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A Crisis of Executive Functioning During a Pandemic

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Thursday, October 29, 2020 - 10:45

By Amanda Sacks-Zimmerman, PhD, and Jessica Spat-Lemus, PhD

Use the same strategies neuropsychologists teach their patients to help yourself through the confusion of the pandemic

In our practice within neurological surgery, we often see patients whose conditions led to a weakness in the cognitive domain known as executive function. One of the skills within this domain includes sequencing and planning steps of a task  the creation of a “mental map,” if you will — to complete it efficiently and without error.  When executive function is working well, life goes smoothly.

But this can be a challenge after, say, a stroke, or after surgery for a brain tumor, due to vulnerable brain networks. The patients we see with weaknesses in executive functioning have difficulty integrating multiple pieces of information. They have trouble with problem-solving, planning and sequencing, and time management, and they struggle with self-monitoring for errors. They feel overwhelmed — which is similar to what many of us feel right now in this nerve-wracking environment that is the prolonged pandemic of Covid-19.

For simple tasks we don’t even notice our executive function at work. After all, a quick run to the grocery store is not that complicated – it’s just grabbing your keys and wallet, getting into the car, driving the usual route, parking, picking up what you need, getting yourself home again. But think about what diverse cognitive skills you need to do that: remembering where your keys are, where your car is parked, and the route to the store, then organizing your path through the store depending on what items you need, going through the check-out steps, then navigating home again and putting the purchases away. When a task is more complicated (organizing home schooling, navigating unemployment, filing taxes), each step is more difficult, and getting it all under control can feel impossible.

Stress can significantly impact our executive functioning, making decision-making (weighing pros and cons) more difficult. Add to that the feelings of anxiety or mood changes brought on by the pandemic, and you may find yourself experiencing symptoms that suggest an executive function problem:

“I have so much to do, and don’t know what to do first.”

 “I’m hearing so many different things, and don’t know what is important or how it all fits together.”

With a structured remediation program, patients can learn to restore or improve executive function skills. And in these completely abnormal times of the coronavirus pandemic, we can apply the principles of remediation to help anyone get through these difficult days.

We work with our patients on a four-step problem-solving strategy that anyone can use on a problem/situation when overwhelmed:

1. Stop. What is the problem?
In this first step you simply take a moment to define the problem in its simplest terms (e.g., “I need to be able to get in and out of the grocery store quickly and efficiently”)
2. Alternatives and Options
Don’t judge anything as “bad” or “good” yet  just make a list of possible strategies. You might include writing down a shopping list, thinking about the layout of the store ahead of time, calling ahead to ensure products you need are there and when the store is least busy, ordering online, asking someone to go with you and split up the list, or limiting your purchases to the top 10 needs. Go through your list of options and circle the three or four that are realistic and doable.
3. Make your plan
Write down your plan, such as:
• Make a shopping list, grouping the items by store layout
• Call the store to confirm those items are in stock
• Go to the store once everything is confirmed
4. Review
Look over the plan AND write it down. This can be your plan every time you shop; sort of like your “mental map” for shopping in the pandemic — the items may be different, but the plan is always the same.

It may sound overly simplistic at first, or more time-consuming than necessary. But you may be surprised, as many of our patients are, by how these simple steps can have a calming effect that makes you less anxious, more organized, and better equipped to handle tasks during this challenging time.