Brain Injury and Motivation with Andrea Kusec

In August, we were very lucky to have Andrea Kusec from the MRC Cognition and Brain Sciences Unit at Cambridge University address the Headway Essex support groups on the subject of brain injury and motivation. The session was so interesting we asked Andrea if she could write an article on the subject:

Motivation, such an aggravation: Why can it be so tough?

After an acquired brain injury (ABI) such as traumatic brain injury, stroke, or brain tumours, low motivation is common. As many as two-thirds of people with an ABI report having low motivation, difficulties outlining how best to spend their time, how to get started on a task, and how to finish something important to them.

Many people have a hard time with motivation – especially during the ongoing COVID-19 pandemic, people are finding it harder to feel productive. For people with an ABI there may be additional reasons why motivation is hard. Poor attention and memory can make it easy to become distracted, leading to tasks being half-finished or abandoned. The ability to finish a task can be affected by increased fatigue. Feeling down can prevent someone from having the energy to start a task, and feeling anxious that a task will go wrong can prevent someone from trying something new. The parts of the brain that are responsible for feeling rewarded after we complete a task are often impaired in ABI, which in turn affects motivation for future tasks.

How do People become Motivated?

One motivation theory, self-determination theory, states that motivation is formed of intrinsic (internal) or extrinsic (external) factors. Intrinsic motivation focuses on what drives someone to complete a task on their own, while extrinsic motivation focuses on how a person becomes motivated from sources other than the self.

All humans have a basic need for autonomy (feeling independent), competence (feeling skilled at what you do), and relatedness (connecting with other people). These three basic needs drive internal motivation. External motivation on the other hand can be affected by reward (such as pay for work), social support (such as encouragement from others), and environment (such as working in a space with sunlight).

This theory can help us make sense of why all of us feel a lack of motivation during COVID-19. We have less independence to do what we want, we are not yet skilled at coping with new health regulations and regularly reading difficult news, and it is easy to feel isolated due to necessary social distancing policies.

This can have a negative impact on motivation, which can get us stuck in our “comfort zone” and do only the bare minimum. This feels good in the short term, but in the long term, we can get too comfortable and don’t challenge ourselves. Your comfort zone will get you into thinking traps such as:

• “I have the whole day to do this, so I’ll do it later”
• “I’ll just watch that TV show instead, it’s more fun”
• “I’m not good at this anyway, so it doesn’t matter”
• “I feel bad now, so I’ll come back to this when I feel better”

These thinking traps can be especially hard to overcome after an ABI. Luckily, there are lots of ways we can motivate ourselves. Trying out different strategies is best to help figure out what works best.

Brain Injury and Motivation Tips – Deciding What to Do

You might find yourself thinking “I want to do something, but I don’t know what to do with my time.” This may be a more common thought if you have had major changes in your daily activities such as taking a leave of absence from your job.  Some ways to overcome this are:

• Get listing – as Marie Kondo famously says, what sparks joy? Write a list of things you might enjoy. Having this list handy can help the lower cognitive effort of thinking on the spot.
• Try something new – usually, new things are exciting because we haven’t experienced them personally yet or we have heard good things about them from others. When something is new we tend to have more energy to try it out.
• “I’d like to phone a friend” – just like in Who wants to be a Millionaire, having someone you call is valuable. Is there someone you haven’t spoken to for a while that you’ve been meaning to catch up with? Even a brief call can be motivating.
• Ask the Audience – after an ABI it can be hard to think on the spot, so asking others around you what they have been up to recently can help you get ideas.
• Start Big, then scale back – after ABI it can be easy to state “big picture” goals like “I want to have a relationship” but it might be harder to outline what to do daily. Write down one activity that relates to the big picture – for example, if a relationship is a goal, try setting up a dating app.

Brain Injury and Motivation Tips – Getting Started

Another barrier with brain injury and motivation is having a hard time getting started.

• Get Moving – Literally – when you do less, your body becomes less used to moving and physical fatigue can set in quickly. Try 5 minutes of exercise, whether tai chi or walking around your home to get your brain more alert.
• Cut the Goal in Half – we often set unrealistic goals for ourselves, and motivation can decrease when we cannot complete them. If you want to walk for 2 hours, cut it down to 1 hour. We usually have more motivation for smaller goals.
• Get Specific – write out the steps needed to complete something. For example, if you want to bake a cake, write out steps in order such as 1) get ingredients and tools together 2) look up a recipe 3) preheat the oven 4) read recipe instructions carefully 5) keep a timer for the oven.
• The “Just 5 Minutes” Rule – The hardest part is step one – if there’s something that is very difficult to start, try out just 5 minutes of it – usually, once you get started, motivation carries forward.
• Follow a Plan, not a Feeling – Keep a schedule and follow it as best as you can – your comfort zone will tell you a task can be done later, but following your schedule instead will give you a motivation boost.

Brain Injury and Motivation Tips – Finishing a Task

Finishing a task can be particularly challenging after ABI. Some strategies that may work are:

• Imagining the positives of finishing up – picturing how you will feel and what benefits there are of completing a task can be a very effective motivator.
• 25 minutes on task, 5-minute break – also known as a “Pomodoro” this is a way to break up a large task into manageable time chunks.
• Keep a Routine –Try setting specific times for the same task (e.g., washing dishes every night at 7pm) – your brain will eventually maintain this as a regular habit.
• Reflect & Ask – it’s okay to need help for bigger tasks, and if you find yourself struggling to finish something despite your best efforts you might need a hand – especially as doing too much can be fatiguing.
• Motivation Loves Company – holding Zoom calls with a friend to get some writing done, inviting a friend for a walk, or sharing the shopping list with a family member can help keep you responsible.

How to help someone feel motivated

It can be difficult to understand what it’s like for a person with an ABI is going through, and low motivation can be interpreted as laziness. More often than not, it is changes due to the injury itself that are affecting motivation.

Although years of research show that external motivators can be powerful, the best method is to support the individual’s internal motivation.

• Give Them Options – after an ABI, it is common to feel a loss of independence as many choices are made for the person. Give them the option of which task to start with or which task they find the most interesting or enjoyable.
• Start small, then Challenge – Especially in the early stages of an ABI, tasks can feel overwhelming. Start by giving the individual “step one” of a task or a task that can be easily completed, then progressively give more challenging tasks.
• Encouragement over Punishment – it can be frustrating for the person with an ABI if something goes wrong, and there may be safety concerns (such as forgetting to turn off the gas stove). Encouraging the person with the ABI to write down a strategy (for example, using timers) rather than reducing access can help increase independence and thus motivation.
• Get Specific – specific guidance on what tasks are required is effective at facilitating motivation in ABI, especially for complicated tasks. Asking someone with an ABI to outline the steps needed to complete a task (such as steps to organise a Zoom call with relatives) can help the task become more achievable
• Motivation Loves Company – Sharing the workload of a task (such as taking care of the garden) can help increase motivation – especially if it is the first time the person with an ABI is attempting a task. Likely, this will help increase motivation for attempting the task again on their own as they will have increased feelings of competence.

You Can Do It

Low motivation can be difficult to navigate, especially after an ABI, but ultimately if there’s one tip to take away it’s to tell yourself to “just do it” –  our comfort zone may take over and cause thinking traps, but if you can push yourself out of your comfort zone once, you can get out of it again. As the saying goes, the past cannot be changed, but the future is yet in your hands.

Andrea Kusec,

Graduate Student

MRC Cognition and Brain Sciences Unit, Cambridge University