Ask HN: How to restore cognition after years of trauma? I feel slow and dumb
From impaired long-term and working memory, clarity of thought, mental agility, to executive function, it feels like the depression and anxiety caused by trauma have completely blunted my mind to a debilitating degree. Acquiring, integrating, and productively applying information is an enormous challenge. In meetings, I feel like a mental sloth. I've tried a variety of antidepressants, psychedelics, and supplements, to no avail. Talk therapy has done little.
Has anyone been able to cognitively recover?
96 comments
[ 2.6 ms ] story [ 175 ms ] threadSlowly you'll realize what's important, you'll find yourself. And you'll come back stronger than ever, with a different attitude towards careers, jobs and you'll learn to be human and just BE.
EDIT: YMMV, Not advocating for social isolation and complacency
I'm saying it's okay to not WORK for a living. You can work on hobbies, things that bring you joy, volunteer, but just not be on a 9-5 schedule and just chill for a while, to recover.
Definitely take time off, but impose a limit on how long you are completely aimless for, or without feedback that you're growing in some way.
If today all you could do was: Brush your teeth then go back to bed. You've accomplished.
We are not PRODUCTIVITY MACHINES. We are humans, just like birds are birding, squirrels are squirreling, bees are beeing?
I'm not saying to stay complacent, but we humans in this current society have set ourselves for failures.
OMG! I'm not making 250k a year, i'm a failure, I don't have a TRILLION dollar startup, I'm a failure (not saying you feel this way) but you get my point.
I struggle with this thinking. My job is nothing glorious -- boring, plain SWE state government work. I feel unvalued and unchallenged, but I also do not feel confident enough in my abilities to make any meaningful changes. What if I leave and/or and can't find anything? What if I find something and cannot perform well enough to keep it?
I feel like I am not "ready" to leave because I need to gain more valuable skills and knowledge, and I won't get it at my current position (Gov isn't really known for being up to date or using highly valuable tech stacks). I know I could probably accomplish more if I buckled down and put in the work, but I just don't have the mental energy or drive to do so for some reason.
But what if I do land some killer gig? Will I finally be happy? Probably not, and I never want work to be my entire life -- just a means to fund other areas of my life. So, I often flip-flop on if this whole "career game" is even worth playing. . .
> If today all you could do was: Brush your teeth then go back to bed. You've accomplished.
I think this is especially important to remember during the negative self-talk cycles. For awhile I would try and push through telling myself things are in the past, I have moved on and it's time to look forward etc and would fail miserably. Then would hate on myself for failing my expectations on top of losing my ability to connect thoughts like I use too, or even come up with new ideas or see how systems worked anymore. So I started traveling regularly, 8-10 intl trips a year (with a few domestic) and while there were flashes of brilliance, mostly it was as dull and numb as everything else, and only slightly helped with life satisfaction, but not so much for the cognitive issues.
After a few years the slivers of color started coming back into my world, then covid hit. Right around the start I came down with long covid for about 12-18/mo (I assume, my mental processing felt like it no longer existed/got even worse than before and that it would never come back this time).
The negative self-talk cycle started back with a vengeance. At one point I started having panic attacks which I never had before, and at the time, didn't know what was happening. It forced me to accept the small steps forward. Where, if today I can take a shower, put on clean clothes and go to the grocery store and systematically go through the isles picking up each item without getting annoyed by other people "in my way/front of what I need", it was a successful day. With bonus points if I acknowledged other peoples existence or engaged in pleasantries with someone (most likely the cashier). These kinds of actions/goals were not the types of things I ever thought would make me feel like I had a successful day. Learning to see success in way that success was measured by what I could do - really changed things for me.
I don't know what changed, I think it was just time taken to recover my mind. I wish you the best, it's a difficult state of mind to be in.
A break from work is definitely a good thing, but I'd add the suggestion that you get as solid a promise/prospect of re-employment as possible to eliminate stress during your time off.
This advice can feel trite, or it can feel overwhelming. Changing physical habits when you're already depressed is a huge undertaking, and I don't want to minimize it. However, my revelation has been the mind truly is not separate from the body, and taking care of myself by running, lifting weights, falling asleep at the same time has had largely outsized benefits vs any medication or therapy I've tried in the past.
Navigating the balance between self improvement, and being okay with the idea you may never improve to the point you want is hard. I know as much as I wish I could run a 5 minute mile, I was incredibly sedentary in my teens and 20's. It bothers me that I may never become "elite" in fitness because of my past, and that's just a fundamental barrier for me now.
My current thought is trying to find my personal worth in the journey of attempting self improvement, and not having an absolute goal of "I must be this smart" or "I must be this fit" to consider myself valuable. That mindset is easier said than done, though.
Yep, I've found that accepting a new value framework at an intellectual level is far easier than getting your emotional brain to accept it. I've found that having deep conversations with people where you talk about your new value system helps. There's something about the process of sharing your new value system with your friends & acquaintances that hastens the re-wiring of your emotional brain.
Is it possible that these negative thought patterns are holding you back? Awhile back, I became aware of some irrational negative thought patterns I had myself, and worked on reframing them, and it helped immensely w/ confidence.
Here's a random link on the general idea (can't vouch for all the content, but it captures the idea of this pattern): https://positivepsychology.com/cbt-cognitive-restructuring-c...
1. If you very much believe no amount of physical health interventions will have any cognitive effects, then it seems like the probability of you sticking with any sort of health/fitness routine is very low. If in fact, health/diet/fitness DOES have positive cognitive effects (it's been proven scientifically and there are tons of anecdotes), you may end up depriving yourself of a really great thing for improving quality of life and cognition. So examining the possibility that your cognition is not doomed and immune to physical health interventions could greatly increase the odds of improvement.
2. In 2 of your examples, they were social situations. In my experience, negative thought patterns can definitely impact that. I'm saying this somewhat loosely, as I'm not an expert, but have done research in the past on this: Thoughts can trigger bio/physiological responses in the body/brain that can definitely impact cognition.
Another way to put it is laying around on the coach, eating and sleeping a lot will not make you feel more energized even though you filled up your tank
However, after 3-5 years, my capacity for critical thinking basically returned to normal. To this day, my working memory still seems worse, but it's unclear whether that's simply because my days are now filled with crazy amounts of multitasking.
All said, the major effects you're describing subsided after a few years for me. I did some talk therapy, and I also spent a good amount of time redesigning my personal values to not include extrinsic variables (such as being intelligent).
The biggest thing I did was just waiting for my body to recover. Be patient and if you're anxious about the time it's taking, then spend some time realigning your values to your reality, which will help relieve your anxiety.
- developing a regular aerobic exercise routine. Starting my day with a walk or run makes such a difference, I feel like a different person after I exercise
- reducing/cutting out substances. I love cannabis but I recognize that it exacerbates my ADHD symptoms, reduces my desire to connect socially and reduces my cognitive ability. Alcohol disturbs my sleep as well. If I don't keep tight limits on my consumption and take long breaks between use, my mental health declines significantly
- find a constructive activity that you love to do. I've fallen in love with painting. It gets me off the screens and relaxes me while giving me a sense of personal accomplishment and growth. It gives me space to appreciate myself and cultivate self-compassion and love. Don't try to make it a side hustle, just something that you enjoy and helps you unwind
- practicing a self-care/personal space cleaning routine. I still struggle with this and by no means keep a 100% clean house all the time. But I know that no matter how bad I'm feeling, I always feel a little better after cleaning. If I'm having a really bad day, I try to clean at least one room in my house (and once I do one, I usually feel motivated enough to do more)
- psychiatric drugs have not worked for me personally, but that certainly doesn't mean they won't work for you. The key to recovery is making them a part of a larger commitment to your overall health. You cannot simply take a drug and ignore the other aspects of your life. Americans have been conditioned to think that a pill solves everything, but this could not be further from the truth
Fellow ADHD'er here, and I am starting to realize this too. I made it through more than 2/3 of my life without treatment, but have sought treatment for almost a decade now. In hindsight, I am not actually sure the treatments really helped as much as I thought they did during those times. I sometimes wonder if the psychoactive effects of treatment merely make me perceive like I am more productive than I am in reality.
I believe the treatments obviously had an effect, but the benefits came with their own costs. Therefore, I feel like I have consistently had a net-gain of 0 improvement. Treatments seem to help with more physical symptoms than mental i.e., lessened hyperactivity but not much improvement in executive functioning.
I feel like I was promised a panacea with how doctors, research, and various anecdota describe the effects, but have been left with a more disappointing reality. I have been debating stopping treatment, but I fear there could be negative repercussions as well.
I experimented with it as an alcohol replacement. I had to stop because I’d forget the point of my sentence before I got to the end.
My buddy is a great guy but cannot focus. He’s worse when he’s been smoking. My nephew too. He utterly fails to understand verbal direction after he has been smoking. Also my two friends in jr high went from sharp and smarter than me to barely keeping up. I know that’s not science, but it’s good enough for me (and there’s no scientific study that disagrees)
I’m not anti weed (it’s legal where I am and I’ve used it and had fun) but if you need to focus, please for the love of god, avoid the stuff.
A lot of trauma is internalization. You blame yourself. It's made to be your fault. You're told you're a terrible person. Get mad about what happened to you. Anger is your tool for being pissed off and asserting your boundaries.
https://cptsdfoundation.org/2022/05/31/the-importance-of-ang...
Anger is very hard to control, can easily backfire into self-loathing and cause you to strain existing relationships, which can also further fuel internal anger at oneself. If you get mad about what happened to you and start lashing out at others, you risk isolating yourself and deepening your depression.
Fear and anger are like look and leap. People who can't feel anger can only look and never leap.
Why is this the case?
Try one small step at a time and keep a journal to see what works and what doesn't; experiment and A/B test yourself. Keep these things as values on a scale of 1 to 10 and grade yourself at the end of each day, try something like shower in the morning and take a run, eat healthier, don't drink, whatever & score it. See what helps. Do that more often and try something else.
Good luck and I wish you the best.
You could find a good psychiatrist or psyschologist who helps you out. You could find a terrible one who makes things worse or get's you hooked on some drug you majorly regret.
Get advice from anyone who you think has something worthwhile to say and ignore this.
In about 2 weeks, I noticed my short-term memory had improved.
1. The Mind Illuminated for Meditation 2. Feeling Good book for therapy 3. Your local gym for exercise
It will take some time but it will work.
I also started microdosing mushrooms a year ago. I know you said you tried psychedelics, but I don't know if you've tried microdosing; Before I tried it, I always thought it was ridiculous and kind of an abuse/waste of psychedelics. But I like to say that the mushrooms are teaching my brain how to feel good: Maybe they repair connections in the brain or whatever, but I just needed to kick-start having a good day, so my brain could have an example of how that works.
Another major step was finding a new community...My experience is that when you're depressed, people come to expect it from you. Even if you're in a particularly good mood one day, your friends and family will kind of prompt you to act depressed. They do it out of love, probably, but it makes it that much harder to break the pattern.
One more piece, which may or may not be appropriate for you, is utilizing sex workers. Having trauma and pain, it was always a shitty experience for me to seek physical comfort. If you aren't ashamed of it, paying for affection can be a great way to meet your needs in a simple, non-judgemental way that's less emotionally and physically draining.
I would caution against this. Many if not most sex workers are also dealing with significant pain and trauma, and by using and abusing their bodies for your own needs, you are likely to be exacerbating this.
See e.g. https://www.adoptnordicwa.org/uncategorized/insights-into-pr... for an account of what sex work is like 'behind the scenes'.
I'm at least hopeful that there is going to be a better treatment for me that doesn't involve invasive, prospective brain surgery. That's my way of staying positive.
> Talk therapy has done little.
I honestly don't think recovery from trauma can be achieved without psychotherapy. You can cover it up, but it's still going to impact your thoughts, feelings, and behaviors to some degree. You might get lucky with things like psychedelics, but finding the right therapist and right therapy will bring about change more consistently.
The challenge, however, is that there are many styles of therapy and many styles of therapists. Also, there are different types of trauma (eg. shock trauma, complex trauma, attachment trauma) that require different approaches to treatment. I was lucky in that I found a therapy and therapist that worked for me in my first try. My partner, however, went through 7 therapists over the course of a few years before they found a good fit. Any decent therapist will not be offended if you tell them you feel therapy is not going anywhere, in fact it's in their code of ethics that they need to help you find a better fit.
What works for me isn't going to work for you, but here's my opinion (that you didn't ask for) on therapies that are better at treating trauma than CBT or "traditional" talk therapy: Internal Family Systems therapy, EMDR, the NeuroAffective Relational Model, and Somatic Experiencing / Sensorimotor. AEDP and Coherence Therapy are also decent options. If CBT is all that's available, at least try to find TF-CBT (trauma-focused).
1) Figure out the type of person who caused the trauma
2) Learn their psychology/world view (there are books on abusive personalities)
3) Learn to recognise them quickly
4) Have a plan to deal with them
5) Profit (you'll always have the upper hand)
By doing this you take away their ability to do anything. For some types this riles them up, which can be advantageous in eliminating the threat but also dangerous. You can plan for this.
Good luck.
I had one that was a huge waste of time and money for about 3 months and wrote the whole thing off
I started up again a few months ago with a therapist that specializes more in trauma/family issues and it’s been invaluable
After reading that material, I sought out a neurofeedback practitioner who works in the style that Fisher and van der Kolk recommend. I've found it helpful and recommended it to family and friends. Several have reported cognitive improvement, including one who said that her "brain fog" was gone.
I've looked into the research literature on neurofeedback and it's unfortunately rather poor, but there are some interesting recent results in the work of Ruth Lanius. My own feeling, FWIW, is that neurofeedback+psychotherapy is able to reach levels of the nervous system that talk therapies alone cannot, because many effects of trauma are encoded in nonverbal parts of the brain.
There are many products out there that use the name "neurofeedback", but if you contact the company the makes the system that Sebern Fisher works with, they will send you a list of practitioners in your area. The recommended approach is to find a psychotherapist who incorporates neurofeedback into their practice. There aren't many of those, but there are some, and in my experience it makes a big difference, so big that it becomes a puzzle why this practice is still so little known.
Whatever you end up trying, please don't give up. It can take a long while to find something that works for you. My experience was that most therapies I tried just didn't go deep enough, and my problems would "snap back" into place no matter what happened in the sessions. It was frustrating. What's different about neurofeedback, in my experience, is that it's able to "talk" directly to the brain in a way that is uncorrelated with the rest of what therapists do. I'm not saying it's for everybody, but it's worth a try if nothing else has helped.
I'd also joined the company softball team, and I noticed that on the nights where I got back from playing softball after work, it was almost effortless to roll up my sleeves and start on my homework.
It's sometimes difficult to pause an overdue/critical task to go take a 30-45 minute walk, because it just seems like wasting _more_ time. But I've found that after a walk or some kind of exercise break, I often become "un-stuck" on a task that I was bogged down or procrastinating on.
I experienced a severe 4 month PTSD event in 2019 pre-covid (covid later didn't help), plus 1.5 years of related issues, the psychological side effect of constant depressing stress that couldn't be escaped resulted in physical problems - twitches, verbal stuttering, indecisiveness, emotional swings and regular memory loss (both short term and of the event).
Around the end of 2021 as I recovered I found I had the ability to learn like really, really easily, I did 3 IT certifications in 3 months, MS, Google and an AWS cram, got noticed at work for higher achievement in solving issues there too - winning a hackathon and receiving an unrelated pay rise - it felt like no boundaries and I put this down to the fog lifting. I was still a little unhappy behind the scenes despite this, but by 2022 I felt 95% recovered (I doubt I'll be 100%" as I'm a different person now as a consequence).
Sadly the ability and urge to achieve like in 2021 went away - a window in total of around 6 months I was able to run at this "higher level" without much effort.
Articles on PTG say extroverts are more likely to experience it - I'm introverted but can socialise when challenged or feel like putting in effort (but prefer not to and avoid presentations etc.), so don't get disheartened if you think you may not have the personality for it, just remember to watch out in case it does and take full advantage :)
Extra info: Did 2 sessions a week with a psychiatrist for months - talking - not EMDR or CBT as they weren't as effective* - usually ended up in tears every time and over running - I rarely cried at all up to 2019, and flat out refused to take drugs the doctor suggested because they affect concentration and I didn't want to dull my ability more than it was already.
* They were, but I didn't want to go down that route as one session made me experience a load of events I'd forgotten details of, to the degree it was like hypnosis, I could see more, hear new noises and almost feel the cold touch of things in the memories almost like I was asleep. That was expected but I wasn't warned of it properly.
I will say that as a pretty practical, science-minded person, I generally don't get into stuff that seems like woo pseudo-science. But years back I had an agreement with a neurofeedback practitioner (eeg biofeedback) to accept free treatment in exchange for giving her a journal of my experience. And I still believe it helped me quite a bit. It might be some of the same benefits of meditation, but I had never successfully been able to meditate before doing that.
Other than that, I've only got the same probably-trite-sounding drink plenty of water, get lots of sleep, try to keep up your physical activity levels... drink amino acid shakes...
Best of luck to you.