Mind-hacking Your Way Through

the Doldrums After Physical Injury

|| AYCOfest 2019 Discussion||

By Lynette Lau

Circus can be a physically demanding field and physical injuries are often not uncommon as we push our bodies to achieve the incredible. When physical injuries occur, we know to seek out medical attention and regularly complete our prescribed rehabilitation exercises so that we can get back to activity. However, it can be just as important to recognize and pay attention to our mental state as we recover physically. Experiencing (as well as witnessing) someone get injured can often result in psychological distress, that may persist even after the injured individual is physically recovered.

Common Psychological Responses After Physical Injury

It is natural for circassians to feel a multitude of emotions after physical injury. Sadness and/or anxiety may be prompted or exacerbated by some of these following factors:

• Decreased physical activity as a result of injury can result in disrupted levels in hormones and neurotransmitters that generally help to maintain healthy physical and psychological functioning.
• Body image may be affected after physical injury, depending on the severity of the injury and changes in physical form and functioning that may occur as a result of the injury.
• Self-identity is likely to be especially important for pre-professional and professional circassians. Being unable to engage in one’s chosen craft may negatively impact one’s self-identity and result in negative alterations in thoughts and mood. 
• Perfectionism can often be a motivating force, as it propels one to set high goals.
• Perceived external pressures (from peers, parents, coaches)
• Loss of financial opportunity can be a real problem for professional circassians who are unable to perform or teach due to physical injury. Additional stress from trying to live on a reduced budget and survive financially can cause significant anxiety and depression.
• Decreased contact with important sources of community and social support may occur.
• Social media

Depression

Everyone experiences sadness and periods of feeling down. However, when sadness persists and starts to interfere with habits and patterns of daily living, it can cross over to clinical depression and be hard to shake off.

• Persistent depressed mood (or irritability)
• Loss of interest in activities one used to enjoy
• Significant weight or appetite change (not trying)
• Insomnia or hypersomnia (see National Sleep Foundation’s guidelines for recommended amount of sleep by age group)
• Objective psychomotor agitation or retardation
• Daily fatigue or loss of energy
• Feelings of worthlessness, excessive/inappropriate guilt
• Indecisiveness or diminished ability to think or concentrate
• Recurrent thoughts of death

Stress-Related Conditions

Experiencing or witnessing a circus injury can sometimes be traumatic. Two common (and related) forms of stress-related psychological conditions can arise as a result of experiencing or witnessing a traumatic event. Symptoms of psychological distress associated with these conditions generally manifest in the form of:

1. Psychological intrusion (i.e., involuntary recollections, nightmares, dissociative flashbacks, intense distress, and/or marked physiological reactivity after traumatic reminders)
2. Avoidance of thoughts, places, memories associated with the traumatic event
3. Negative changes in mood and thoughts
4. Amplified arousal/reactivity associated with the event (e.g., irritability, aggressiveness, self-destructive/reckless behavior, hypervigilance, an exaggerated startle response, concentration problems, sleep disturbances)

The following table outlines the diagnostic criteria for both Acute Stress Disorder and Post-traumatic Stress Disorder (PTSD).

Addressing and Alleviating Psychological Distress After Injury

If you recognize the presence of any of the above psychological conditions or if you are experiencing distress and impairment, you might consider seeking support. The following section outlines how to select a mental health provider, as well as a range of interventions that will likely be helpful for addressing post-injury depression, anxiety, and PTSD.

Finding a Mental Health Therapist

Licensed mental health therapists include psychologists, clinical social workers, and marriage and family therapists.

Apart from your chosen mental health professional’s training background and occupational competence, it is extremely important that you trust and feel relationally connected to them. Your chosen clinician should ideally work respectfully and collaboratively with you to understand your situation and identify treatment goals.

Top Down Interventions

The most common contemporary interventions for relieving psychological distress are based in changing cognitions (i.e., thoughts) and behaviors that cause distress and life impairment. Without delving too deeply into the neuroscience of things, such interventions can be classified as “top down” because engaging in the realm of thoughts and behaviors generally requires some level of executive functioning that is typically regulated by the topmost layer of our brain – the prefrontal cortex (PFC).

Cognitive Behavioral Therapy (CBT) Is one of the most well-known and -supported forms of cognitive-behavioral intervention. It is grounded in the concept of the cognitive triangle: that emotions, thoughts, and behaviors are interrelated. Thus, altering the trajectory in one of these three domains can help to shift an individual’s psychological trajectory away from distress and impairment. CBT improves an individual’s mood via:

• Behavioral Activation
  • Monitoring daily activities
    • Be sure to maintain regularity of 
  • Scheduling pleasurable activities and activities that boost sense of mastery
• Identification and correction of thought distortions
  • Thought monitoring
  • Generating alternative thoughts

Acceptance and Commitment Therapy (ACT) is a cognitive-behavioral intervention that aims to create psychological flexibility and relieve distress by helping the individual:

• Recognize and accept rather than correct distorted thoughts
• Recognize and defuse themselves from “sticky” thoughts
• Commit to action in service of the individual’s identified values

Mindful awareness meditation is often used in ACT to increase an individual’s ability to recognize their internal states (i.e., thoughts and feelings).

Bottom Up Interventions

While top down interventions often work very effectively to relieve distress from negative mood and patterns of thought, they can sometimes fail to work when an individual is severely distressed (and thus responding primarily from the more reactive or primitive parts of the brain, such as the limbic system/diencephalon or the brain stem).

Resources for Learning More About Mental Health

Suicide Prevention

Thoughts of suicide can be a natural and common occurrence during times of stress. It is important to note that thoughts and feelings are just that – thoughts and feelings. While the 

• Common Myths Debunked
  • Talking about suicide will NOT encourage someone to kill themselves. It provides the opportunity for dialogue that may help.
  • Talking about suicide DOES NOT mean that the individual won’t kill themself. It is still important to continue dialogue and watching out for other signs.
  • Suicidal thoughts and feelings can occur to ANYONE. It doesn’t only affect folx who are depressed or who show signs of being down.
• What To Do
  • Take all implications and indications of suicide seriously.
  • Seek help from an adult (or an adultier adult). Most often, this chain ends with connecting the individual with a mental health professional trained to handle issues relating to suicidal thoughts and plans.
  • For emergent situations:
    • Call a suicide prevention hotline
      • National Suicide Prevention Lifeline 24/7 at 1-800-273-8255
      • Crisis Text Line 24/7 by texting “START” to 741-741
    • Call the local psychiatric mobile response unit
    • Bring the individual to the local psychiatric emergency room or call 911
• Resources
  • To Write With Love On Her Arms https://twloha.com/find-help/

Support From the Sidelines

If you have a friend or family member who has been physically injured, you can support their mental wellness with some of the following suggestions.

• Provide reassurance to the individual about their worth, ability, and identity
• Offer to join the individual in completing their rehab exercises
• Invite the individual to social gatherings outside of training and circus-related events

Back to ACE MAG 2019: ISSUE 2, VOL. 15