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.

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.

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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

2. Since your old habits don’t quite work well enough, you need to TAKE CONTROL of your brain….

brain withi paint spattered on it and a grungy border

From the Give Back Give Back – TBI Self-Therapy Guide – which you can download by clicking this link, here’s the second point about how to fix your brain. It’s an important one, because it puts you in the driver’s seat of your own recovery. That’s huge.

2. Since your old habits don’t quite work well enough, you need to TAKE CONTROL of your brain and get it to think through the things you are going to do.

  • Your BRAIN no longer does its job well enough on automatic pilot.

You may think it does, but it doesn’t. All those years your brain invested in learning how to do things… well, the things it learned about “the right way to do things” has changed. The connections and pathways that your brain was used to using to get from Point A to Point B… well, those old highways and byways may have been “washed out” by your TBI, so all the signals traveling through your brain need to find new ways to do their job.

  • Now, your MIND has to make sure it does its job properly, whenever you do anything in which the results are important.

You can’t just rely on your brain to be on autopilot. You have to use your MIND. And you have to stay engaged. You have to pay attention. The brain can do its job, but it needs to be watched — cared for — tended. And that’s the job of your mind.

  • Any time you need your actions or your words to have quality, your mind has to make sure that your brain produces quality at every step.

Your mind is in your control. Your brain … well, not so much. Some people make no distinction between brain and mind, but for our purposes here (and for Give Back purposes), we need to make that distinction. The brain is the organ, the result of a whole lot of physical and neurological processes. The mind is the result of the brain’s activity and your presence… of mind.

  • It’s as if your mind now has to be the boss.

Yep. It does. It has to run the show. You can’t rely “mindlessly” on your brain to just do its job as usual. Because the ways that it used to do things have altered. And that change is permanent. Does that mean you can’t create new ways and pathways for your brain to do things differently? NO.  That’s the point — it can change and learn and grow. But it’s used to doing things the same-old-same-old, and that’s not going to work for you anymore.

  • You need to be MINDFUL so that you can be an effective boss.

Give yourself a promotion. Make yourself the CEO of your own life. You’ve got to run things, now. Not just your autopilot brain, but your powerful mind, which learns and grows and changes constantly and acquires skill over time. Mindfulness, paying attention, properly managing your energy and frustrations… you’ve got a new job.

You can do it. You got this. Many, many other people have been through this and have come out on the other side in good shape. Follow this link to read more: Models of Exceptional Adaptation in Recovery After Traumatic Brain Injury: A Case Series

TBI recovery (even for the so-called “mild” type) is an ongoing process which involves your whole self. Take heart. There is a way forward. I found my own way, and you can too.

Onward.

Well *that* rehab price is not going to work for me

stacks of 100 dollar bills

And so, the insurance drama comes to a sputtering halt.

I’m opting out. The neuropsych who agreed to work with me despite insurance problems has jacked up the price to 4 times what it used to be. That’s way more than I can afford. Apparently, I’m absorbing the cost of their insurance shortfall.

That’s fine. I don’t need to deal with this crap. They can carry on without me. I don’t feel like getting caught in the middle of their conflicts. I mean, seriously, these specialists offer their services and expect insurance to cover it all — without really making a case for why they should — and then the patients get caught in the middle, when both sides can’t agree about what’s worth the investment. I’ve been paying good money into the whole tax system for years, thanks to neuropsychological rehab work. But apparently, the insurance companies don’t value that enough to help me keep solvent. And that neuropsych can’t see fit to cut me a break on their reimbursement. They’re gonna get their money, one way or another.

The wild thing is, they’re the one who’s decided they’re going to charge all that money. And they’re the one who’s decided they won’t go the extra mile with the insurance company to help me out. So, they have one less client, as of today.

I had been pretty stoked about continuing to work with a neuropsych, but it’s clear that’s not going to work for me. I’d thought about cutting back to once a month, but realistically, that isn’t going to work, either. With me, contact has to be at regular intervals, or not at all.

The whole thing pisses me off, quite frankly. The NP I’ve been working with knows I’m the sole provider for my household, that I’m making 20% less than the market rate (because my employer decided to stiff us on our year-end bonuses) and that my spouse is increasingly dependent. They know that I’m not made of money. But for some reason they think I can afford hundreds of dollars a month to see them.

Nope. Not gonna happen.

The other thing that gets me is how — all of a sudden — I’m paying 3-4 times what I’d been paying before. Suddenly, the price jumped, without my consent or assent. They should have discussed this price increase with me before they made the move, but they never came right out and told me how much more expensive it will be to work with them, without the full insurance coverage. They just jacked up the price, and that was that.

I’m not happy about it. It wasn’t responsible of them. And if they’d told me this was going to be the case, when they changed their billing practices, I could have saved myself a couple hundred bucks by just cutting them off.

I actually shoulda cut them off three weeks ago, when they started push-pulling me around. I don’t have time for the back-and-forth. It’s harder to deal with than a simple let-down.

On the other hand, not having the added expense of their sessions each week (and the gas I burn to get there), and not having those additional 2.5 hours of drive time, will certainly simplify my life. I’ll have time to do more things I want to do — like relax. And get some rest. Maybe even read something. Oh, and blog.

So, this is a new start for me. And it’s fine.

Onward.

The things I need to know, to move forward

two rock climbers on climbing wall

So, the session with my neuropsych (NP) went well yesterday. We actually sat down and went through the data from my prior two evaluations, and I got to refresh my memory about what’s going on with me behind the scenes.

The things that jumped out, which are measurable problems are:

  • processing speed
  • visual memory problems
  • resistance to short-term interference

We talked a bit about these issues, and I got a clearer view of what actual difficulties I have. I struggle with certain things all the time, but I don’t always have a clear view of why that is. Maybe it’s my processing speed. I don’t seem to put things together right away, so I often don’t even realize that I’m struggling till later.

The idea that I’m slow doesn’t make me very happy. I’ve got “superior” intelligence, but my speed can be glacial at times. That puts me at a disadvantage in the speed-addicted world, where everything happens at high speed. It also doesn’t help me in social situations, where people gauge your intelligence by how quick you are. Obviously, that’s not a fair comparison. But that seems to be the public bias.

The thing that bothers me more is the visual memory thing. I tend to think of myself as a visual thinker, but maybe that’s not the case. My memory was the worst, when I was trying to remember pictures. I forgot things pretty quickly. Like they’d never even existed. Compared to my verbal memory (which also kind of trailed off at times — I lost track of important details), it was a lot worse.

I need to dig into this more, because I think this may be why I struggle with some things I really, really love. I’m an “anatomy geek”.  I love to study pictures of human anatomy — feet, hands, shoulders, backs, legs, torsos, internal organs, the nervous system, even the musculature of the head. But for some reason, no matter how hard I study, no matter how hard I try, I can’t seem to keep the images in my head. I tried to become a personal trainer, years ago, and the reading materials were fine. But I couldn’t get the anatomy piece.

Maybe that’s why. If that’s the case, I need to either stop getting all these atlases of the human body, thinking I’m going to memorize them all… or I need to find another way to study. I’m not willing to let go of my love of the human system, so I’m not going to give up my atlases. I just need to find a new way to memorize. And not just memorize, but really understand how things are put together, using all the tricks in my toolbox.

My first NP was pretty intent on making sure I didn’t get down on myself and think less of my abilities. I have a tendency to focus on the things I do wrong (I was raised that way, actually), and that can really drag me down.

Now I really need to work with my issues in a more focused way. I know the numbers I’m looking at are old — the last eval I had was about 5 years ago. I should really get a new eval, but it costs a lot of money, and my insurance won’t cover it. So, unless I come across an extra $5K that I don’t need for something else (and wouldn’t that be wonderful), I’ve got to work with what I have. Too bad. I’m stuck.

Then again, I’m not that stuck. I can still observe what’s going in my life, see what’s causing me problems, and deal with that. I have a lot going on, so it can be a bit of a “dust storm” with lots of competing information, and I may not always be able to make distinctions. But at least with the handful of issues that my NP eval has identified, it gives me a handhold.

All of this can be like standing in front of a rock wall, trying to figure out where to grab onto first, to start climbing. All I need is a few tips and hints.

Then I can get started.

Moving up.

Onward.

Upward.

Well, then, get some exercise. Move.

Bangkok traffic jam with cars and trucks and motorcycles all backed up below tram lines
Feeling a bit backed up, lately

I’ve been feeling a bit down, lately. Dragging. Drab. In pain. I’ve been having some tightness around my ribcage that really hurts when I laugh. I can’t remember doing anything to myself – – no recent injury. Just maybe sleeping on it wrong.

I’ve been feeling down, too. Just a low-level depression. The Catch-22 situation with my neuropsych — if I really go into great detail about how much help I need, then I get bumped down in the proverbial pecking order and end up stigmatized (and potentially looking at higher insurance rates, on down the line, if the current health coverage changes go through). But if I don’t enumerate all the different ways I need support, I can’t ask for it. Literally, it’s Catch-22.

I think I’ll read that book again. I think I read it years ago, and I need to read it again.

I really have to take matters into my own hand, in this regard. I’m not disabled enough to require outside help to function at a basic level. That can be arranged. I have the means to do that, and I have books and information at my disposal to expand my understanding about what’s going on. I need to just do that. Take matters into my own hands, and reach out to others for help with clarification.

I’ve signed up for some free online courses about the brain. I need to stagger then, so I’m only taking one at a time. I think I’m going to use those online courses — and access to the instructors — as a professional reference point. I’m not actually getting the kind of assistance I want from the NP I’m working with now, so I’ll branch out and cover myself in other ways.

As for my day-to-day, I need to get myself back on track. I haven’t been exercising as much as I should. I’ve been locked on target with some projects I’m working on — as frustrating as it is, my work situation is keeping me busy — and I’ve been sitting too much, moving too little. I have all-day workshops today and tomorrow, which I can easily do, just sitting down all day.

That’s no good. I need to get up and move on a regular basis. I have a lot of energy, and if I don’t move, that energy tends to “back up” like a lot of traffic trying to cram its way through a narrow space.

That can be fixed, though. I exercised more today than I have been, lately, and now I actually feel better. It’s amazing, how much a bit of movement will do — especially lifting weights. Even if they’re not very heavy, still, the motion and the resistance is good for me.

I’m also working from home today, so I can walk around the house while I’m on the phone. That’s the magic of a mobile phone — it’s mobile. Tomorrow, I can walk around, too. I just need to listen in, so I can walk around the building while I’m listening. It’s not hard. I just need to do it.

And so I will.

I’m feeling better better today about my future prospects than I have been, lately. I got plenty of sleep, last night (almost 9 hours), I did a full set of exercises, I had a good breakfast, and I’ve got a path forward charted for moving forward.

I believe I can trust myself, and that I have the ability to see where I’m falling short. I trust that I can research and reach out for ideas to address issues that arise. The main thing is really to keep on top of things. Take responsibility for myself. Do what I  know I need to do. And just keep moving on.

The world’s a big place with a lot of different options. I just need to make the most of the opportunities I have, keep focused on my end goals, look for opportunities, and keep moving forward.

Will the world step up and help me with my problems? Not if I don’t ask.

Do I need other people to help me at every turn? Sometimes yes. Sometimes no. The main thing is that I help myself, using what assistance I’ve gotten from others and the resources I have on hand.

I’m in a very fortunate situation, where I have the ability and the available resources (time, energy, attention, interest — even if money’s missing) to take care of myself. So, I’ll do that.

A new chapter is on the way, and I’m actually looking forward to what’s to come.

Turning a new page in the chapters of my life… again

open book with a landscape scene in the pages
This picture looks a lot more pleasant than my situation feels…

I’ve shifted direction in my TBI recovery, yet again. I’ve had to do some soul-searching, over the past year, as I’ve adjusted to the change in neuropsychologists — and my insurance company said they wouldn’t cover the support I need on a weekly basis. My official diagnosis, for insurance billing purposes is “Generalized Anxiety Disorder”. Ha – if only they knew. Actually, my anxiety is very specific. It’s comprehensive and exhaustive in detail. Calling it “generalized” isn’t exactly accurate.

Basically, some doctor who’s contracted to review their cases said he can’t see any reason why I continue to  need professional support from a neuropsych, and I should seek out “community support” instead.

So, I guess I’m supposed to attend support groups held by the local BIA or something like that. Or make more friends. Maybe call a support hotline. Dunno.

That’s all very well and good, and in a perfect world scripted by Hollywood, that would work. The thing is, I’m the sole caregiver for an increasingly challenged spouse, who has trouble walking, and is getting more emotionally volatile, impulsive, and forgetful by the month. I’m the sole breadwinner for our household, and my responsibilities include $upporting a weekly national broadcast that’s run on over 100 markets nationwide. I have a mortgage. I have a full-time job. I have a lot of people depending on me, but my ability to reach out for help is constrained by A) my reluctance to disclose my TBI history to anyone, and B) my spouse’s professional reputation, which is very much at stake.

If I disclose my TBI and the full range of my challenges (which extend past the brain injury stuff) and get 100% accurate about what I need and why, I will automatically enter the ranks of the “disabled”, according to the official definition.

And I can’t have that. No way. No how.

This is not a slam against disabled people. It is a slam against our society which stigmatizes and relegates the disabled to second-class citizens and makes it next to impossible to live a full life with a designation of “disabled”.

I cannot live my life in a “disabled” social/economic bracket. I just can’t. And as long as I can keep up the appearance of performing at “normal” levels, I’m going to do exactly that. Regardless.

If I turn to the community for help — leaning on friends and acquaintances and my social circle — my spouse will pay the price. Because they are keeping up appearances, too, and much of what they do with others hinges on others’ perception of them as a 100% capable individual. The mobility issues are obvious to everyone, but their cognitive-behavioral challenges only appear behind closed doors. I can’t go around telling the world about what really happens, because that would seriously hose their reputation and ability to participate and be accepted in the circles they work in.

So, there’s my conundrum. And there’s the reason I could really use a neuropsych who understands not only TBI, but other neurologically based cognitive-behavioral issues.

I have a couple of choices:

  1. I can find another neuropsych (“NP”) who can work with me, who is smarter about billing with the right codes, not to mention helping me rise above my current situation. I need to do this, anyway, because the current NP is very focused on just averting disaster — calling attention to the problems I have, rather than my strengths. I’ve developed a bit of a complex, working with them. My old NP was very focused on growth and development and living large, even in the face of TBI. This one… not so much.
  2. I can go it alone. I’ve done that before, and an awful lot of TBI survivors do just that. I’ve got access to a lot of great NP books — some on my bookshelf, some in the library — so I can study up on it, myself. I’ve pretty much rehabilitated myself, anyway, in many respects. My old NP told me so. I’ve sometimes wondered why the heck I have to work with an NP, anyway. I’m not nearly as bad-off as many. I’m more functional than even those who haven’t gotten hit on the head a bunch of times. Why not just handle this myself?

Here’s the thing — I really am focused on growth and development, and I’m also very focused on a neuropsychological approach. And it’s important to me to have access to a highly trained professional who can offer their expertise and insights to my situation. I’m not like a lot of TBI survivors who don’t have an academic interest in this stuff. I’m very different. And my results have been atypical for TBI recovery.

My old NP told me so. In 40 years of rehab work, they’d never seen anything like it.

So, anyway, I got a bunch of names to contact about getting another NP evaluation, as well as working with my situation to improve and take things to the next level. I got the info a week ago, but I took a bunch of days off, just to relax and let myself catch up with things. Now I’ve had my break, so it’s time to start calling around. I’ll do that this morning.

If I find someone, great. If I don’t, I’ll take matters into my own hands. Even if I do find someone, I’ll still do that. It’s all a work in progress. The next chapter… as the page turns.

Seems strange that we don’t know more about #concussion

According to the CDC’s web page(s) on TBI and Concussion:

How big is the problem?

  • In 2013,1 about 2.8 million TBI-related emergency department (ED) visits, hospitalizations, and deaths occurred in the United States.
    • TBI contributed to the deaths of nearly 50,000 people.
    • TBI was a diagnosis in more than 282,000 hospitalizations and 2.5 million ED visits.  These consisted of TBI alone or TBI in combination with other injuries.
  • Over the span of six years (2007–2013), while rates of TBI-related ED visits increased by 47%, hospitalization rates decreased by 2.5% and death rates decreased by 5%.
  • In 2012, an estimated 329,290 children (age 19 or younger) were treated in U.S. EDs for sports and recreation-related injuries that included a diagnosis of concussion or TBI.3
    • From 2001 to 2012, the rate of ED visits for sports and recreation-related injuries with a diagnosis of concussion or TBI, alone or in combination with other injuries, more than doubled among children (age 19 or younger).3

What are the leading causes of TBI?

  • In 2013,1 falls were the leading cause of TBI. Falls accounted for 47% of all TBI-related ED visits, hospitalizations, and deaths in the United States. Falls disproportionately affect the youngest and oldest age groups:

    • More than half (54%) of TBI-related ED visits hospitalizations, and deaths among children 0 to 14 years were caused by falls.
    • Nearly 4 in 5 (79%) TBI-related ED visits, hospitalizations, and deaths in adults aged 65 and older were caused by falls.
  • Being struck by or against an object was the second leading cause of TBI, accounting for about 15% of TBI-related ED visits, hospitalizations, and deaths in the United States in 2013.

    • Over 1 in 5 (22%) TBI-related ED visits, hospitalizations, and deaths in children less than 15 years of age were caused by being struck by or against an object.
  • Among all age groups, motor vehicle crashes were the third overall leading cause of TBI-related ED visits, hospitalizations, and deaths (14%). When looking at just TBI-related deaths, motor vehicle crashes were the third leading cause (19%) in 2013.

  • Intentional self-harm was the second leading cause of TBI-related deaths (33%) in 2013.

That, to me, is a pretty big deal. And that’s not even counting the costs of concussion to all the people who sustain them, as well as the friends, family members, co-workers, and employers involved.

While other diseases, injuries, conditions, etc. have “epidemic” status and get a whole lot of attention and visibility drawn to them, concussion / TBI still lurks just under the surface. Maybe because it’s so scary for people. Maybe because it’s so invisible. Maybe because people still have this perception of TBI as being “just a clunk on the head” that’s no big deal.

Guess what — it is a big deal. And it affects your whole person.

So, maybe people really do get that. They just don’t have the ways of thinking/taking about it in a productive way.

Maybe we just aren’t properly equipped.

I’m not sure there’s ever a way to properly equip people to confront their deepest, darkest fears. But the right information goes a long way.

Also, having standards of care, getting the word out on a regular basis about how to understand and handle concussion / TBI, and not treating it like a taboo that can’t be discussed in polite company… that would help, too. Heck, if we could just discuss it, period, that would be a positive development.

Well, that’s what this blog is about. Sharing information, as well as discussing what it’s like from a personal point of view. It’s important. And it doesn’t happen that often, in a productive and pro-active way. At least, not compared to the frequency with which it happens.

It really doesn’t.

Except here, of course.

So, as always, onward…

Getting the right information about #concussion

train tracks rounding a bend and disappearing
Who can say what lies ahead?

It never ceases to amaze me, how little is generally known about concussion / mild TBI. Either it’s dismissed, or it’s viewed with a combination of fear and horror. Just mentioning to someone that you’ve had one (or two, or — like me — 9) can seriously alter their perception of you.

I’ve had conversations with people who I thought would “get it”. But as soon as I mentioned my history of mild TBI, their manner changed from collegial to guarded. As though they were waiting for me to slip up or do something stupid.

Eh, well. Whatever. I can’t get too bent out of shape about it. After all, it’s largely not their fault. We just don’t have a lot of good information about concussion / mild TBI. Nor do we have stellar management practices. It’s either negligent, or it’s over-protective. And unless I’ve been under my rock too long (always a chance of that), I don’t believe there are widely recognized, standardized best practices for docs and patients, alike.

We’re getting there. But we’re not there yet.

That being said, I’m working on updating my series 10 Things I Wish Someone Told Me After My Concussion(s) I collected 10 posts in one place, and I also published it as an eBook, to give people more access to it. But looking at it last night, when I had some time to myself, I see I really need to both expand it, as well as create a more condensed, high-level version of it.

The point of the collection is to let people know they’re not alone – and to share with them things that really would have helped me, had I known about them sooner. When you hit your head hard enough to alter your consciousness, it can impact you heavily. It might not be obvious from the outside right away, and it may take a few hours or days or weeks (sometimes even months) for things to start to get weird, but something actually has changed inside your skull.

We need to know this. Not just from doctors when we think to consult with them. Not just from experts, who have all the domain expertise. But in the general population. That’s why I’m expanding the book into print — because I want to get it out to libraries, as well as to individuals. It’ll be on Amazon, just like the eBook is.

I’ll be updating this site, too, as I go along, adding more information to help clarify. This is important. People need to know. It can’t protect them from that first impact, but it might just help them deal with that — and possibly avoid the next impact that becomes even more likely when you’re already concussed.

Watch this space.

For this news … and more.