement) can be moderated by engaging in leisure activities for both bereaved and non-bereaved elderly men. Implications of the findings for future practice and research are discussed (Fitzpatrick et al., 2001).

Family and outdoor activities along with participative and supportive parental monitoring reduce the tendencies. Parental monitoring is inhibitors of adolescents Internet addiction. Thus adolescent should be supervised and monitored in their daily routines and encouraged to participate in family and outdoor activities. Further, adolescents should develop a positive attitude toward leisure and the skills to deter overdependence on online relationship (Chien et al., 2009)

Internet addicts can be a form of wrong leisure pattern. Internet addicts often encounter time-management problems. This means unbalanced time allocation and leisure boredom and unsatisfaction from unpleasant leisure activities may be motivated to seek another alternative – The Internet.

The high risk game addicted people not much leisure activity with families compared to low risk game addicted people. The more they addicted to the game, the more they want to get recreation activities or hobbies. They answered to participating leisure activity with friends (46.4%) or families (27.6%). 65.3% of young juvenile addicted the game want to participate family leisure activity. Unusual thing is students who are rich or have highly educated parents also were addicted to the game.

Music therapy: Drumming activities

Recent publications reveal the substance abuse rehab. Program has incorporated drumming and related community and shamanic activities into substance abuse treatment (Michel, 2003).

Drumming circles have important role as complementary addition therapy, particularly for repeated relapse and when other counseling modalities have failed.

Drumming enhances hypnotic susceptibility, increase relaxation and induces shamanic experiences (Mandell, 1980). Drumming and other rhythmic auditory stimulation impose a driving pattern on the brain, particularly in theta and alpha rages. Physiological changes associated with ASC facilitate healing and psychological relaxation: facilitating self-regulation of physiological processes: reducing tension, anxiety, and phobic reactions: manipulating psychosomatic effects; accessing unconscious information in visual symbolism and analogical representations; including interhemispheric fusion, synchronization and facilitating cognitive-emotional integration and social bonding affiliation (Mandell, 1980).

Art therapy

Park et al. (2009) applied the art therapy to game addiction juvenile for improving the self-control techniques. As a result, hostile attitude was decreased and social interaction with peer group and family members was increased.

THE APPLICABILITY OF EXERCISE REHABILITATION

Exercise rehabilitation has the evidence-based exercise science knowledge to address a wide range of physical and psychological problems. It use exercise programs for patient rehabilitation based on exercise science. It follows the scientific process. In the clinical subfield, baseline such as physical capacity, health information, medical history, work status, previous exercise experience need to be set. After assessment, supervised rehabilitation sessions conducted for achieving the stated goals. Exercise rehabilitation aims to recover not only musculo-articular rehabilitation after surgery, chronic pain or fatigue, neurological or metabolic conditions but also even psychological conditions such as depression and anxiety.

Smartphone addiction is psychological disorder appearing physical and psychological signs and symptoms. The person who addict the internet or smartphone not do much physical activities, they generally disregard their health, and also negative physical signs like carpal tunnel syndrome, poor posture, backaches, migraine headaches, poor personal hygiene, irregular eating, sleep deprivation, eye strain, dry eyes, lack of sleep can affect immune functioning and hormone secretion patterns, cardiovascular and digestive pattern (Diane, 2005).

Exercise rehabilitation can employ the first goal for recuperating their physical health on the surface. Moreover if they indulge in specific exercise program such as horseback riding or exercise gymnastics, treatment can be going on to the second stage. Mindfulness program is also based on yoga or physical activity for meditation. Exercise rehabilitation could seek mental changes through feeling of confidence, satisfaction, and new feeling of happiness.

DISCUSSION

There are many reasons to addiction, internet accessibility is also one of the most decisive factors for overuse by college students (Anderson, 2012; Lin and Tsai, 2002). When access is free and easy, college students tend to be vulnerable to becoming addicted to the internet (Kandell, 1998). In South Korea, anyone have easy internet access due to the nationwide internet infrastructure and may be vulnerable to pathological internet use. So fair is not fair internet and smartphone addiction. We need to regulate the internet and smartphone access.

To date, the Youth Internet Addiction rehab program was composed of classical treatment represented the behavioral and cognitive-behavioral approaches focusing on aware of the risk and severity about internet addiction, and learning the way to regulate their emotions then adjust their behaviors. In response to the increasing risk of internet addiction and its negative consequences, there is a need to explore intervention models. Unfortunately, a survey of the literature shows that there are settled only a few treatment programs for internet addiction, such as CBT and MI interventions, group therapy with a combination of Readiness to Change (RtC), (Orzack et al., 2006), as well as Reality therapy group counseling programs.

We examined by references about complementary treatment using many activities for curing the internet addiction rehabilitation based on the environmental addiction factor. Therapeutic recreation is much interested on the family leisure types, music therapy using drumming activity are hypnotic susceptibility, increase relaxation and induces shamanic experiences.

Exercise rehabilitation is not much utilize the internet addiction until now, but if given that young student were most addicted to the internet, exercise rehabilitation can be the efficient activity they want to participate and also help to grow their health and mental status.

CONCLUSIONS

This paper has attempted to sketch out the diverse addiction treatment and the feasibility of exercise rehabilitation. To capitulate briefly, we have shown that 2 discernible approaches: behavioral treatment and complementary treatment. The standard to divide the treatment for addiction have drown from the addiction path and causes. There are 2 factors to causing the addition; that is personalized individual characters and environmental factors around them. CBT is representative of classical methods for changing additive thoughts and behaviors. MI is also the brief approach for persona not ready to change their behavior. MCBT also the adapted treatment based on CBT. There are different types following the stressful point, MBRP or MORE. It is apparent that therapeutic recreation, music approach using drumming activity and art therapy are useful complementary treatment. In general terms, it is highly probable that exercise rehab can apply for smartphone addiction.

The argument which is the best program between behavioral treatment and complementary treatment is waste of time. What remains to be determined by the future research is the evidence-based certain addiction study revealing the significant factors. Exercise rehabilitation program can also one of main program for smartphone addiction but considerable work needs to be done.

Footnotes

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

REFERENCES

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Articles from Journal of Exercise Rehabilitation are provided here courtesy of Korean Society of Exercise Rehabilitation

From J Exerc Rehabil. 2013 Dec; 9(6): 500–505.
Published online 2013 Dec 31. doi: 10.12965/jer.130080
PMCID: PMC3884868

What is Stress?

Shadow of hunchback walking up stairs
Stress is the shadow that creeps up on me

Ken Collins sent along some great info about stress. Stress is by far one of the biggest problems after TBI. We experience it from all sides. First, we’re forced to deal with a very real change in how we function in the world. Second, we can get stressed about being stressed. And it builds…

I’ll add to Ken’s notes below:

KC: 99% of the stress you experience is caused by your thinking, your interpretation and your hardwired beliefs. Sure if you grew up in an abusive family, got assaulted, molested or raped, physically threatened or even wrongfully arrested those would all be examples of trauma/stress you have experienced. This trauma is buried in your sub-conscious and under stress is triggered – limbic system fight or flight response in the Amygdala.

True, true. Trauma does stay in the system, unless it is “moved out” in some way. It builds up, and over the long term, it causes traumatic responses to “kindle” more quickly. We get set off more, over time, as the biochemical load increases — and doesn’t decrease.

KC: Now think of how many hundreds of times of day it is your PERCEPTION that traffic jams, difficult bosses, rude people, arguments with your family members, deadlines, long meetings, having too much to do and not enough time to do it are the main sources of your stress? These events are only stressful if you BELIEVE they are.

True again. We tend to make up a lot of interpretations about what’s going on with us, because we need a shortcut to help us think through a situation. We also are very fond of our own versions of what’s happening, and we can actually be energized by our outrage — or stress. Especially if you’re dealing with low tonic arousal (that’s when your brain is sleepy and can’t seem to wake up), you may find that stress wakes you up… so you instinctively try to get more of it. That’s not a good long-term strategy, but on the surface it seems to work.

KC: Often times what causes us the most stress are irrational thoughts like: I’m a terrible parent, or, I’m a loser, or, I’m no good at anything, or, I’m stupid, or, I can’t do anything right! Once you really start tracking where your stress is coming from you will see, in the vast majority of cases, it’s coming from you and your beliefs, judgments and expectations about how things “ought” to be.

Indeed. We really do a number on ourselves by coming up with all kinds of criticisms and descriptions of ourselves that tear us down. We do it automatically — especially if we’ve been told over and over again that we’re losers or stupid or not good at anything.

KC: The basis of all mind/body medicine boils down to the fact that your body believes what your mind thinks. (The only proof you need of this – and pardon me for being totally frank here – is masturbating over a sexual fantasy.)

Yep, it’s true. And I can think of a lot of other examples — athletes who visualize their performance tend to do better. And our mind’s activity changes our biochemistry, so that our internal signals are received differently. Depression affects the body. As does being in a good mood. Chronic stress suppresses our immune system, and a sudden burst of applause from an audience can make competitors find that extra something to get them to the next level in terms of their abilities.

KC: So if you are worrying about if you can succeed in your treatment, or worrying about family or friends while being here, or feeling guilty about being in treatment and all the drama this way of thinking brings, your brain will start the “fight or flight” response and release stress chemicals like adrenaline and cortisol into your bloodstream that will cause your heart to beat faster, your muscles to tense and your blood pressure to rise.

That tension and increase is one side of things. The other side (and there are probably more) is the effect that fight-flight has on the brain itself. It shuts down our ability to think complex thoughts. It over-simplifies everything, turning off blood flow to different parts of our bodies, and “hijacking” our thinking. So, when you’re worried about your recovery, you may actually be negatively affecting your recovery — because brain injury recovery is all about learning new ways of doing the same old things. And if your self-talk is turning up the fight-flight, it’s also dialing back your ability to think and learn and adapt and change.

KC: The only way to control this biologic process is to take deep breaths, relax and calm down.

Deep breaths that are slow and steady work for me. Breathing in to a count of 5 (seconds), then breathing out to a count of 5 has been shown to slow down the heart rate and balance out the fight-flight with rest-digest. It’s a biologic process, as Ken says. Your mind is involved, but if you can slow the physiological piece of things, you’re a step closer to getting your system balanced out.

KC: To accomplish this it will help to think good thoughts about someone you love, or good things that have happened in your life with family and friends. These thoughts will help to build new neuro-pathways in your brain and increase your ability to control stress and improve your sense of well-being.

Gratitude is a huge help for me. I sometimes have to force myself to be grateful, but once I get started, it comes more easily. When I focus on how much I have, versus how much I’ve lost… and I concentrate on being of service to others… that helps me get my act together. It keeps me headed in the right direction.

Onward.

Save

Emotional/Behavioural Changes after Brain Injury – Part 2

head with brain opening and question marks coming out

Continued from Part 1

From The Toronto Acquired Brain Injury Network.

My comments are in bold like this.

Emotional/Behavioural Changes

Impulsivity and disinhibition

A person may lose their ability to control their actions or their speech. This problem often goes hand in hand with lack of awareness, and the person may not be aware of breaking any social rules or etiquette. There are strategies that can help to improve the situation, and prevent a person from developing unacceptable behaviours through habit.

BB: The first thing that we need to know, as we recover, is that we're breaking social rules. We may not be aware. And while the people around us may not be comfortable "calling us out" on our behavior, it's important to do it. And it's important to persevere in convincing us that our behavior is just not good. Because we may literally not know. We may also resist accepting that fact. But brain injury and "bad manners" often go together - and if you  never realize you're behaving badly in the first place, it's impossible to fix it.

Emotional Lability

This describes a person’s tendency to laugh and cry very easily and to move from one emotional state to another very quickly. Loss of control over emotions means the person may express their feelings inappropriately or at the wrong time. This can be very tiring and embarrassing for family members to deal with, but in time a person can begin to re-learn emotional control.

BB: I am not a fan of emotional lability. Nor is anyone around me. It can be embarrassing and stressful, and it can make things worse. The best thing to do, for me, is find some humor in it. Over time, this can sort itself out and become more manageable. In the meantime, you just have to make the best of it -- and remember to not over-react to every emotional storm that comes along.

Self-centredness

Someone may become self-centred. For example, the person may not show any interest in family matters and only be concerned with their own needs. Brain injury can affect a person’s ability to judge how someone else is feeling. The person may also become used to the huge amount of attention they receive while in hospital.

BB: Recovering from brain injury requires you to become self-centered, in my opinion. You have to pay attention to yourself in new ways. You have to get familiar with yourself again. But it's easy to get too caught up in yourself, and that can distance others. Ultimately, the thing that's saved me, time and again, is getting past myself. Learning now to be less self-centered. It helps me with depression, it helps relieve my sense of being disconnected from others. Putting others first... that's been a big benefit for me.

Apathy and poor motivation

Lack of motivation, or apathy, is a direct result of injury to the part of the brain that controls emotion, motivation and forward planning. Over time, lack of motivation can lead to social isolation and lack of pleasure. For example, a person may show no interest in hobbies enjoyed previously, or they may not get out of a chair all day. To help, activities can be broken down into small steps to avoid overwhelming the person.

BB: This is a big one for me. Most of the time, I just don't care about much of anything at all. Seriously, I don't. And so many things I've started... well, they've just fallen apart and went nowhere, which made me feel like a total loser who wasted everyone's time. My motivation generally sucks. I wish it didn't, but then again... a lot of times, I just don't care, one way or the other.

But yet, I need to keep moving. I need to stay productive. I need to keep myself from falling into "disrepair" and ending up feeling worse than I already do. Life has always been painful for me. It hasn't been a long exercise in glee and joyfulness. It's been awkward and uncomfortable, and I've been in multiple kinds of pain for as long as I can remember. 

But something in me needs to keep moving. I find motivation where I can get it - generally not from the things that other people get motivation from. Just staying alive. Feeling like I'm doing something productive with myself. And constantly coming around again to take another shot at what I want to do.

Motivation is a tough one for me. I guess I've just developed habits around getting stuff done, and they work for me when I have no motivation to do anything, at all.

One thing that keeps me motivated, is doing things for others. Serving others. Being available to others to help, so they can have the best life possible. That motivates me, I guess. It's probably my biggest one. The rest of the things -- money, success, fame -- nah, I'd rather do something useful that benefits others, to be honest.

Depression

Depression is a very common emotional reaction experienced in the later stages of rehabilitation—often when a person realizes the full extent of the problems caused by the accident. This can be seen as a good sign: the person is aware of the reality of the situation and is coming to terms with the emotional consequences. “Healthy” depression can be worked through in time, as adjustments are made. If a person feels emotionally blocked and unable to move on, professional counseling from someone who understands head injury may be helpful.

BB: I never gave much thought to this before, probably because I've always been depressed, and it's nothing new for me. When I was in high school (I had a handful of mild TBIs in the course of three years), I went through a period that was utterly, completely black. Literally. I couldn't see anything, at some points. Everything was dark for a little bit, and my vision wasn't working.  Fortunately, it seemed to happen when I was sitting down. But the emotional darkness was the worst. I just felt like I didn't even exist, and I didn't care, one way or the other. 

I'm not sure that it had anything to do with realizing how messed up I was. I didn't realize those blows to the head had any effect on me at all. I just felt awful. Whether it was the mTBIs or just being a teenager, is anybody's guess.

Someone asked me once, if I had a history of depression. I said, "Of course," and they seemed sad. I didn't mean to make them sad -- just tell the truth.

Anxiety

It is natural for people who have had a traumatic experience to feel anxious afterwards. Individuals may experience a loss of confidence when they are faced with situations and tasks that are difficult to cope with. However, problems can occur if difficult situations are continually avoided, or if those caring for them encourage dependence rather than independence. Talking about fears and worries is very helpful. Learning ways to stay calm under stress can also reduce the effect of anxiety on everyday life.

BB: I know this one all too well. And what most people don't realize, is that anxiety isn't just about the injury itself. If anything, the injury is just a small part of the total anxiety-generating stuff. Insecurity and instability builds throughout the course of your recovery (because some recovery is invariably happening, even if it doesn't seem like it), as you walk into different situations that you feel should be OK, but then you screw things up -- many times without even realizing it -- and it happens over and over again. Everyone around you is afraid to say anything, because you might A) blow up, B) cry, C) fight them on it, D) feel terrible. Everybody's walking on eggshells, so you never get the information you need to recover sufficiently, or adjust your behavior and adapt to situations.

So, people just basically leave you to your own devices, which is a terrible idea, because it leaves you alone with the very thing that's causing you problems -- your brain. And the anxiety builds over and over and over, because you can't get the help you need to adjust and recover -- and regain your dignity.

Small wonder, that we start to avoid situations. Sometimes it's just easier to not even bother, than get dragged across the hot coals of embarrassment all over again.

Inflexibility and obsessionality

Examples of this behaviour include: unreasonable stubbornness; an obsessive pattern of behaviour such as washing or checking things; or fear of possessions being stolen. The person can lose the ability to jump from one idea to another, and becomes “stuck” on one particular thought. This type of behaviour is often made worse by anxiety or insecurity, so it is helpful to reassure the person and and redirect their attention to more constructive ideas and behaviour.

BB: You never know if the stubbornness is unreasonable or not. There may be a very good reason for it - but nobody's asking the right questions, so you end up looking "unreasonable" to people who might be able to help you, if they just took a different route or opened their minds.

Getting stuck on an idea or a frustration is a big problem for me, to this day. If I'm tired, I can get "stuck in a loop" where I'll keep arguing about the same point, over and over and over again, making everyone around me absolutely nuts with frustration. And they don't know how to get me out of it. 

It's impossible to argue with me at those points. Best thing to do, like they said, is redirect my attention in another more productive direction.

Save

Save

Save

Hello officer – the tremor you’re seeing is not fear. It’s fatigue.

transportation security administration officer screening a bagI recently had to fly halfway across the country for a work commitment. I had to fly out early, which meant I had to get to the airport really early… and that meant I had to wake up really really early.

Not much fun, to be honest.

But I did it.

I hadn’t been sleeping well, for several days prior to that – I was getting maybe 5 – 6 hours a night, which is no good. But that’s what I had to work with, so… that’s what I worked with.

The drive to the airport felt like it took forever.

And just getting from the parking garage to the terminal was another slog. One of the wheels on my carry-on was “wonky” and it vibrated really loudly, as I pulled it along. Not the best thing, when your hearing is already over-sensitive.

Anyway, by the time I got to Security, I was a little shaky. I was operating on maybe 2 “cylinders” (out of a potential 4), and I hadn’t had my full breakfast like I usually did. I was off balance and out of sorts, and when I handed my boarding pass and ID to the security officer, my hands were shaking a bit, like they do when I’m overly tired.

The officer gave me a look, and I tried to exchange a few words, but I was “off kilter” and my voice was shaky. I started to get nervous, wondering if they were going to alert others that I was a sketchy character. They gave me another look, and I just shut up. I sounded a little drunk and discombobulated, and my hands were trembling. That’s never a good sign, when you’re trying to board a plane. So, I did my best to gather what dignity I could and just moved on to the x-ray screener – hands over head – and then walked on through.

Fortunately, my luggage made it through without incident. At the last minute, I remembered to pack only small bottles of liquids and creams. That was a last-minute change, because I was going to take full tubes of toothpaste and a special skin cream I need to use for my beat-up hands. At least I got that right.

In the end, it all turned out okay. But I really hate that feeling, when my neurology is acting up on me, and I’m interacting with someone who can flag me as a risk, take me aside, pat me down, possibly strip search me (worst case). The worst case didn’t happen – not even close. So, that was good.

And the trip went pretty well, from that point on.

So it goes.

And so I go… onward.

From Ken Collins: When we injure our brain, we injure an important part of our body.

Piecing it all together
Piecing it all together

When we injure our brain, we injure an important part of our body. Our brains control our ability to think, talk, move, and breathe. In addition to being responsible for our senses, emotions, memory, and personality, our brain allows every part of our body to function even when we’re sleeping.

The brain can be hijacked by the Amygdala in the limbic system after our brain injuries as outlined in this source:

Wikipedia: Daniel Goleman speaks about Amygdala hiijacking – Amygdala hijack is a term coined by Daniel Goleman in his 1996 book Emotional Intelligence: Why It Can Matter More Than IQ.[1] Drawing on the work of Joseph E. LeDoux, Goleman uses the term to describe emotional responses from people which are immediate and overwhelming, and out of measure with the actual stimulus because it has triggered a much more significant emotional threat.[2] From the thalamus, a part of the stimulus goes directly to the amygdala while another part is sent to the neocortex or “thinking brain”. If the amygdala perceives a match to the stimulus, i.e., if the record of experiences in the hippocampus tells the amygdala that it is a fight, flight or freeze situation, then the amygdala triggers the HPA (hypothalamic-pituitary-adrenal) axis and hijacks the rational brain. This emotional brain activity processes information milliseconds earlier than the rational brain, so in case of a match, the amygdala acts before any possible direction from the neocortex can be received. If, however, the amygdala does not find any match to the stimulus received with its recorded threatening situations, then it acts according to the directions received from the neo-cortex. When the amygdala perceives a threat, it can lead that person to react irrationally and destructively.[3]

Goleman states that “[e]motions make us pay attention right now — this is urgent – and gives us an immediate action plan without having to think twice. The emotional component evolved very early: Do I eat it, or does it eat me?” The emotional response “can take over the rest of the brain in a millisecond if threatened.”[4]HYPERLINK “http://en.wikipedia.org/wiki/Amygdala_hijack”%5B5%5D An amygdala hijack exhibits three signs: strong emotional reaction, sudden onset, and post-episode realization if the reaction was inappropriate.[4]

Goleman later emphasized that “self-control is crucial …when facing someone who is in the throes of an amygdala hijack”[6] so as to avoid a complementary hijacking – whether in work situations, or in private life. Thus for example ‘one key marital competence is for partners to learn to soothe their own distressed feelings…nothing gets resolved positively when husband or wife is in the midst of an emotional hijacking.'[7] The danger is that “when our partner becomes, in effect, our enemy, we are in the grip of an ‘amygdala hijack’ in which our emotional memory, lodged in the limbic center of our brain, rules our reactions without the benefit of logic or reason…which causes our bodies to go into a ‘fight or flight’ response.”[8].

Understanding the role stress plays on triggering the limbic system fight or flight response is critical for people to learn about after our brain injuries. Brain injuries are often described as either traumatic or acquired based on the cause of the injury.

Traumatic brain injury (TBI) is an insult to the brain, not of a degenerative or congenital nature, which is caused by an external physical force that may produce a diminished or altered state of consciousness, and results in an impairment of cognitive abilities or physical functioning. It can also result in the disturbance of behavioral or emotional functioning.

A TBI can affect our ability to, think and solve problems, move our body and speak, and control our behavior, emotions, and reactions.
Acquired brain injuries are caused by many medical conditions, including strokes, encephalitis, aneurysms, anoxia (lack of oxygen during surgery, drug overdose, or near drowning), metabolic disorders, meningitis, and brain tumors.

Although the causes of brain injury differs, the effects of these injuries on a person’s life are quite similar.

This is why understanding about the consequences of stress on the limbic system after a brain injury is so important.

Understanding the Sympathetic Nervous System in the brain injury recovery process is seldom talked about to us after our brain injuries by doctors or health care professionals because they only treat the symptoms.

The following information is critical to understand and has great value for people with brain injuries and their families to understand.
The Sympathetic Nervous System – “limbic system is autonomic” and creates many problems people with brain injuries face during our recovery process. If people with brain injuries don’t understand the Sympathetic Nervous System and how it works – our family members and friends react to our emotions and unwittingly create more stress for us for us to deal with.

This stress triggers the “limbic system’s fight or flight response” into action.

We do not have any control over what we are reacting to because of the stress that is being generated by our emotions shuts down the thinking part of our brain – pre-frontal cortex.

What happens next is – we react and they react, the stress builds and we lose control, get angry and have emotional meltdowns or worse.
During any stressful situation our loved ones react to our “actions” and we react to theirs – which increases our stress during those hard and difficult times.

We (family members/ people with brain injuries and friends) get caught up in a reactionary mode instead of being proactive to keep the limbic system in check.

If we set up daily routines, have structure and find purpose and meaning in our lives we have a better chance of controlling stress and the situations that trigger the limbic system fight or flight response.

If we do not control the stress, our families and friends will constantly be reacting to issues we have little control over. Learning relaxation techniques like mindfulness-based stress reduction can help to stay calm so the limbic system is managed.

Mindfulness-based stress reduction can help with this and I encourage you to look this up on the internet because there is a lot to learn about this tool that can help us rebuild or lives after a brain injury.

After our brain injuries “emotional outbursts, anger, and memory issues” are an expression of the problems caused by our limbic system fight or flight response under stress. By understanding how our emotions can get out of control we will have a better understanding of why we react to things that don’t make any sense to us.

There is a reason for all this madness and by learning the role the sympathetic nervous system plays in our recovery, the better chance we have to live full and rewarding lives again – after our brain injuries!

Here you go – downloadable memory training/tests you can use over and over.

Well, that took less time than I expected

I’ve collected 17 similar images for memory training into a single document. Here it is: Memory Training with Circles, Squares and Lines

It’s a PDF you can download and print out. It’s 17 different versions of the circles and bars and squares training I’ve been doing. From the introductory text:

This collection of geometric shapes is designed to help train memory and attention to detail.

How does it work?

First, you fold the paper into four sides – in half in one direction, and then in half in the other direction.

fold the paper twice, in directions, then use the blank spaces and also the notes
Here’s how to fold the memory test sheets

Then, you study the image for a while, committing it to memory as much as possible.

Then you put the image aside and go do something else – you can think about the image a lot, occasionally, or not at all. You just get on with your life.

After an hour, or several hours, or maybe a whole day, you draw what you think is an exact replica of the image on one of the blank sides of the paper.

Then, you open up the sheet, so you can see your image beside the original, and you study it to see where you got details wrong, as well as where you got things right.

You can write down notes about your observations of your memory – what you remembered, what you forgot – and if anything “jumps out at you” about your drawing.

Repeat this process again, drawing what you think is the right image on the other blank part of the paper. Then open up the sheet and compare what you drew with the original.

Writing down notes can be a good way to train yourself about the kinds of details you missed. Nobody’s perfect, and some of the images are trickier than they seem.

Also, the images on all the pages look enough like each other that, as you do this exercise each day, you may find yourself remembering things that you committed to memory from before. This is on purpose. It’s meant to test you, to get you to really focus in on the unique and original image in front of you – not something you saw before.

At first, it may be tricky. And you may find yourself noticing things or forgetting things that surprise you. Let yourself be surprised. Learn about your mind and how it works. And learn how to memorize, one day at a time.

This collection of sheets is meant to be printed out, and each one used separately. You can re-print sheets to re-try. You can also make modifications to the original images to make them your own. You can also color in the sections of the original image and work on your color memory, too. It’s up to you.

You can use this however you want – just use it. Get better. Be better. And have fun, while you’re at it.

I hope this helps you and you find it useful. Just after doing my memory training for a few days, I was able to remember three items on a shopping list I’d left at home that morning. There were three items on the list. And I remembered them all. I was able to recall them mainly because I was able to visualize the writing — I didn’t remember the things, as much as I remembered the look of the writing of the list. But either way, it’s good. And it was such an awesome feeling to be walking through the grocery store with my other list (which was pretty long) AND remember the three items on the little list I’d forgotten at home that morning.

Obviously, I can’t guarantee results for everybody else. We are all very different from each other, and I’m a very visual thinker. So, my results are going to be probably be different from someone who is a verbal thinker, or someone who needs audio prompt.

But my philosophy is that every little bit helps, and strengthening one part of your brain can — and will — strengthen other parts as well.

So, give these exercises a try. I’ve made it easy for myself — and others — to use this. It’s not cumbersome. You have a rectangle of paper you keep around for as long as you need it. And then when you’re done with it, you can either toss it in the recycling (please don’t just throw it away – recycle, please), or you can keep it in a folder to track your progress over time.

It’s funny – when I think about my test the other day, I never even realized that the two squares underneath the bar were supposed to be separated. I totally missed that, both when I was drawing, as well as when I was reviewing. It took me a day to realize that. And then it was so obvious! Duh! But that’s how it goes with me, sometimes. So, I’ve gotta cut myself a break. For sure.

I hope you find this tool useful. I will absolutely be making more. It’s fun! And it helps! What could be better, than making life better for everyone?

Here’s the PDF download link again: Memory Training with Circles, Squares and Lines

Using bad for good

I want to do more than keep my head above water.
I want to do more than keep my head above water.

It’s been a rough couple of weeks. No – wait – three weeks, actually. Ever since the middle of September, things have been… exciting.

And I’ve been getting emotionally overwrought over little things that shouldn’t even be “moving the needle”. It’s costing me sleep. And it’s very intrusive. I’ll be going along, going about my business, just living my life… then all of a sudden, this rush of thoughts and emotions over stuff I have no control over (and don’t really understand) wash over me, and I’m hijacked by all that.

I’ve tried tamping it down, but that’s not working very well. It’s really bothering me, too. So, I have to do something different.

And I’m using that rush of emotion, the intrusive thoughts, the “riled” state I get into as motivation and propulsion to do good things. There’s a lot I want to do with my life, and there’s a lot I can do. So I’m using that unwelcome energy in welcome ways.

Getting my act together — cleaning up my work spaces… doing fall cleaning around the house… working out… really kicking it at work… being incredibly productive — far more than in the past… and finding ways that I can elevate myself. Somehow. Some way.

And also doing my mindfulness meditation, my zazen, just sitting and breathing, slowing down my racing mind and focusing on the in-breath and out-breath.

I can’t always control my thoughts. I can’t change what’s happened to me. But I can control what to do with it, and I can use the energy to accomplish things that I’ve been wanting to do. There are a bunch of things I’ve been wanting to do, so now I can use this rush that I get for something productive.

It’s all a learning process, of course.

This isn’t my favorite thing, but at least there’s something I can do with it all.

Balancing my system, taking better care of myself

rocks piled in a balanced arrangement on a beach with the sea behind them
All the pieces fit together. Steady… steady…

I had a good session with my new neuropsych on Monday. They’re a little concerned about all the stress going on in my life. Between job craziness and the challenges my spouse is having, and the ever-present danger of me actually injuring myself… sheesh, I’ve got a few things to manage.

And they’re not alone – I’m worried, too. Not so much worried… no, actually worried. I have to stay steady, I have to keep my act together. This is no time to fall apart. The thing is, life isn’t going to get any less exciting anytime soon. Everything feels like it’s ramping up, and I’m being forced to learn a lot. I’m not adverse to learning. I just get very rigid and brittle when I am under pressure, digging in my heels, walking away from challenges, and being generally difficult with others — who are relying on me to step up and play my part. On the outside, I seem fine, but inside, I’m freaking out, going through all kinds of mental “gyrations” over how unfair everything is, how much trouble I’m having, and how nothing ever works out in my favor. It’s a pity-party extraordinaire.

And that makes it difficult to change and adapt to the extent I — and others — need me to. I need to be there for people. I need to step up. But I get tired, and that rigidity kicks in. I push back. That’s not helpful. I need to just go with it.

That rigidity and brittleness is such a problem. But I know what can help assuage it… take the edge off… relieve the pressure. It’s called extreme self-care.

As in — doing my stretches each night before I go to bed. Doing some modified yoga stretches for my back and stretching my legs and arms and shoulders. If I don’t stretch, I wake up in the wee hours in all kinds of contorted pain.

As in — doing my intentional breathing after I’m done stretching. I sit on the edge of my bed and focus my attention on a spot on the wall across from me, and I do slow breathing — 5 seconds in, 5 seconds out — for a little while, till I feel my system relax and my breathing becomes easier. When I first start out, my system is all tight and tense, and I have a hard time just breathing regularly. But after about 10 in-and-out breaths, my system starts to relax, and I can actually do it without forcing myself. It doesn’t come automatically. It takes a while to get going. But it happens. And then I can relax.

I have also started doing measured breathing in the morning when I wake up. I don’t want to get out of bed, anyway, so I might as well work on my breathing and also relaxing. I lie there and relax my body and breathe. And after a while, I’m not as stressed out, and I actually want to get up. Then I go downstairs, get my exercise (cardio every day, weight lifting every other day), have my breakfast, and get into my day.

So, I have my ways of dealing with my situation — regulate my fight-flight response and keep my heart rate in a healthy range. Strengthen both my body and my mind, and keep making continuous progress.

One thing that is throwing me off, is that I have to do this at all. Most of the people I know don’t have to go to great lengths to rise to the occasion and deal with these crisis situations. They just do it. And they adapt without a lot of apparent pain and suffering. It seems like everyone else in my group is able to adjust and “jump on it”, while I’m still struggling to just get out of bed in a proper frame of mind.

It’s a little discouraging, but I’ve got “stuff” going on with me that nobody can see, and I know how much it affects me. So, I can’t lose sight of that — of my own issues, as well as my spouse’s issues. I’ve got a lot on my plate, even when everything isn’t falling to bits around me. And when everything gets that much more “exciting”, I have to take extra steps that others seem to not have to bother with. They can skip their exercise. They can eat anything they want. They can go without more than 4 hours of sleep, night after night, and it never seems to block them. They keep on.

Of course, it only goes for so long… No matter what, the human body can only take so much abuse. But in the meantime, they’re quite unaffected and love to wax eloquent about how much abuse they’re taking, and how much they’re getting done, regardless.

It’s all a smoke-screen in many cases, of course. At least I know my limits and I know how to work around them. It’s just a little demoralizing that I have to, while others can sail along without problems — getting the favorable attention of everyone who makes decisions about promotions.

In the end, though, all I really want is to lie down in peace at the end of the day. And that’s something I can control and manage on my own. The fact that nobody else really knows I have as many problems as I do, is testament to how well I’m doing.

And I want to keep it that way.

Because letting everyone around me know how much I’m struggling isn’t good for my career prospects, position on my team, or my life in general.

Just keep on… keep on…

Onward.

Taking care of what needs taking care of

fairground ride spinning wildly
The ride’s getting rough – when can I get off?

Life is pretty crazy for me, right now. And it’s not going to get less crazy, anytime soon.

So, I need to create systems for myself… and stick with them.

I’ve got a pretty good system down for getting to bed at a decent hour. I just need to work on my ability to get as much sleep as I need.

Last weekend, I lost a day to socializing — a day I usually spend catching up with myself, my chores, my sleep. I spent the afternoon with some friends, instead of taking care of myself and catching up on my sleep. I really feel it now. They want to get together this coming Saturday, but I just can’t do it. Frankly, we spent the whole time discussing one person’s dysfunctional life — which has been caused by poor decision-making. It was very stressful to listen to, because they just weren’t all that coherent — and they were constantly apologizing for it, rather than doing something about it.

Plus, we were meeting in a Starbucks in a busy part of town, so there was constant noise, constant foot traffic, constant interruption, which made it hard for me to hear and also concentrate. It was exhausting to be honest. And there was an hour drive to and from – both directions.

That sort of activity doesn’t work for me. If I’m going to spend time on anything, it needs to be productive and beneficial for me, not just everyone else. I didn’t enjoy myself that much, to be honest. It was fine to be social, but then again, I get that at work, each day — way too much, each day, to be honest. When the weekend comes, I just want to drop.

Literally.

So, this coming weekend, I’m doing just that — dropping. I’ve told them I can’t make it, and I need to stick with that. I have so little time to myself, I can’t spend what little I have on people who offer me nothing in return.

Anyway, I need to sort out my systems. Get myself on a better schedule with work. Take things a bit at a time, and plan things better in advance. I have a bunch of stuff I need to do with my house — fall cleaning, getting ready for winter — and most of all, I have to take care of myself.

It’s no good pushing myself, especially over other people’s self-created problems. I’m sorry they are going through all that, but I have no patience for folks who wallow. Especially when I’m having so much trouble, myself, and am just dealing with it all.

I have been having trouble, lately. I’ve not been sleeping well. I’ve been waking up in pain from my legs and back, and then I can’t get back to sleep. I’ve been having terrible dreams about traveling and missing flights, forgetting my passport, losing track of time, feeling like I’m dying, being told I’m going to die, having people threatening to kill me. It just hasn’t been fun, lately, in my dreams. And that takes a toll on my days.

Of course, this will pass. I will figure it out. I will sort through things and find out what’s next… what’s coming down the pike. To get there, I just need to keep steady, keep focused on what’s important — and what’s not. Get my exercise — I rode my exercise bike for nearly an hour, this morning, and I lifted heavier weights, and later today I plan to swim. Eat properly — I’m eating big salads for lunch, I eat fresh fruit and a bowl of raisin bran instead of junk food to keep my energy up, and I drink about half a gallon of distilled water each day. Take care of my body, so I have the strength and stamina to make it through.

And I will make it through. I have my dark moments, with pauses of silent tears when no one is around and I can let down my defenses. But that’s all part of it, I suppose. There’s so much going on, I’m overwhelmed and terribly uncertain about my spouse’s and my future. I don’t know if I’m up to the challenge of caring for them, as they age in the coming years. I don’t know if I’m up to the challenge of interacting with all the doctors and various providers we deal with. Plus, my spouse’s PCP died last weekend, and he was the one who really kept them going, kept them motivated, and believed in them. Now we have to find another doctor … and that’s a big source of concern with me.

We just need to take things one at a time and figure it out as we go. Some things you can’t plan for. So, I need to keep strong and flexible, for those times when an emergency comes up, or I get hit by the unexpected.

That means sleeping. It means eating right. It means exercising religiously. Treating my body like my best friend, which it is, really.

One thing at a time, one day at a time… it’ll happen.

Onward.