I am very excited to share this week’s post, written by Stefanie Kruger. She had an exciting interview this week with Dr Teresa May-Benson. Happy reading!
A roller coaster ride is known for its speed, intensity of highs and lows, unexpected turns, and even elements like flames or splashing through a water tunnel, adding more fun to the adventure. It is described by the thrill seekers as exciting. They will go back for more, or look for even bigger and faster rides. Some might choose simply not to get on a roller coaster ride, and for others it will be their worst nightmare.
The past couple of months have been compared to a roller coaster ride by various people due to the prolonged impact of the COVID-19 pandemic. Depending on our individual preferences, perceptions, and ideas, we have all had different experiences of lock down, as well as the ever-changing rules and regulations. Some are taking one day at a time, while others are able to care for their families and even beyond,supporting their communities.
The dilemma with this metaphor, is that a typical roller coaster ride is confined to a specific context such as a theme park. People have the choice (i.e. sense of autonomy) to go on them or not. It has a definite beginning and end. The external elements are controlled. There is some kind of protection from falling off (e.g. seat belt), and there are safety precautions to prevent the coaster from derailing. We can see it, and can form some idea of what is to be expected and around which exact corners the sudden drops are.
The Corona Coaster
With the proverbial Corona-coaster, it is probably like going on a roller coaster ride with a blindfold, a huge unknown. The unexpected twists and turns intensify the sensory event, never mind the risks involved when the proper safety precautions aren’t implemented.We do not have control over the fear-provoking elements, and there are so many news reports and critics, that we are not sure whose version to believe and which facts are accurate.
Imagine “carrying on with life” on such a roller coaster… with the environment being controlled by external forces…
Despite our individual differences, the past couple of months have certainly challenged our ability to adapt and to establish some sense of balance. We have had to form new ideas about doing familiar things in a new way, like getting dressed, going to the shops or preparing a meal, doing work or school projects, maintaining relationships and regulating our sensory and emotional needs. There has also been a significant financial impact on businesses and families, and no one could really have been prepared for what lay ahead. We also had to deal with the disappointment of events that got cancelled and the emotional strain of constantly solving problems or making new plans. The parameters were very different and often hard to measure, and then we had to change them at least once, sometimes several times before a plan could be implemented. And only then could the effectiveness of the plan be determined.
As occupational therapists with a special interest in sensory integration, we are familiar with concepts such as praxis. We know how important it is to regulate a calm-alert state for optimal performance, or how to make environmental changes to facilitate success, to feel good and to have fun. When we think of the components of praxis such as ideation, motor planning, motor execution, feedback mechanisms, language and theory of mind,one particular name comes to mind. Dr Teresa May-Benson is a well-known and respected clinician, lecturer, researcher and author on Ayres Sensory Integration® theory and intervention.She has written numerous book chapters and articles on praxis, and completed her doctoral dissertation on ideational praxis (from https://www.sensoryintegration.org.uk/Teresa-May-Benson) .
We are very grateful that Dr Teresa May-Benson was willing to answer a few questions. Here are her thoughts on Praxis and Rolling with the Corona-Coaster:
Question 1: Why are we feeling so exhausted, or even disorganized at times? Is it because of the cognitive effort we have to put in to THINK about doing the things that ought to be automatic? Or the lack of control we have? Or the energy we put into constantly adapting and adjusting, doing everyday life activities in a new way, or even not being able to do these activities at all?
Dr Teresa May-Benson: I think you hit the nail on the head and it is really the combination of all these factors. First, our routines and schedules have been disrupted, so we have to put energy into developing new ways of doing things from deciding when to get up and go to bed to deciding what to wear for the day and how to structure our daily time schedule. This is exhausting. As you noted, the cognitive attention we have been, and many people still are putting, into these decisions can be overwhelming. These are things that should be fairly automatic for us.
The lack of control is also a huge factor, along with all the changing demands that brings. Literally what we can and cannot do has changed nearly daily over the past five months. Something as routine and simple as going to the grocery now takes constant re-evaluation…can you actually go out today or have the rules changed overnight? Can you go with someone, like a spouse or do you need to go alone? How long will it take? Are there long lines to wait in? The constant lack of being able to anticipate and control our futures certainly takes a toll. All of these activities place demands on our praxis and related organizational skills that we are used to being pretty easy at this point in our lives. Now we are having to put tons of energy into basic life activities that most of us have not had to worry about since we became adults. Add in all the additional changes caused by work disruption, job loss, kids home from school and resultant demands on parents for home school and it can be overwhelming for the most capable person, let along any of us with praxis issues.
Question 2: Our ability to form ideas, solve problems and apply our practic abilities is certainly challenged by our perceptions of this pandemic on our lives and environment. Is it accurate to say that the flip-side could also be true: that our emotions could have an impact on our ability to effectively deal with all the changes and to apply our practic knowledge and skills?
Dr Teresa May-Benson: Yes, absolutely. When we are in a high state of arousal, emotional or sensory, that state interferes with our ability to process and organize information. Thus, interfering with our ability to access the praxis skills we have. Think about what happens to your ability to safely drive a car when you are upset. So in this covid situation, our emotions are high…for many different reasons…which then makes accessing our praxis hard. And we have already said that the praxis demands have significantly increased. For many people, this resulted in just shutting down and not being able to do much of anything for a while.
Question 3: We acknowledge that there are individual differences, preferences and experiences in everything in life. However, many people are experiencing some sense of uncertainty, increased fear or anxiety. In your opinion, what are the factors contributing to our emotional vulnerability?
Dr Teresa May-Benson: As we have discussed, I believe there are a variety of reasons why many of us are experiencing such emotional vulnerability. We are afraid of becoming ill, potentially dying, or having loved ones around us become ill. The media constantly bombards us with terrifying and conflicting information so it is difficult to know what to believe. All this uncertainty increases our arousal and makes it hard to know how to act or to respond. Many people have responded by becoming very rigid, others are rebelling. The increased practice demands and cognitive load we all are living with adds to the challenge. I believe much of our current civil unrest is related to this underlying emotional uncertainty we are living with right now. Individuals are acting out in a way that is allowing them to feel powerful or in some kind of control.
Question 4: To what extent is there interaction between how we experience the quality of our daily occupations such as the satisfaction of good sleeping and eating habits,and the impact of prolonged exposure to stress hormones e.g. on our digestive system or our ability to pay attention?
Dr Teresa May-Benson: We all know that increased stress results in increased levels of cortisol. High cortisol levels are detrimental to sleep, eating and emotional well-being, as well as our general health condition. When stress is high, we do not experience a good quality of life and completion of daily occupations of all sorts is disrupted. You mentioned attention as well. This is important as high cortisol levels result in decreased attention. It facilitates our flight or fight responses and we are constantly on high alert. This high alert state diverts blood flow from our gut to our muscles for flight so we are often not hungry, contributing to poor mealtime routines. Sleep is similarly affected and when you do not sleep you will be even more vulnerable to stress.
Question 5: From your experience, what has been the most helpful in dealing with these challenges and changes, and what positive life lesson(s) have you learnt?
Dr Teresa May-Benson: Wow, that is a tough question. My family is in the middle of making a major life move in the midst of this pandemic so we are dealing with both the pandemic issues as well as issues related to our relocation and job changes. That makes it harder to separate out what is originating from where. I have found that getting enough sleep, whether that means taking naps, using sleep aids, sleep and relaxation strategies, etc. is critical. Establishing some kind of a schedule and new routines which may be very different than before. For instance, getting up no later than 8:00, getting dressed in real clothes by 9:00 and then to work. Having dedicated space for work and for home and keeping those occupation spaces separate as far as possible helps. I go into my office to work. My husband works at the kitchen table but goes into the living room for leisure. Allowing myself to have “off” days when I just cannot function and being OK with that has been important. Making family time and re-establishing family relationships. My family has actually started cooking dinner and eating together earlier in the evening. Find things that are enjoyable for you and be OK doing them. Read a book, listen to an audio track, meditate, do yoga, go for a walk. It all sounds so easy, but can be hard to implement. I put everything on my calendar, just as I did when I went into the office. It makes all the overwhelming things to do easier and keep track of when they are put in a time frame on a calendar you can refer to and follow. I guess the major life lesson I have learned is that life goes on. As hard as this time is for us, others have had it harder and they managed. We will too, we will get back to normal eventually and by then it will be a different normal because our life circumstances will have changed anyway. Break down tasks into small steps. Be ok with accomplishing small things. Be kind to yourself, give yourself the space to rest and be OK with not being 100%. Be kind to others, they are as stressed and overwhelmed as you are.
Concluding thought: For me personally, I have learnt to appreciate the small things, which are actually the big things. Life is like a camera, point it to the beautiful things. We have a choice what we focus on.
Acknowledgement: Thank you to Dr Teresa May-Benson for sharing your valuable insights and perspectives. We appreciate your contribution.