Managing anxiety as an overuse injury

Physical overuse injuries such as repetitive strain injuries are caused by too much, too hard, too soon. They are difficult to diagnose and treatment is not always straightforward.  The basic principles of treatment are i) to protect and rest the injury to avoid secondary injury and to promote healing and ii) to rehabilitate the injury. Everybody has their own vulnerabilities that can predispose them to certain injuries and there are different patterns of injury according to factors such as age and gender and previous injury. However there are a range of steps that can be taken to avoid injury.These include avoiding too much, too hard, too soon and having good core stability, flexibility and using the correct posture.

I noticed that when I developed problems with anxiety that it was often associated with a change to my routine, and similarly when I developed physical overuse injuries I observed the same pattern. After working in the field of mental health I noticed that like myself most people suffering with anxiety and depression had suffered significant stress in their lives, often from being a child. These observations made me wonder if the same processes that are at play in these mental health issues were the same as in physical overuse injuries.

Both physical overuse injuries and anxiety are depression are difficult to diagnose and/or treat so maybe taking a fresh approach and treating these conditions as being in some cases ‘mental overuse injuries’ is surely a good thing. Often the approach to these mental health issues is very simplistic – CBT, relaxation therapy, counselling, medications – and though some people with mild problems benefit from these approaches, many others struggle on for many years battling these problems.

Maybe the approach to these mental health problems is fundamentally wrong. Maybe the approaches such as CBT etc. listed above are quick fixes and what is needed is a change of lifestyle which may include aspects of these approaches but which goes deeper and tries to tackle the underlying causes more effectively. I think there is a parallel here with trying to tackle being overweight in that you can try to tackle your weight problem by going on a crash diet, and maybe you will see some results from this but as soon as you stop the diet not only will your weight come back but you may even put on weight more easily.  Rather than following a crash diet you may need to change your lifestyle. In the same way with anxiety and depression maybe you will feel better in the short term after following one of the approaches listed above like CBT but if you don’t change things more fundamentally these approaches might even make you worse. It surely stands to reason that where anxiety and depression stem from ingrained patterns of thinking and feeling that were laid down in childhood, a quick course of CBT, hypnosis or counselling is unlikely to have a significant impact.

So what is the answer? I am suggesting that treating these problems more holistically – i.e. tackling each part of the problem – the mental, physical, psychological – through a change in lifestyle that also addresses the effects of a mental overuse injury. The mental overuse injury (MOI) is addressed through dealing with stress more effectively by applying  what is known to be effective in dealing with physical stress.  This probably involves a change of daily routine, and it is not an easy option.  Not that I am against easy options, and eventually no doubt there will eventually be more effective medicines and psychological approaches to treat these conditions, but the march of medicine and therapeutic psychology is proceeding at a slow pace currently in regard to anxiety and depression.

So now I am going to examine in a step by step way the similarities are between physical and mental overuse injuries and what this means in terms of how trauma based mental health issues such as anxiety and depression should be approached. (I do accept that there are some people who experience anxiety and depression who have not experienced trauma and that other factors may be at work in this complex area).

1) ‘Too much stress, too hard, too soon’

Too much…

Physical and mental stress is part of life. It is never possible to completely eliminate physical or mental stress. Every time we move and maybe every time we think or interact with other people, our bodies and minds will respectively experience stress. One way to reduce stress and to maintain functioning is to vary one stresses. In physical rehabilitation this involves perhaps cross training or if one is dealing with repetitive strain injury then it may involve alternating typing, writing or other physical activities. Maybe there are also ways that one can vary one’s mental stresses by simply having a variety of activities that one undertakes.

The first step may be to make a list of the psychological stresses that you experience in your life and see how with each stress it may be possible to build up in short breaks from the stress and then how it may be possible to vary the timing of the stresses so that you are not being exposed to one stress for too long a period.

One can reduce stress by making sure that one has sufficient rest time in terms of mental rest time. As with physical rest time this does not necessarily mean doing nothing because this in itself can be stressful, it just means doing things that one enjoys doing for most people this rest time will involve a combination of social activity, pursuing hobbies and ensuring that one has adequate sleep if that is possible.

It is recommended that to avoid too much physical stress when exercising it is better to have lots of small breaks rather than one big break for example whilst typing it is better to have lots of these micro-breaks rather than just one really long break. So possibly when one is experiencing mental stress it is better to have lots of small breaks rather than just one big break. In relation to holidays these should be factored into one’s schedule. Holidays themselves can be stressful but at least they involve a change, and  a change is as good as a rest. An alternative to the holiday is the ‘Staycation ‘ , offering you a time to catch up on things, see friends more and take things more easily.

Another approach is to ensure that wherever possible one deals with just one stress at a time. Sometimes this is difficult to avoid for example if you have to move to another city to take up a job then you are exposing yourself to 2 major life stressors in one go. However sometimes it is possible to organise things in such a way that one staggers one’s exposure to stressors. If you have no alternative but to for example move to another city to take up a job then it’s useful to visit the place where you’re going to work and where you will be living on a number of occasions to make them feel more familiar.

Please follow link to page about personality and stress and how one’s personality can predispose one to stress or reduce stress

The principle of having recovery time is important to mental health and as an individual you need to think about how you can build recovery time into your daily routine. Aim to have at least one thing you enjoy doing everyday and that you can look forward to. Try to slow down a bit.  If you know that a difficult situation is on the horizon, then plan something nice to do for afterwards.

Too soon…

Children who are exposed to too much stress may not be able to process what they are experiencing and this may predispose them to mental damage.  For example, when a child is neglected they can feel as if they are personally responsible for the neglect, maybe by rationalising it by thinking that they have done something to deserve the neglect or that it happened simply because they are in some way intrinsically bad. If the neglect continues then the repetition of the negative self-image can be a permanent feature of the way that the child and eventually the adult views themselves.  They can try to do things to compensate, but these things in themselves can lead to further pressure and stress. I think that the often life-long effects of stress on young minds shows a clear parallel with physical overuse injuries.  Children who over-exercise can cause themselves physical damage because their bodies are not mature enough to cope with above certain levels of physical stress and children who are exposed to too much mental stress experience mental damage because their minds are even more vulnerable to mental stress than adult minds that have more experience and tools to process stressful circumstances.

In the same way that it is good to build up physical stresses gradually, I think that it is wise to build up mental stresses gradually too. This may mean for example, not jumping into situations too quickly.  You can do this by breaking a new situation into component parts – for example when I started a new job I didn’t eat with the other staff at lunch time to start with, but left it a couple of months.  When I was a child living away from home I found it reassuring to have some of my own toys around me. Maybe just maximising the elements of familiarity in a new situation can be reassuring and can reduce the stress. If you are starting a new relationship just take things a little bit more gradually. It’s a bit like in sport where you warm up before playing, so try to find ways to warm up (and cool down) in new situations.

If you are changing your routine it may be wise to change it gradually. If you are changing one aspect of your life is better to focus on this one aspect rather than to change other aspects at the same time.

2) Everyone has their own vulnerabilities and limitations

This is as true for mental limitations as it is for physical limitations.  When these limitations are exceeded then problems will emerge.

3) Posture

Correct posture is an essential part of avoiding physical overuse injuries, however does this apply to avoiding mental injuries as well? I think it might do.  As described above, children who are neglected and abused can develop a negative self-perception which is akin to a poor mental posture that has similar harmful effects as a poor physical posture. This poor mental posture can, I believe, predispose one to stress because it makes social interactions more stressful and because one can try to compensate for this negative self-perception in such a way that one ‘over does’ something.  In my case, I think that I tried to compensate as a teenager by focusing too much on academic work which made me neglect my social development.

There are other ways that one can have a poor mental posture. One is by taking a negative approach to life or by worrying too much.  Both of these habitual patterns of thinking can result in more stress and an increased likelihood of developing a problem with anxiety or depression.  It seems probable to me that people who have been abused or neglected as children did not experience their needs as being met and thereby developed a habitual anxious state of my mind because of the insecurity that they experienced around their needs not being met.  Unfortunately this can carry over into adulthood and lead to anxiety or depression.  No doubt there are also some people who are just ‘born worriers’ as well, in the same way that some people are born with a skeleton that is not perfectly aligned and predisposes their body to not dealing as well with physical stress.

A third way in which I think one can have a poor mental posture is where one has a lack of social support.  Our physical posture is largely just one’s own, but because we are fundamentally social animals it is not possible to separate the individual psychology from the social context in which they are operating. To make this more specific, I mentioned earlier about how neglect and abuse can cause stress by damaging self-esteem.  People who have experienced neglect have also not experienced enough social support so the neglect has a doubly negative impact i.e. it effects the individual’s self-esteem and also how much social support they feel they have to deal with problems.

4) Previous injury can be a vulnerability to future injury

Having had a physical injury to a part of one’s body, can predispose one to have a further injury to that part. In the same way it seems likely to me that if one has had a mental injury or trauma, that this process makes it more likely that one will have further mental injury or trauma. As with physical injury this is probably because of a combination of tissues being weakened and the vulnerabilities and circumstances caused the initial injury being repeated.  I have found that the second time I have been injured is always worse than the first time.

5) There are a range of steps that can be taken to avoid injury.These include having good core stability, flexibility and using the correct posture and avoiding too much, too hard, too soon.

So how can these physical protective factors be applied to mental injury. Obviously I am using some licence here but I think the mental equivalent to core stability is some combination of good self esteem and social support. In regard to physical flexibility, I think it is possible to have mental flexibility too through, for example, adapting one’s expectations.

There are other ways that I think it is possible to build up mental resilience to stress.  I think one of the most important of his ways is to develop good communication skills because a great deal of mental stress is related to social stress and if one can learn how to communicate better one will be reducing one’s level of social stress.

6)  Physical overuse injuries creep up without any symptoms until a triggering event causes a noticeable symptom.  I think that the same process may be at work with mental overuse injuries.  What seemed to be the cause of anxiety symptoms may just be the triggering event. On this basis it seems likely to me that when you are doing things to help with the mental injury there will be an equal time lag where you do not feel better.  This is difficult because it can be tempting just to give up.  Most of the approaches to anxiety involve trying to get a quick result, and if I am correct in the logic that I have outlined, this may not be the right approach.  What may be required is a lot of patience, optimism and courage in sticking with an approach that reduces stress but may take a while to bear fruit. This is why I refer to the stress that precedes physical and mental overuse injuries as ‘silent stress’ because you might actually feel alright.  When I was doing loads of typing and sitting in a terrible posture with my feet up, I didn’t actually experience any discomfort.  However, one day – out of the blue apparently – I did begin to feel a lot of pain.