General

Brain Game Video

 

 

Thanks for taking the time to view our video. How did you get on?

Interpreting Your Results

The video is based on a real Cognitive test called The Stroop Test. This is named after J. R. Stroop, who first published the effect in 1935. Within our version a larger range of colours are used and it is presented in a different format via the video.

The test is normally used to assess the Executive functions, which are a range of complex abilities, such as multi-tasking, planning, impulse control, flexible thinking and organisation. The area of the brain commonly linked to executive functions is the Frontal Lobes.

In the case of this test, the key skills are inhibition, attention and processing speed. During trial three, when you are asked to read the colour of the word, this is measuring your ability to inhibit that learned response of reading the actual word.

Next Steps

If you enjoyed the video please share it with your friends and see how they get on.

If you would like to learn more about Alba Psychology and how we apply the testing of cognitive function in practice, please click on our information video below:

 

Effort testing – Worth the effort? (Part 1 of 3)

Every neuropsychological assessment should include a test of effort?

Dr Fraser Morrison, Clinical Director, Alba Psychology

Part one

The purpose of a neuropsychological assessment is to assess the level of cognitive functioning in an individual, ordinarily within the context of identifying a neuropsychological deficit. A neuropsychological assessment can comprise of a number of assessment methods including clinical judgement, feedback from significant others and cognitive testing (Hebben & Milberg, 2002). The assessment process is used with the assumption that it will improve the understanding of an individual’s neuropsychological functioning and offer an explanation for the observed deficit and behavioural presentation of brain dysfunction (British Psychological Society, 2009).

 

Within the context of a Personal Injury Claim, neuropsychological assessments are used ordinarily in cases that involve brain injury, possibly as a result of an incident such as Road Traffic Accident. Other cases involving potential negligence such as medical procedures or industrial accidents that have led to cognitive impairment can also necessitate the use of a neuropsychological assessment.

 

As is the case with any assessment, it is crucial that the process is based on valid and relevant pieces of information. In the context of cognitive testing a basic assumption of testing principles is that an individual will attempt to perform at their best level, or with maximum effort. If they do not then it would categorise an assessment as an inaccurate measure of cognitive abilities. In the case of cognitive testing, one assumes that test scores will reflect test performance, which in turn offers an accurate reflection of neuropsychological domains of functioning. If, for whatever reason, performance in cognitive testing is deemed to be an inaccurate reflection of actual neuropsychological functioning then the assessment process is worthless. Thus the accuracy of test performance must be examined to ensure this is reflective of actual neuropsychological functioning.

 

In order to determine whether neuropsychological test results are valid there must be evidence that clinical presentation during testing in consistent with an individual’s history. It is equally important that the observed pattern of results fit with a model of disease or neuropsychological disorder (Lezak et al., 2004). In examples where this is not the case it offers evidence that an individual may be performing at a level below their optimum performance and implies that the assessment process and test results have questionable validity.

 

Part two to follow next week……….

Coping with Panic Attacks – 1 of 2

Symptoms of anxiety are common following major life event such as a brain injury. This can sometimes result in a panic attack. The following methods can be used to help.

 

COPING WITH A PANIC ATTACK

 

During a panic attack you are extremely likely to breathe very fast and/or deeply.  This will have the effect of reducing the amount of carbon dioxide you have in your lungs which  in turn will create a lot of unpleasant body sensations which are likely to make you more afraid.  A vicious circle of fear leading to over breathing which leads to unpleasant body sensations (tingling, headaches, racing heart, flushes, nausea, chest pain, etc.) which cause more fear which leads again to over breathing,, gets established.  To stop this very nasty process you have to raise the carbon dioxide amount in your lungs.  You can do this in two ways:

 

A)   If you have a paper bag handy hold it tight over your nose and mouth so that no air can get into your lungs from outside the bag and breathe the air in the bag for several minutes until you calm down.

 

B)   If a bag is not handy or it would be embarrassing to use one (say in a supermarket) then you should change your breathing so you breathe in less air in a given period of time.  You can probably do this most easily by slowing down your breathing in small steps.  Attempt to breathe in smoothly and slowly and to let your breathe out just as slowly.  As you slow your breathing down you are bound to increase the depth of each breath.  However, try to avoid a very big increase in depth because that would undo the good work you have done by slowing down.  The ideal you are aiming for is SMOOTH, SLOW, REGULAR and fairly shallow breathing.  If you have managed to slow down for a few seconds but feel out of breath* and a stronger urge to take a quick gulp,  DON’T.  Resist it by swallowing a couple of times, that should get rid of the urge;  if it doesn’t then go ahead, take a gulp BUT once you’ve let the air in HOLD IT in for about 5 seconds and then let it out SLOWLY.  If you can hold a gulp for a few seconds you prevent it from lowering the carbon dioxide level.

 

To sum up, breathe in and out as slowly and evenly as you can and avoid any big increase in depth as you do so.

TO HELP YOURSELF SLOW DOWN YOUR BREATHING YOU COULD:

 

Count to yourself while breathing.  To start off with you might say “one thousand” to your self while breathing in and “two thousand” while breathing out so your breathing would be:

 

IN                     OUT                        IN

 

“one thousand”     “two thousand”      “one thousand”    etc.

 

and soon you might be able to say more to yourself while breathing in and out and so take longer to do it.

 

For example,

 

IN                                                 OUT

 

“one thousand, two                       “three thousand,  four

thousand”                                     thousand”

 

 

*  The feeling of being out of breath that people sometimes get when anxious is paradoxically often caused by breathing too much air.  Taking in less air for a little while will often make it go away.  We don’t know why some people become breathless after over breathing but it is a well established fact that they do.

Improving Social Skills in Brain Injury

Following brain injury it can be common to find it difficult to interact with others socially. Here are some tips to making those situations easier

You can learn how to start a conversation and converse with anybody, anytime.

 

1. In order to make interesting conversation, you must be interesting to others. Keeping yourself informed on current events, staying involved in activities, and keeping a mental list of good topics of discussion are excellent ways to break the ice. And a great tool to help you learn how to start a conversation with almost anybody.

 

2. Instead of focusing on how uncomfortable you feel, prepare yourself by thinking of the issues that interest you most and what you would like to discuss about a particular subject.

A little preparation will go a long way in enabling you to easily converse with others. Don’t be afraid to ask questions.

In general, people like to talk about themselves and will respond favourably when asked simple, friendly questions. Learning how to start a conversation is not quite as difficult if you prepare in advance.

 

3. Make an effort to be a good listener when starting a conversation. After you make the initial effort, listen closely to the other person’s response.

Often you’ll find an invitation to continue the conversation if you listen carefully and respond accordingly. Balance is the key in any conversation.

Alternate between talking and listening to what the other person is saying and make additional comments as appropriate.

Learning how to start a conversation is really just using good manners and showing a genuine interest in others.

 

4. Even if you find it extremely difficult, always greet those you encounter with a smile and look them directly in the eye.

It may be hard at first, but self-confidence is a learned skill and by acting confidently, you will gain new self-confidence.

Soon enough you will notice that it is not as hard to maintain eye contact and carry on a conversation. Act confidently and you will eventually become confident.

Developing self-confidence is an important part of learning how to start a conversation.

5. Try to remember small details about co-workers and acquaintances. Asking about a weekend plan or a relative is an excellent way to start a conversation and show genuine interest in those around you.

If you are interesting, attentive, and act with confidence you will appear to be the kind of person people like to have as a friend.

By practicing these new skills until they become second nature, you will increase your own self-esteem and learn how to start a conversation easily.

Learning how to start a conversation is really just a process of practicing your social skills until they become a habit.

Repetition and determination are the most important factors in building your level of confidence and conversing effortlessly in any situation.

 

 

If you need to improve your conversational skills, here are a few tips that can help you enhance your conversational skills and boost your image.

 

1. Always say what you think, not what you think others want you to say. Especially in a professional setting, learning to express your views and ideas in a positive, non-threatening manner will invite reactions and responses.

Effective leaders always say what they are thinking and express their ideas freely. Having the courage to speak your mind as well as listening openly to the views and ideas of others is a sure way to earn the respect and admiration of all those you encounter.

 

2. Listen carefully to what others are saying. People often interpret things said by others in a way that clouds their ability to hear what people are intending to say.

By giving your full attention to the speaker, you can hear what they intend for you to hear instead of what you want to hear.

The art of conversation includes the ability to listen to others as well as the ability to speak effectively.

 

3. Always assume that a speaker is saying exactly what they mean to say. Even if it seems unclear, try to find meaning and coherence to the words they are saying and give them the respect of hearing what they want you to hear.

In any conversation, the ability to give respect is just as important as receiving it. The art of conversation is a give and take between parties, not one speaker and one listener.

 

4. Any conversation can be broken down into three parts.

The first part is small talk. Small talk is dictated by social rules and includes polite greetings, inquiries about the well-being of others, etc.

Stage two is the end of the small talk and moving on to the purpose of the conversation such as business, the sharing of opinions and personal views.

Without the ability to express yourself efficiently, the conversation can easily slip back into small talk, lessening the chances of accomplishing the initial goal of the conversation.

The third part of a conversation is where the various ideas and views expressed can be merged into a satisfying end for all parties involved in the conversation.

The art of conversation is a learned skill that is common among successful, energetic people. If you are unable to effectively express yourself in any situation, you will likely find that you do not attract the attention and command the respect that is bestowed upon some others.

People who talk freely and easily with others usually find more professional and personal fulfilment than those who are introverted and silent.

If you want to improve your professional and social standing, learn to communicate efficiently and in a positive manner.

You will notice a dramatic difference in the way other people perceive you if you demonstrate self-confidence and project a friendly, informed image.

 

 

CHALLENGES TO UPSETTING THOUGHTS USING CBT IN BRAIN INJURY

When adjusting to a head injury it can be common to experience low mood or depression. An effective way to manage this is using principles of Cognitive Behavioural Therapy to “challenge thoughts”.

 

  • What is the evidence ?

            What evidence do I have to support my thoughts ?

What evidence do I have against them ?

 

  • What alternative views are there ?

How would someone else view this situation ?

How would I have viewed this situation in the past ?

 

  • What is the effect of thinking the way I do ?

Does it help me, or hinder me from getting what I want ?  How ?

 

  • What thinking error am I making ?

(a)   Am I thinking in all-or-nothing terms

ignoring the middle ground ?

 

            (b)   Am I catastrophizing

overestimating the chances of disaster ?

 

(c)   Am I personalizing

blaming myself for something which is not my fault ?

 

(d)   Am I focusing on the negative

looking on the dark side; ignoring my strengths ?

 

(e)   Am I jumping to conclusions

predicting the future and mind-reading ?

 

            (f)   Am I living by fixed rules

fretting about how things ought to be; overusing the words

                  should, must and can’t ?

 

  • What action can I take ?

What can I do to change my situation ?

Am I overlooking solutions to problems on the assumption they

won’t work ?

Managing Anger – Self Statements

Anger issues can be common following head injury. Have a look at the following statements that may help with this initially.

For further help please contact Alba Psychology.

ANGER MANAGEMENT  – COPING  SELF-STATEMENTS

Following brain injury it is common to experience difficulties with mood regulation or anger. A useful way of coping with these is the use of “self talk” or “self statements” which can be used to review your behaviour following a situation.

PREPARING FOR A PROVOCATION

This could be a rough situation, but I know how to deal with it.

I can work on a plan to handle this.

Easy does it.

Remember, stick to the issues and don’t take it personally.

There won’t be any need for an argument.

I know what to do.

IMPACT AND CONFRONTATION

As long as I keep my cool, I’m in control of the situation.

You don’t need to prove yourself.

Don’t make more of this than you have to.

There is no point in getting angry.

Think of what you have to do.

Look for the positives and don’t jump to conclusions.

COPING WITH AROUSAL

Muscles are getting tight, relax and slow things down.

Time to take a deep breath, let’s take the issue point by point.

My anger is a signal of what I need to do.

Time for problem solving.

He probably wants me to get angry, but I’m going to deal with this constructively.

SUBSEQUENT REFLECTION

A.  Conflict unresolved

Forget about the aggravation.

Thinking about it only makes me upset, try to shake it off.

Don’t let it interfere with your job.

Remember relaxation.

Don’t take it personally.

It’s probably not so serious.

B.  Conflict resolved

I handled that one pretty well.

That’s doing a good job.

I could have become more upset than it was worth.

My pride can get me into trouble, but I’m getting better at this all the time.

I actually got through that without getting angry.

Cognitive Impairment, Substances and Ability to Drive

The current guidelines provided by the DVLA suggest you should not drive for a period of time if you have a neurological condition, such as brain injury, that impairs your cognitive function. This applies to cognitive impairment associated to substance use, however, how do substances impact on your cognitive function in terms of ability to drive? The evidence in this area is not clear however some useful guidance is provided by USA – National Highway Traffic Safety Administration, and is discussed below.

 Methadone

In individuals receiving 35-85 mg methadone daily, significant impairment was measured on attention, perception and learning tasks but there was no reaction time deficit. In individuals receiving a daily average of 63 mg methadone, significant impairment in distance perception, attention span and time perception was observed. No significant adverse effects were measured with addicts stabilized for at least 1 year on daily oral doses of methadone

Cannabis

The short term effects of marijuana use include problems with memory and learning, distorted perception, difficultly in thinking and problem-solving, and loss of coordination. Heavy users may have increased difficulty sustaining attention, shifting attention to meet the demands of changes in the environment, and in registering, processing and using information. In general, laboratory performance studies indicate that sensory functions are not highly impaired, but perceptual functions are significantly affected. The ability to concentrate and maintain attention are decreased during marijuana use, and impairment of hand-eye coordination is dose-related over a wide range of dosages.Impairment in retention time and tracking, subjective sleepiness, distortion of time and distance, vigilance, and loss of coordination in divided attention tasks have been reported. Note however, that subjects can often “pull themselves together” to concentrate on simple tasks for brief periods of time. Significant performance impairments are usually observed for at least 1-2 hours following marijuana use, and residual effects have been reported up to 24 hours.

 

Heroin

Performance Effects: Laboratory studies have shown that morphine may cause sedation and significant psychomotor impairment for up to 4 hours following a single dose in normal individuals. Early effects may include slowed reaction time, depressed consciousness, sleepiness, and poor performance on divided attention and psychomotor tasks. Late effects may include inattentiveness, slowed reaction time, greater error rate in tests, poor concentration, distractibility, fatigue, and poor performance in psychomotor tests. Subjective feelings of sedation, sluggishness, fatigue, intoxication, and body sway have also been reported. Significant tolerance may develop making effects less pronounced in long-term users for the same dose. In a laboratory setting, heroin produced subjective feelings of sedation for up to 5-6 hours and slowed reaction times up to 4 hours, in former narcotic addicts. Euphoria and elation could also play a role on perception of risks and alteration of behaviors.

Effects on Driving: The drug manufacturer states that morphine may impair the mental and/or physical abilities needed to perform potentially hazardous activities such as driving a car, and individuals must be cautioned accordingly. Driving ability in cancer individuals receiving long-term morphine analgesia (mean 209 mg daily) was considered not to be impaired by the sedative effects of morphine to an extent that accidents might occur. There were no significant differences between the morphine treated cancer individuals and a control group in vigilance, concentration, motor reactions, or divided attention. A small but significant slowing of reaction time was observed at 3 hours. In several driving under the influence case reports, where the subjects tested positive for morphine and/or 6-acetylmorphine, observations included slow driving, weaving, poor vehicle control, poor coordination, slow response to stimuli, delayed reactions, difficultly in following instructions, and falling asleep at the wheel.

Diazepam

Performance Effects: Laboratory studies have shown that single doses of diazepam (5-20 mg) are capable of causing significant performance decrements, with maximal effect occurring at approximately 2 hour post dose, and lasting up to at least 3-4 hours. Decreases in divided attention, increases in lane travel, slowed reaction time (auditory and visual), increased braking time, decreased eye-hand coordination, and impairment of tracking, vigilance, information retrieval, psychomotor and cognitive skills have been recorded. Lengthened reaction times have been observed up to 9.5 hours post dose. Lethargy and fatigue are common, and diazepam increases subjective perceptions of sedation. Such performance effects are likely to be exacerbated in the elderly. In drug users, diazepam has greater behavioral changes, including subjects’ rating of liking and decrements in psychomotor and cognitive performance. Reduced concentration, impaired speech patterns and content, and amnesia can also be produced, and diazepam may produce some effects that may last for days. Laboratory studies testing the effect of ethanol on subjects already using benzodiazepines demonstrate further increases in impairment of psychomotor and other driving skills, compared to either drug alone.

Effects on Driving: The drug manufacturer suggests individuals treated with diazepam be cautioned against engaging in hazardous occupations requiring complete mental alertness such as driving a motor vehicle. Simulator and driving studies have shown that diazepam produces significant driving impairment over multiple doses. Single doses of diazepam can increase lateral deviation of lane control, reduce reaction times, reduce ability to perform multiple tasks, decrease attention, adversely effect memory and cognition, and increase the effects of fatigue. Significant impairment is further increased when diazepam is combined with low concentrations of alcohol (0.05 g/100 mL). A number of epidemiological studies have been conducted to evaluate the risk of crashes associated with the use of diazepam and other benzodiazepines. These show a range of relative risk, but most demonstrate increases in risk compared to drug free drivers. These increases have been twice to several fold. The elderly may have an increased risk of a motor vehicle crash.

Amphetamine

Performance Effects: Laboratory studies have been limited to much lower doses than those used by methamphetamine abusers. Doses of 10-30 mg methamphetamine have shown to improve reaction time, relief fatigue, improve cognitive function testing, increase subjective feelings of alertness, increase time estimation, and increase euphoria. However, subjects were willing to make more high-risk choices. The majority of laboratory tests were administered 1 hour post dose. Expected performance effects following higher doses may include agitation, inability to focus attention on divided attention tasks, inattention, restlessness, motor excitation, increased reaction time, and time distortion, depressed reflexes, poor balance and coordination, and inability to follow directions.

Effects on Driving: The drug manufacturer states that individuals should be informed that methamphetamine and amphetamine may impair the ability to engage in potentially hazardous activities such as driving a motor vehicle. In epidemiology studies drive-off-the-road type accidents, high speed, failing to stop, diminished divided attention, inattentive driving, impatience, and high risk driving have been reported. Significant impairment of driving performance would also be expected during drug withdrawal. In a recent review of 101 driving under the influence cases, where methamphetamine was the only drug detected, blood concentrations ranged from <0.05-2.36 mg/L (mean 0.35 mg/L, median 0.23 mg/L). Driving and driver behaviors included speeding, lane travel, erratic driving, accidents, nervousness, rapid and non-stop speech, unintelligible speech, disorientation, agitation, staggering and awkward movements, irrational or violent behavior, and unconsciousness. Impairment was attributed to distraction, disorientation, motor excitation, hyperactive reflexes, general cognitive impairment, or withdrawal, fatigue and hypersomnolence.

Customer Service Survey 2014

Alba Psychology recently carried out a survey with all instructing solicitors over the past year. The results are very interesting and are described below.

Q1. How satisfied were you with the quality of the report Alba Psychology provided?

66% of respondents said they were “Very Satisfied”

16% of respondents said they were “Extremely Satisfied”

Q2. How satisfied were you with the turnaround time of the report?

53% of respondents said they were “Very Satisfied”

18% of respondents said they were “Extremely Satisfied”

Q3. How satisfied were you with the usefulness of the report provided?

68% of respondents said they were “Very Satisfied”

14% of respondents said they were “Extremely Satisfied”

Q4. How satisfied were you with the level of communication provided by Alba Psychology?

 75% of respondents said they were “Very Satisfied”

15% of respondents said they were “Extremely Satisfied”

Overall the results look extremely positive in terms of our performance over 2013 however we will endeavor to improve the performance of Alba Psychology in 2014.

Please do not hesitate to contact us if you have anything you wish to feedback about your experience with Alba Psychology.

Best wishes,

Fraser

Dr Fraser Morrison

Clinical Director, Alba Psychology

Managing Sleep Problems

Sleep difficulties can be common following brain injury. The following blog offers some self-help tips for this area.

Establish a regular waking time

Establishing a regular sleep–wake pattern is very important, especially waking up at the same time each morning. The time that you wake helps to set (or synchronise) all of your body’s circadian rhythms. In fact, you should try not to vary the time of day that you get up by more than one hour, even across the weekends. In particular, avoid laying in bed until 12 noon on the weekend if you get up at 6 o’clock each weekday morning for work.

Establish a proper sleep environment

1. Comfort

The discomfort caused by a rumbling stomach, persistent aches and pains, or being too hot or cold, can prevent you from relaxing enough to fall asleep. Therefore, it is necessary that all your immediate needs have been met before you try to sleep. If you are hungry, have a light snack or a warm milk drink (caffeine-free) before you go to bed. If you are in pain, take a mild pain reliever. It is much easier to sleep if you are comfortable.

2. Noise

Noise during the night (such as traffic) is another common source of sleep disturbance. Even if you do not awaken and cannot remember the noises the next day, the noises can interfere with your normal sleep pattern. If you sleep in a place that tends to be noisy, try to shut out sound by closing windows and doors, wearing earplugs, or sound-proofing the room. Even if you think that you cannot fall sleep without a radio or television in the background, remember that this noise will disrupt your sleep during the night. A clock radio that will automatically turn itself off may be useful.

3. Light

A light room will make it more difficult for you to sleep. Therefore, if you have trouble sleeping, it will be helpful to darken the room before going to bed and to ensure that the morning light does not wake you up in the morning. If you have a tendency to oversleep, it may be helpful to allow the light to enter the bedroom in the morning.

Allow a wind-down time before sleep

Make sure that you stop work at least 30 minutes before you go to bed and do something different and non-stressful, such as reading, watching television, or listening to music.

Use your bed only for sleep

Your bedroom should only be used for sleep, and of course sexual activity (which may help you to sleep). Activities such as eating, working, watching television, reading, drinking, arguing, or discussing the days problems should be done elsewhere, because their associated arousal may interfere with you getting to sleep. These activities also make you associate your bed with wakefulness and alertness rather than drowsiness and sleep onset. It may be useful to remove all objects in your bedroom that are not associated with sleep.

Do not stay in bed when you are not asleep

If you have been having problems falling asleep, only go to bed when you are sleepy. If you do not fall asleep in about 10 minutes, get up and go to another room. Stay up until sleepy and only then return to your bed to sleep. If you return to bed and still cannot sleep, repeat the preceding instruction. Do this as often as is necessary to fall asleep in 10 minutes.

Coping with worry and anxiety

One of the most common causes of sleep disturbance is anxiety. Many people find it difficult to wind down when they climb into bed at night after a hectic day. Often this is the first chance they have had to think about things that are concerning them. People can find themselves lying in bed worrying about their problems when they would really rather be asleep. The feelings of tension and arousal that accompany these thoughts make it more difficult to fall asleep; therefore, these individuals also begin to worry about their sleeplessness as well as their other problems. They may end up tossing and turning well into the night. If you think you are having trouble sleeping because you are anxious about things that are happening in your life, there are two things you can do to improve your sleep.

1. Set aside time for problem solving during the day

Bed is not the place for thinking about things that distress you. If you do not normally find time during the day for thinking about things that are happening in your life then you need to set aside a time each day to do so. It should be a time when you are alone. Try to think of ways to resolve your problems. Usually this will require you to make decisions, some of which may be difficult because they concern important features of your life such as family and work. However, putting off stressful decisions only extends your feelings of anxiety. In most cases, the uncertainty that accompanies difficult decisions is much more stressful and unpleasant than living with the outcome of the decision once the decision is made. Talk to your health worker if you would like more information about useful problem solving techniques.

 

2. Learn to relax

Learning ways to relax can help sleep problems. There are many relaxation techniques. Here, we will give you a breathing relaxation technique from which you will benefit:

 

  • Breathe in slowly to the count of three seconds.
  • When you get to three, slowly breathe out to the count of three seconds.
  • Pause for three seconds before breathing in again
  • After five minutes or so, say the word ‘relax’ to yourself as you breathe out
  • Breathe in using your abdomen (not your chest) and through your nose
  • Practise five to ten minutes at night in a comfortable chair
  • Keep in mind that the benefits of relaxation will not occur unless you practise
  • Do not try hard to relax or to sleep; just carry out the exercise.

3. Get out of bed

If you find yourself unable to stop worrying about things when you are in bed, get up and do something that is distracting yet relaxing, like knitting, listening to music, or reading a book. You may even want to listen to a relaxation tape. Do not return to bed until you feel sleepy again. When you do go back to bed, if you find that you are still worried and sleepless, get out of bed again and do something relaxing (as above) until you are sleepy enough to return to bed once more. At first, you may find you need to get out of bed a number of times before you are finally able to fall asleep. The important thing is that you will learn to associate your bed with sleep and not with worry.

Avoid napping during the day

It is not uncommon for people who have had a particularly bad night’s sleep to feel sleepy the next day. This daytime sleepiness can make it very tempting for you to take a nap in the middle of the day or early afternoon. However, if you have insomnia and nap in the afternoon, you make it much more likely that you will have another night of poor sleep. This is because when it comes to time for bed you will be less tired and will need less sleep because you have slept during the day. You will probably take longer to fall asleep and you will awaken more frequently during the night. The next day you are likely to feel sleepy again and will be tempted to have another daytime nap.

As you can see, this pattern of napping soon becomes a vicious cycle that makes your original sleeping problem even worse. If you have insomnia, no matter how tired you are during the day, try to avoid daytime naps (unless you are doing shift work). Stick to regular sleep times by going to bed at the same time every night and waking up at the same time every morning. If you cannot get to sleep until later than your normal sleep time, do not sleep late the next morning — get up at your normal waking time. By following these instructions, you will help to ensure that your natural body rhythm works with you, helping you to sleep at the times you want to sleep.

Avoid caffeine

This drug is found in coffee, tea, cocoa, cola drinks, as well as some over the counter medications. Consuming caffeine before bedtime, or drinking too much caffeine during the day will increase feelings of energy and wakefulness and make it more difficult for you to fall asleep. Any caffeine consumed after about 4 pm will still have an effect by the time you go to bed.

 

Sometimes individuals get into a pattern of drinking too much caffeine during the day, sleeping badly at night time, and then consuming even larger quantities of caffeine the following day to help ward off sleepiness. Such behaviour sets up a vicious cycle, which is to be avoided wherever possible. Some helpful suggestions about caffeine are provided below:

  • limit caffeine intake
  • avoid drinking caffeine after about 4pm
  • avoid using caffeine as a means of staying awake.

Avoid nicotine

Nicotine stimulates the nervous system by releasing a hormone called ‘adrenaline’. Adrenaline acts to arouse the body and mind, making you alert and ready for action. Your body normally releases small doses of adrenaline throughout the day and large doses when you are faced with something challenging or threatening. Therefore, smoking prior to bedtime causes adrenaline to be released, thereby increasing energy and liveliness at the very time when you want to be relaxed and ready for sleep. If you are a smoker and you normally have trouble getting to sleep at night, it is best that you do not smoke for at least an hour before going to bed (preferably an hour and a half), since this is the length of time it takes for the stimulating effects of nicotine to wear off. Furthermore, if you wake up during the night and cannot go back to sleep, try not to smoke because the nicotine will make the sleeplessness worse.

Avoid excessive alcohol

A popular belief about alcohol is that alcohol will help you sleep if you are uptight and anxious. One or two glasses of wine or beer in the evening may help you to relax, but regularly having several drinks in the evening causes you to get much poorer sleep overall. As the alcohol in your system is broken down by your body, you tend to awaken more frequently and you spend less time in the deeper stages of sleep. If you drink regularly, you may find that you come to depend on the alcohol to reduce your anxiety and help you get to sleep. Not only will alcohol leave you feeling unrefreshed the next morning (because you are robbed of better quality sleep), but you are likely to have rebound anxiety which will last throughout the day and make it even more difficult to sleep at night. Alcohol is not the solution to sleeping problems so do not drink before you go to bed.

Avoid sleeping pills

The use of sleeping pills (sedative hypnotics) for any length of time causes as many problems as it solves. While sedative hypnotics will help you fall asleep and will decrease your anxiety in the short term, these benefits will disappear in the long term if you continue to use the sedatives regularly. That is, you will begin to feel anxious and sleepless even though you are taking the pills. When this happens you will be tempted to take more sleeping pills since doing so will bring back the benefits of the drug. Unfortunately, however, these benefits will not be permanent either so that after a time you again experience the unwanted symptoms of anxiety and sleeplessness. The process that makes you less sensitive to the benefits of the drug over time is called tolerance. While sleeping pills are useful for overcoming temporary sleep loss, the development of tolerance means that these drugs do not provide a long-term solution to sleeping problems.

Continual use of sleeping pills also has the disadvantage that you will find it extremely difficult to give up the drugs because doing so will cause you to experience withdrawal effects. The levels of anxiety and sleeplessness that you experience after stopping the drug are likely to be greater than the anxiety and sleeplessness that made you start using the drug. Coming off sleeping pills can also cause you to have vivid dreams and nightmares. These dreams are often highly emotional and disturbing.

If you do not use sleeping pills, or use them only occasionally, take heed of these warnings and do not start using them regularly. If you do use sleeping pills every night to help you sleep, it is recommended that you talk to your family doctor about reducing your intake of sleeping pills over time until you can stop using the pills altogether. Your doctor can help you come off the sleeping pills slowly without causing too many unpleasant side effects. Do not stop taking your sleeping pills without first talking to your doctor.

Take a late snack

A light bedtime snack, such as a warm glass of milk or a banana, will help some people get to sleep. These foods are high in an amino acid called tryptophan, which is thought to be involved in the biochemical systems that induce and maintain sleep. If nothing else, the snack will prevent you from getting hungry during the night.

Don’t exercise before going to bed

Avoid exercise in the three hours before you go to bed, otherwise you may still be too aroused following the exercise to be able to fall asleep.

Coping with crying babies

Young babies need frequent feeding and nappy-changing, therefore they tend to wake up often during the night. Moreover, a baby’s sleep cycle is much shorter than an adult’s sleep cycle. A baby usually has a 50-minute sleep cycle and tends to have about two to four cycles per sleep period. Therefore, babies tend to awaken much more frequently than adults who have a 90 minute sleep cycle and experience about 5 to 6 cycles per sleep period.

If you have a young baby to look after, there are a number of things that may help to reduce the extent of the baby’s crying. When a baby cries during the night, he/she usually wants food, or to be comforted. Trying to discipline a young baby by yelling at or ignoring a baby does not usually work. Many parents find it better to give the baby plenty of cuddles and kisses so that the baby quietens down and goes back to sleep feeling safe and secure. Moreover, it may help if you alter the baby’s feeding time so that the baby is fed immediately before you go to bed rather than, say, two hours later. This way, you may not have to get up as often during the night. These suggestions do not always work, but take heart — babies do grow up and one day they will actually sleep undisturbed all night long!

Summary of good sleep habits

1.   Go to bed when you are sleepy and get up at the same time every morning. Do not sleep late in the mornings trying to make up for ‘lost sleep’ and, if you think you have insomnia, do not take naps during the day.

2.   Set aside time for problem solving during the day, not last thing at night. Identify any problems that are causing you to be anxious and try to resolve these problems by making decisions.

3.   Do not lie in bed worrying for long periods of time. If you cannot sleep, get out of bed and do something that is distracting yet relaxing, such as knitting or listening to music. (It will be important to plan appropriate activities in advance.) Return to bed only when you feel sleepy again.

4.   Do not use alcohol to help you sleep.

5.   If you experience insomnia, avoid drinking caffeinated drinks after about 4 pm and do not drink more than two cups of caffeinated drinks each day.

6.   Do not smoke for at least an hour (preferably an hour and a half) before going to bed.

7.   Avoid sleeping pills: they do not provide a long-term solution to sleeping problems.

8.   If you sleep in a noisy place, try to reduce noise levels by closing windows and doors and wearing ear-plugs.

9.   Ensure the room is dark and that the morning light does not filter in. If you have a tendency to oversleep, it may be helpful to let the morning light enter the bedroom.

10.  Getting to sleep when you are comfortable is much easier than getting to sleep when you are hungry, cold, in some kind of physical pain, or when you need to go to the toilet. Make sure all your immediate needs have been met before you go to bed.

11.  Regular exercise during the day or early evening can improve sleeping patterns. Try to avoid exercise late in the evening as this may make it more difficult for you to get to sleep (with the exception of sex, which may help you to sleep).

12.  By doing the same thing every night before you go to bed you can improve your chances of falling asleep quickly. It is a good idea to develop a short routine involving things like washing your face and cleaning your teeth, which you can easily perform before going to bed at night. A hot bath for 20 minutes may also be helpful.

13.  Be aware of things in the environment that may interfere with your sleep. For example, pets can disturb your sleep if they become active during the night or if they prevent you from moving freely in the bed. Moreover, digital clocks can be distracting if they glow or flash. It is often helpful to face the clock in the opposite direction.

 

 

Assessment of Capacity using Neuropsychological Measures

Given the prevalence of cognitive deficits within brain injury the range of deficits an individual can experience has an important influence on their ability to make decisions in relation to daily activity. For example, an individual experiencing executive dysfunction may experience problems with abstract thinking and emotional regulation, which has clear implications for limited ability to engage in complex decision making such as personal care or financial management.

Cognitive impairment may have an impact on the individual’s awareness and understanding of their current circumstances. Furthermore this may have an impact on ability to understand and engage with therapeutic interventions.

A range of legislation exists in the UK that can be used to manage difficulties arising from cognitive impairment. Given the geographical anomalies within the law systems of the UK separate legislation exists in England and Wales, and Scotland:

The Mental Capacity Act (England and Wales)

Adults with Incapacity (Scotland) Act 2000

Adult Support and Protection (Scotland) Act 2007

A range of guidance is available for each of the aforementioned acts which is summarised here in terms of assessment. It is suggested the following areas are considered within assessment based around the Adults with Incapacity (Scotland) Act 2000; Perception, understanding, logical thinking, memory, motivation, planning, reasoning, suggestibility, emotional disorder, thought disorder and communication problems. All of these are included in a comprehensive neuropsychological assessment. Further to this the following points are:

  • Make sure the capacity question is specific
  • Consider evidence of impaired judgement prior to admission
  • Use vignettes to support exploration of the particular decision to be made

If you have a client that requires a capacity assessment please contact Alba Psychology.