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HPRC Fitness Arena: Mind Tactics
Pain can be unpredictable, uncontrollable, and unrelenting, so even the most resilient Warfighters can be vulnerable to it. Because of pain, you may experience symptoms of anxiety or depression; your mind may even exaggerate the intensity and awfulness of pain. Socially, you might experience criticism, rejection, and negative interactions with family, spouse, or peers. Even if interactions are generally positive, you may want to withdraw from people or difficult situations
Chronic pain, which lasts longer than three months and is unresponsive to treatment, can affect quality of life for many. At least 100 million adults in the U.S. suffer from chronic pain. Unfortunately, combat and other situations make Warfighters especially susceptible to experiencing injury and pain. One study of an infantry brigade found that three months after return from Afghanistan, 44% of the soldiers reported chronic pain.
The American Psychological Association has shared evidence that relief from pain is more likely when mind and body are both treated. The National Center for Complimentary and Alternative Medicine has also indicated that continued study of non-drug approaches to pain management is a priority.
The latest trend in treating pain is the “biopsychosocial model,” which focuses on exercise and sleep (not just meds and surgery) as important biological influences. Important psychological factors include thoughts, emotions, behaviors, and attention. And impactful social factors involve healthcare, family, and work. All of these factors can contribute to understanding and mitigating the impacts of pain.
The American Psychological Association shares concrete advice to manage pain, including these tips:
- Distract yourself.
- Stay active and exercise.
- Know your limits.
- Follow prescriptions carefully.
- Make social connections.
- Don’t lose hope.
Whether on the playing field or on a mission, of course you want to succeed. Dreaming of positive outcomes can drive you to train hard. But you may have noticed that when you only focus on the outcome, you’re distracted from the important ingredients for success. Your successes will unfold more easily if you develop goals centered on what’s in your control rather than how you compare to others. Learn more about setting different kinds of goals in this HPRC article on sport psychology goals.
“Sport psychology” uses the principles of psychology to help optimize performance in athletics. These concepts can be applied to just about anybody (including Warfighters) in any setting where performance matters, so sport psychology often gets dubbed “performance psychology.” Regardless of the name, this focus on the mental aspect of performance fits into a holistic approach to Human Performance Optimization (HPO).
A major focus of sport or performance psychology is mental skills training, building a “toolbox” of mental skills based on sport science and clinical/counseling psychology techniques. These scientifically based methods can be applied to Warfighter performance too. Some basic tenets of performance enhancement within military and sport settings include maintaining high awareness, motivation, and self-control, either by reducing how “amped up” you get or by learning to interpret these feelings as either meaningless or helpful to performance. A well-trained Warfighter can either calm down and think, “I’ve got butterflies, but no big deal,” or “I am psyched up and ready!”
Mental skills are important, but they’re only part of a performance psychology package. Performance psychology looks to fix or improve performance by: 1) training skills to proactively address problems, 2) improving resilience to avoid problems in the first place, 3) enhancing performance, and 4) reducing stigma around getting help with problems after they’ve appeared. In applying performance psychology to Warfighters, training is customized to meet the needs of specific groups, focused on real-life applications, and taught in a way such that skills are learned for optimal functioning both at work and at home. HPRC endorses holistic training programs that include performance psychology, such as One Shot One Kill (OSOK), a platform that helps Warfighters to customize their own systematic training.
The “relaxation response” is your body’s counterpart to the stress response you feel during critical situations. As the name suggests, the relaxation response has a calming effect on your mental and physical state, with benefits that include less anxiety, a more positive mood, a sense of calmness and well-being, and reduced heart rate, breathing and metabolic rates, blood pressure, and muscle tension.
Sound good? You can learn how to use your body’s relaxation response for health and well-being. Various mind-body techniques such as deep-breathing exercises, guided imagery, meditation, progressive muscle relaxation, yoga, tai-chi, and qigong all train you to turn this response on. Practicing these mind-body techniques has been found to help with anxiety and depression, as well as physical conditions such as hypertension, cardiovascular disease, and types of cancer that are exacerbated by stress.
To learn more about mind-body techniques, check out HPRC’s Mind-Body Skills section.
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.
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.