As soon as I study something it seems to vanish from my brain. I really do want to learn, but the information just won't seem to stick. Will I be able to remember this information at some later point? Are there techniques for working with this problem?

Using brain power is very exhausting. Are there any techniques for making it less strenuous? How can I pace myself and still accomplish the tasks the school requires?

Thank you for offering your help and support for young persons with chronic fatigue and immune dysfunction syndrome (CFIDS)!
Chelsea, age 14, Colorado

Dear Chelsea,
Thank you for your letter. You asked for some general strategies to maximize brain power. Healthy adults can only concentrate for about 50 minutes, which is why high school classes are only that long. With CFIDS, your ability to concentrate for long periods of time is severely compromised. The best way to optimize the "window" of brain power is to test your attention span.

You can test your attention span by buying an egg timer and initially setting it for 20 minutes. Based upon my experience with CFIDS patients, 20 minutes is about the time you can reasonably expect to concentrate. If you find your mind wandering before the timer goes off, stop and look at how much time has elapsed and compute your attention span. You will find that your attention span will be different when you're relapsing than when you feel somewhat better.

You need to take at least a 10-minute break after each of these work sessions. During your break, do something as non-cognitive as possible. For example, go and get a glass of water or milk, look out the window, close your eyes and kick back. The goal is to string together three "cognitive" sessions with small breaks of 10- to 20-minutes after each of the first two sessions and a long break at the end of the third session. I hope this is helpful to you. Keep me posted on your progress. (More techniques for maximizing your brain power are found in the answer to the next question. -The Editors)


Am I Learning Even if it Doesn't Feel Like I Am?
Dear Dr. Iger,
When I study, I often feel like I can't remember or learn anything. It all goes over my head. I know that I should try to keep up with my classes but sometimes I wonder if the effort is really worth it. Am I learning even if it doesn't feel like I am?
Anonymous in New York

Dear Anonymous,
Yes, you are taking in information and are processing it even if it doesn't feel like you are. The answer to your question has to do with the difference between passive and active learning. Truly, we take in information even when we don't think that we are doing anything.

If you are sitting in a room, casually gazing about, and you close your eyes, you'll find that you can recall what you've just seen. This shows you that your senses are still working and taking in information; you are able to learn passively. But when people with CFIDS are trying to learn very actively, the effort involved in trying to concentrate, combined with anxiety about learning, can make studying difficult.

Even though you are afraid, and you may be thinking about giving up the ship, it's important to keep trying. If you're in the years where school is your primary work effort and you stop making an attempt to actively learn, you're really going to fall behind. Then it's going to be all the more frustrating. So it's important to keep plugging away.

To that end, I'm going to explain some other ideas about how we learn, so that you can use their principles in your efforts.

The Serial Position Effect

The Serial Position Effect is one of the principles of cognitive restructuring. It is the tendency for us to remember items at the beginning or at the end of a long string, rather than those in the middle. For instance, try reading this string of numbers and saying them out loud to yourself at the same time.

9 l 8 2 7 6 0

If you close your eyes and try to repeat that string, you will probably remember the "9 1 8" and you might get the "6 0" but the ones in the center will be the most difficult for you to remember.

If you string together "9 l 8" and then put a dash before the "2 7 6 0" it's a lot easier to process. By trimming down this series of numbers to a series of three or four, you make it much easier for yourself. Obviously, telephone companies learned very quickly that human beings can learn in small increments much better than they can in large increments!

I would suggest that when you're actively trying to learn, you should trim the information down into small increments rather than trying to take in the whole picture.

Cut Out Competing Stimuli

Another helpful strategy is cutting out as much competing stimuli as possible when you're trying to study. That means having a totally clear desk and, if necessary, using a study carrel. One can be made from plywood and placed on a desk or table, providing a planned environment around three sides of the individual. This creates a noncompetitive background, allowing the person to focus solely on the task at hand.

Cutting out competing stimuli is particularly important for people who have problems tracking information in more than one modality at a time. If you find that you're distracted by auditory stimuli when you're trying to take in written and other visual forms of information, create an atmosphere which is as noise-free as possible. This will mean not having the radio on. If you're still easily distracted, use disposable foam ear plugs when you're trying to concentrate on visually inputting text.

In addition, make sure that the room you study in has a comfortable temperature and good quality lighting which doesn't cause glare. Make sure that the desk is not facing something interesting, like your bulletin board. In other words, when setting up a study environment within the home, you need to think about good general study principles and then maximize them, because with CFIDS every aspect of the distractibility that most people have to some extent is going to be exaggerated.

Strategies for Auditory Learning

Around eighth or ninth grade, classrooms shift from having a lot of visual material to a more bland environment and teachers provide more information verbally. A lot of people who are primarily visual learners don't make this learning shift easily, and it's particularly difficult for those CFIDS patients who are visual learners to take in information auditorally.

What has been an effective tool for some of the people that I've worked with is recording classes with a tape recorder. (Make sure to get permission in advance from the school and your teachers to do this.) Take notes and record your classes at the same time, and then compare the information given by the teacher with the information that you've put down on paper. This will give you some idea about your ability to take in the important information presented.

Listening to your tape is also an excellent way to review, because you hear the information twice (once in the classroom and a second time on tape), and you can also compare what you hear with your written notes. This gives you a rudimentary multi-modal learning approach, which is by far the best approach for CFIDS patients because some days one modality will work better than another.

A multi-modal approach is like washing your brain in every possible way with the information. Try this method when reading over your notes. Use your finger to follow the sentences, and say them out loud as you read. You're then feeding the information back to your brain using three of the five senses: touch by following the sentences with your finger, visual by reading the words and auditory by saying the information out loud. This method gives you three different ways for your brain to process the information.

Dealing With Anxiety

I want to give you one last piece of advice, one which comes from being both a clinical psychologist and a neuropsychologist. Young people who are in a school situation when they are ill also have to deal with personal anxiety about returning to the classroom. They wonder how they will perform.

Most people, in particular students, are performance-oriented to some degree, and because CFIDS patients have an additional challenge beyond the normal challenges of the classroom, I think it's a valid assumption that there's going to be some level of anxiety. With a complex cognitive task, anxiety inhibits performance. So there has to be some way to address anxiety directly.

Many of my patients who are in a classroom setting get highly anxious before an exam. I suggest that, when the teacher is handing out an exam, they put their head down on the desk, turn their head to the side, close their eyes and just breathe. Take a minute or two to breathe deeply and try to relax the body as much as possible. When you're feeling tense or anxious, say to yourself, "I need to relax. I need to consciously relax my body, to breathe deeply, to close my eyes and to put myself in a better place mentally."

Use imagery to think of something pleasurable - an enjoyable experience at the beach, for example - and try to "put yourself" mentally there for a minute or two. That will help you calm the body down and your performance on the test will be enhanced. I ask patients to make a conscious effort to take breaks like this at regular intervals during the day because they will relieve stress. Kids might even want to do this on the way to school, if they're feeling nervous about going back.

Imagery has tremendous healing power. When we're anxious, our heart rate goes up, our muscles tense, we prepare to fight or flee and the amount of oxygen available to the parts of the brain that we use in thinking is drastically cut down. That's why when people say, "I was so angry I couldn't think straight," they really mean it! If you can relax yourself on the way to school, periodically during the day and before exams, and start to breathe deeply and use imagery that you find relaxing, it will reverse those effects. It will lower your heart rate to a more normal level, decrease the tension of the muscles and increase the cerebral blood flow.