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HPRC Fitness Arena: Mind Tactics
Walk into the new facility of the National Intrepid Center of Excellence (NICoE) on the campus of Naval Support Activity Bethesda, and one of the first things you will see is a sign commemorating the center’s origins, including the fact that the $65 million facility itself was donated by the Intrepid Fallen Heroes Fund. NICoE is committed to the interdisciplinary diagnosis, treatment, and long-term healing of Warfighters, and educational support for their families, from all branches of service.
Unlike many military environments, the facility is curved, spacious, quiet, and pleasant. Some notable features are the high ceilings, artwork, and state-of-the-art treatment rooms.
Patients at NICoE typically are active-duty service members with mild traumatic brain injuries (mTBI) combined with other psychological health conditions such as post-traumatic stress (PTS), anxiety, and depression. Most have already begun treatment elsewhere, often with many medications. The tranquil environment of NICoE instantly helps put them at ease and often leads to more effective treatment with fewer medications.
Recognizing that traditional therapies can’t heal all wounds, NICoE has rooms dedicated to art therapy, virtual reality, and meditation. Beautiful masks line the entrance to the art therapy room, providing a small glimpse into Warfighters’ individual and unique roads to recovery. The virtual reality room allows Warfighters to face traumatic scenarios at a pace that makes sense, an incredibly lifelike setting full of sound, movement, scents, and images. The spirituality room lets in natural light to a space with a beautiful wood floor surrounded by natural plants and a speaker system that plays sounds of nature.
An interdisciplinary approach, combining traditional and integrative medicine, contributes to NICoE’s 99% satisfaction rate, with more than 600 patients from all different services having completed their four-week program. There is no one-size-fits-all approach to healing, and the interdisciplinary makeup of the clinical team enables patients to pursue various treatment options. Providers can collaborate regularly and have cutting edge equipment at their disposal.
Patients usually bring a non-medical attendant, often a spouse or parent. Children also are welcome at NICoE. A private family room with frosted glass includes a children’s play area, and a playground is located behind the facility.
NICoE also focuses on research to help ensure long-term treatment success. There has been discussion of opening their doors to a wider range of Warfighter patients (treating more conditions) and opening more NICoE satellite centers. Referred to as Intrepid Spirits, such centers are open already at Fort Belvoir and Camp Lejeune. The Intrepid Spirit at Fort Campbell will open this summer, and ground was broken recently for one at Fort Bragg. Other bases that may receive an Intrepid Spirit include Forts Hood, Bliss, and Carson, along with Joint Base Lewis-McCord and Camp Pendleton.
Why do some people with devastating injuries do well in their recoveries and others do not? People often focus on the negative fallout, but there can be positive consequences called post-traumatic growth. Scientists use the term “disability paradox” to refer to how some people with devastating illness or injuries are still able to enjoy a good quality of life. The characteristics of these folks describe someone with a “survivor mentality.” Characteristics include:
- Subscribing meaning to one’s disability or lot in life and sharing this meaning with others.
- Not choosing to live as a victim but instead to feel empowered and motivated to deal with struggles and come out as a victor.
- Being flexible, adaptable, resilient, and rolling with the punches.
Many factors play into developing a survivor mentality. Here are some tips to help:
- Create a strong support system: family, church, community, fellow Warfighters, healthcare providers, etc. A support system should be just that—supportive, encouraging, and a promoter of independence, not an enabler for being or feeling like a victim.
- Maintain a “can do” attitude. See challenges or setbacks as an opportunity to learn and grow. Focus on strengths and abilities, not on limitations. Survivors exhibit the 4 Cs of mental toughness.
- Maintain hope and optimism; focus on the future and move from thinking about the negative aspects of injury/illness to focusing on the positives or possibilities.
Adults need seven to eight hours of sleep a day, but do you know how much sleep your children should be getting? Pre-school children (ages 3-5) need 11–12 hours a day, school-age children (ages 5-12) need at least 10 hours a day, and teens (ages 13–18) need 9–10 hours a day. But many children and teens are not getting the recommended amounts. For example, The Centers for Disease Control and Prevention (CDC) highlights how almost 70% of teens are not getting the sleep they need.
Don’t know how much sleep your child is getting? Keep a sleep diary to track his/her sleep for two weeks.
Not sure how to help your child get the best sleep possible? Try the following tips. (They’re great for adults, too.)
Make sure your child has a consistent sleep schedule, including a consistent bedtime.
Provide the same quiet, dark bedroom environment for your child every night.
Help your child or teen have a relaxing bedtime routine that helps them prepare for sleep.
Avoid stimulation near bedtime. That means no sodas or other drinks with caffeine* and no TVs or computers in the bedroom.
Exposure to daylight helps set up a sleep rhythm, so make sure your child spends some time outside every day.
Turn the lights down to help your children wind down about an hour before bed and avoid using TVs or computers during this time as well.
Provide a low-stress family environment. Read HPRC’s “Family relationships affect your child’s sleep” for more information.
* Some experts recommend not giving children any caffeine, but if your child or teen does consume some, the American Academy of Pediatrics suggests that children should not exceed 2.5 mg/kg per day and teens should not exceed 100 mg/day.
We’ve all heard of depression. If you’ve never experienced it, it’s easy to think that someone could just snap out of it if they wanted to. Depression doesn’t work like that. It can have an impact on a person in every way—physically, mentally, and emotionally, even extending to relationships—and can range from mild to severe. According to the American Psychological Association, “Depression is more than just sadness. People with depression may experience a lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide.” Depression is an illness considered to be treatable with professional help.
This factsheet from afterdeployment.org details the signs and symptoms of depression. They also have an anonymous online assessment, general information, personal stories shared by those who’ve experienced depression, an interactive workbook that can help you challenge negative thoughts and identify depression triggers, and information about the link between behaviors and mood. Also take a look at the factsheet on Taking Charge of Depression, which includes helpful strategies.
For more information about depression or other mental states that can influence your performance, check out the section of HPRC’s website on depression. However, if you feel you are in crisis, contact the Military Crisis Line—someone is available 24/7 for online chat or via phone at 1-800-273-TALK.
Mindfulness can help you feel better equipped to handle difficult emotions. It’s a process geared to help you tune into emotional experiences rather than try to escape from them. People can feel overcome by depression, anxiety, PTSD, addiction, or other mental health problems, which, ironically, can be exacerbated by trying to forget the cause. For example, a Warfighter afflicted with PTSD often relives difficult events through dreams, flashbacks, or unwanted memories, because he/she desperately wants to avoid experiencing those events. To illustrate this idea, right now, try NOT to think of weapons. You probably thought about them that much more.
Practicing mindfulness mediation means focusing on whatever you are experiencing in the present moment. It can be a structured meditation activity, but because mindfulness is about being present, you can purposefully engage in mindfulness anytime, anywhere. A common meditative approach is to focus on a physical experience such as your breathing, noticing where your attention wanders, and gently guiding it back to your breath; it allows you to experience sadness, anger, fear, and other unpleasant emotions, letting them pass without clinging to the idea of making them go away.”
If you have ever “white-knuckled” your way through an amusement park ride (or ridden in a car with a driver you didn’t trust), you may remember thinking, “When will this be over? Please let it be over…” This shows that focusing on how long something lasts can make it feel like an eternity. By engaging in mindfulness, you will feel less threatened by certain emotions, and you will be less likely to engage in problematic forms of escape (such as drinking, drugs, or simply spacing out).
When people experience difficult emotions, they often cope by engaging the language center of the brain, using words internally to wrestle with the experience. But when people have difficulty re-evaluating why they feel the way they do, this leads to a circular internal debate (such as “I shouldn’t feel this way, but I do, but I shouldn’t…”), which can be pointless and can actually cause more distress. Emotions can be dealt with not just through words but also by tapping into their physical elements (noticing how you feel in your body). When people engage in regular mindfulness practice, the parts of their brains tuned into physical sensations are activated while they experience hard emotions. And people who regularly have this part of their brain activated tend to be more emotionally steady.
Unfortunately, it’s difficult to escape unwanted emotions. And more problems will probably pop up as you try to escape. But if you’re willing to face hard emotions, letting them come and go like waves on a beach, then mindfulness practice can help you have a different experience. Tune in to HPRC for more mindfulness resources, and take advantage of the fact that mindfulness is everywhere now, whether part of your martial arts or yoga class or filling the self-help shelves of your local bookstore. Become more mindful, and you can feel better equipped to handle tough emotions; your mind and body will engage them more productively.
Whether you know it or not, you’ve probably engaged in “triangulation,” and not just as a kid when you ran to Mom because Dad just said “no” (or vice versa). Similar triangles can also happen with leadership or any work group, committee, or organization (including military) where two people talk about a third.
On the surface, triangulation can look pretty harmless. You vent out of frustration because someone is not acting the way you’d like. Depending on where you are in the triangle, you either receive sympathy or provide it, possibly exerting any power you have to fix the situation. These triangles tend to consist of a “victim,” a “villain,” and a “rescuer.”
Because people are often uncomfortable with conflict, they figure out ways to maintain the status quo, even if it’s a bad one, instead of addressing what the core issue is. Triangulation is one way to avoid facing things, and it can feel like a fix, but it’s temporary at best. The rescuer provides a sympathetic ear so that the victim doesn’t feel a need to take action, or tries to take charge of the situation, but inevitably, the same problems pop up between the original two people.
Next time you feel like a victim and consider going to another person with your conflict, first be clear about your goals. Do you want to be rescued, or do you want to be coached? Before reaching out, ask yourself if you can possibly self-coach your way through whatever is popping up. Prepare yourself for whatever criticism might come your way if the “villain’s” defenses get triggered. And “preparing” does not mean bracing yourself or getting ammunition ready to fire back at that person. It means getting ready to really listen and validate how the other person feels, even if you don’t agree with the content of what that person says. If that person feels listened to, he/she will become more receptive to your position.
When a triangle does occur, the best scenario for the third person (the potential rescuer) is to be a good coach. Coaches don’t play the game for their players; they help them become more self-sufficient. Similarly, good leaders ask challenging questions of the people under their command, helping them to think through situations and become better equipped to face conflict directly. If you’re the potential rescuer, resist your own impulses to fix things and instead work on enabling the victim to fix the situation directly. Know that if you dive into this triangle, any other solution is probably temporary at best.
These strategies may seem simple, but they take practice. Try letting go of triangles and use some of the same kinds of communication strategies that work for couples.
PTSD was finally recognized as a medical condition when recent advances in neuroscience showed that the brain no longer works properly after trauma. Your brain has an alarm system to help ensure your survival; it’s useful as long as it works properly. When the alarm system malfunctions because traumatic events pushed it to its limits, the part of the brain responsible for thinking and memory can’t function properly. When this happens, a person with PTSD can’t compare what’s happening now with events in the past when they were safe. However, there are treatments to help “rewire” the brain, so it can work properly again. Learn more about this in “How is your brain’s circuitry affected by PTSD?”
No single mental technique can do the job for you, just as no single tool is the only one in a construction project. You can’t hammer a nail with a wrench! HPRC offers nine rules and strategies for your mind’s toolbox to help you perform your best. Check out HPRC’s Performance Strategies on “Mental skills for optimal performance” to learn more.
The term “mental toughness” is often tossed about, but what is it really? And do you have it? Mental toughness is important to the success of Warfighters, athletes, business people, and others who have to overcome adversity to be successful.
Sport psychologists and others interested in optimal performance talk a lot about mental toughness, but it’s a bit complex, so it’s often misunderstood. Mental toughness is not just one trait; it’s a mixture of them.
Boiling it down, mental toughness is a strong belief in yourself and an unshakable faith that you control your own destiny. If you’re mentally tough, you can remain undaunted by adversity.
If you have these 4 Cs, you’re mentally tough:
1) Control: You feel in control of your emotions and influential with the people in your life.
2) Commitment: You embrace difficulty rather than running from it.
3) Challenge: You believe that life is full of opportunities, not threats.
4) Confidence: You know you have what it takes to be successful.
Mental toughness is a psychological edge that some are born with and others develop. It allows you to consistently cope with training and lifestyle demands better than those who don’t have it.
You can develop mental toughness through a long-term process of developing mental skills. Leaders can promote mental toughness by creating a learning environment centered on the mastery of those skills (listed above) and by being generally supportive, encouraging Warfighters to maintain positive relationships. Over the long haul, to maintain your mental toughness, you need to continue honing mental skills, and you need a self-driven, insatiable desire to succeed.
Post-Traumatic Stress Disorder (PTSD) can tear apart your sense of what is safe and of what is good.
Part of the diagnosis of PTSD is exposure to a traumatic event: death, serious injury, sexual violence, or the threat of any of these. PTSD symptoms such as intrusive memories, avoidance of situations or feelings, problems in thinking or mood, and feeling overly amped up are common reactions to abnormal circumstances. Think of PTSD symptoms as self-preservation instincts gone haywire. One theory holds that, because you nearly died or experienced something awful or could picture it because it happened to someone close to you, your mind/body tries to sound the alarm bells to keep you safe. But the alarm bells sound at the wrong times and in the wrong ways.
However, PTSD symptoms can come from sources other than fear of bodily harm. They also can arise from inner conflict, when emotions trigger feelings such shame and guilt or when you question fundamental beliefs (such as “the world is basically good”). Witnessing or experiencing betrayal (especially by a leader in a high-stakes situation), within-ranks violence, extreme violence, and incidents involving civilians are some of what can disrupt your world view. It isn’t just an event but the interpretation of an event that causes Warfighters to experience “moral injury.”
If you suffer moral injury as part of PTSD, you start believing you live in an immoral world, or you view yourself as immoral, irredeemable, and defective. If you’re a Warfighter experiencing these feelings, you not only feel lousy, but you are more likely to isolate yourself just when you need others more than ever. Isolation can lead to self-handicapping or self-destructive behaviors.
So how do you save yourself from experiencing moral injury as a part of PTSD? Having a healthy sense of self-esteem can be one of your best protectors. There are no quick fixes. But forgiveness—of others and of yourself—can help you to let go of moral injury. With the help of a psychotherapist, you can begin to wrap your heart and mind around what happened. And pursuing positive interactions, such as getting involved with charitable groups, can give you opportunities to relearn that you are good and the other people in the world are generally good too. Last but not least, connecting with your spirituality—in whatever way is comfortable to you—can help you navigate this difficult journey.