Learning with CFIDS
Edited by Rebecca
C. Moore, Questions answered by Linda Miller Iger,
Originally published in Youth
Allied By CFIDS, Summer
Are There Techniques to
Make Information Stick?
Dear Dr. Iger,
When I am trying to read, the words
seem to get jumbled and don't make sense. Do you have any suggestions for coping
As soon as I study something it seems
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
Chelsea, age 14, Colorado
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
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
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
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
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
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
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.