Coping with short-term memory problems: Part 2
By Dr Sue Jackson
This article is the second in a series focussed on short term memory problems; why we experience them and what we can do to cope. In the previous article we considered the three key components that comprise short term memory, and then detailed the common problems for each which leads to the experiences that we describe as short term memory problems (summarised in table 1).
Table 1: The key components of short term memory (STM) and their associated common problems
STM memory components
Ideas for coping
Or how interesting something is to you
Lack of interest, or relevance, to you
Other competing priorities
Try to do things one at a time
Try to find a mutually convenient time to talk to others (or use written notes)
As above, plus:
Short concentration span
Health status (e.g. having a cold)
Pressing bodily needs (e.g. thirst)
Poor diet or nutritional status
Poor sleep and/or high levels of fatigue
As above, plus:
Try to practice good self-care
Make sure you get enough rest
Try to take enough physical exercise
Your ability to remember later on
As both of the above, plus:
Trying to use your memory for too many things
Too many items on your list of things to do
A random and/or confused list of things to do
Lack of appropriate social cues
As both of the above, plus:
Use short, sensibly ordered lists
Ask yourself: what do I need to do? When do I need to do it? What to do I need to remind me?
This article carries on from where the previous one left off. This time, though, we’re considering the three most common causes of short term memory loss listed on the NHS Choices website: anxiety, stress & depression. In order to do this, we’re going to have to look at a few things about being human and how they interact to cause us problems with our short term memory.
We’re going to start by exploring the confusion that is our moods and emotions, an area where many doctors and psychologists fear to tread! We’ll start with mood states such as anxiety, anger/frustration, and depression. They aren’t the only mood states that we have, but we’re probably more familiar with their names because they cause us such problems.
Our mood state is really important; it determines the amount of energy we have and how much wellbeing we feel. We don’t know why people experience particular mood states. The current thinking is that they develop over time and are related to the demands that we have to deal with in our lives. Which specific events or demands we are facing that influence our brain chemistry, we do not know, but we do know that mood states have a tendency to hang around.
If any of you have been unlucky enough to experience full-blown clinical depression, you’ll know that it can last for months. You always have a mood state in operation, even if you’re not aware of it, a common enough occurrence as some mood states can be difficult to recognise and describe. There is some evidence that your mood state can change over the course of the day as your hormones change (linked to what’s called your circadian rhythm).
Dr Liz Miller, a GP with bipolar disorder, has written a wonderful book called “Mood Mapping” which explains very clearly how the settings of the neurotransmitters (hormones) in our brain and body affect our mood, how we feel and therefore what we can do. Rather than getting bogged down in trying to understand your neurochemistry, she suggests a very simple grid system that you can use to help you understand what’s going on (see Figure 1).
Her grid is based on two of the major systems within the brain: the dopamine system responsible for your levels of arousal (which you experience as energy); and the serotonin-endorphin system, a house-keeping system related to how well your organs are working (and which you would experience as positivity, or wellbeing). So, in Miller’s mood map, if you have high levels of energy but you don’t feel great, you’d probably be feeling either anxiety or anger; if you had low levels of energy and you don’t feel great, you’d probably be feeling depressed or experiencing a bout of lowered mood. These two quadrants make up our threat system and are important in how we respond to stress. Miller suggests using her grid to map how you feel during the day. Figure 2 shows you a completed map for me across one day.
Fig 1: Miller’s Mood Map
Fig 2: Sue’s completed day-time Mood Map
So, what effect do mood states such as anxiety and depression have on our short-term memory? Firstly, your mood state determines your ability to pay attention. Anyone who has had a bout of depression will confirm that it is very hard to summon any interest in anything. The deeper the depression, the less interest we have in the world around us. Anxiety and anger are associated with hyper-vigilance, a state where we are on constantly looking for things that might affect us and that we may need to protect ourselves from. It’s easy to end up feeling overwhelmed by the demands made on your attention when we’re in this state.
In terms of concentration, depression is associated with a significant reduction in our ability to concentrate – we simply don’t have the mental, or physical, energy to do it. While we may have more than enough energy when we’re anxious or angry, the blinkers that these mood states force on our thinking mean that our inner dialogue quite often overwhelms the information coming in from outside. For example, if you’re anxious you may find yourself thinking, “Can I cope with this?” Or, “What will happen if it goes wrong?” If you’re angry you may find yourself thinking, “Where’s Fred? He’s meant to be dealing with this. Why is it always me that’s got to sort things out?”
The way we talk to ourselves can mean that our concentration is disrupted. The stronger our feelings the less able we are to concentrate. Obviously, as the impact on your attention and concentration increases, your ability to successfully remember and retrieve the information significantly decreases.
Miller’s mood map shows two other mood quadrants: “action” and “calm”; so what effect do these have on our short term memory? It’s tempting to believe that if anxiety and depression have a negative effect, then the other two must have a positive effect. Sadly, it doesn’t work quite like that. We used to think that it did, and then recent research showed that you can be in a good mood (“action” on Miller’s mood map) and still be unable to pay attention, concentrate and remember information. The current thinking is that it isn’t the valence of the mood state that matters (i.e. whether it’s good or bad) it’s the degree to which you are experiencing it. You may have had the experience of trying to talk to a happy child – the more excited they get, the less they can pay attention to what you’re saying. Well, it’s the same for adults, the happier and more excited you are, the harder you’re going to find it to pay attention, concentrate and remember. The best quadrant on Miller’s map for short term memory is the “calm” one – here you have fewer disruptions to your ability to do what you need to do.
Top tips to promote calm: Talk to yourself nicely, as though you are your own best friend. Use your senses to enjoy the world, every so often during the day, for just a few seconds, really pay attention to something that you look at, smell, touch, taste, or hear. Work on using your body to tell you mind that everything is OK; e.g. if you have a tendency to clench your fists, work on holding your hands open instead; if you have a tendency to cross your arms, work on relaxing your arms and holding your posture open.
So, if that’s the effect that mood has on us, then what are emotions? Emotions are situation-specific and immediate. They are very important in terms of us being able to protect and defend ourselves. Emotions give us really useful information about the world – mostly, they tell us whether the situation we are in is OK or not. Emotions are supposed to be relatively short-lived.
Figure 3 shows a graph of what happens when we experience an emotion. You need to be aware that your mood state (the grey background on the graph) influences the intensity of emotion you feel. Most people report that they feel their emotions in the body and that they are associated with feelings of energy of some kind. If, for example, you are depressed, the lowered energy would mean that if I told you the funniest joke in the world, you’d probably only have the energy for a wry smile.
To start with, it’s important to note that we’re always feeling something, even if it’s just at a very low level, except for those individuals who have “alexithymia” where they are unable to recognise or feel emotion in themselves and also in others. It’s thought to affect approximately 10% of the population and is associated with a variety of psychiatric conditions. We used to think that emotional processing took up a great deal of cognitive activity, but the most recent research shows this to be untrue. The emotional monitoring your brain does has no really discernible effect on your ability to think at all.
To use a driving example, you’re going along in your car when a dog runs out in front of you. The initial perception of the event is very quick (significantly less than 1 second) and is associated with an instinctual change in your behaviour such as swerving the car out of the way, or performing an emergency stop. We literally do it without thinking about it. The peak of the emotion, or feeling (possibly fear in this example), is only supposed to last approximately 2 to 3 minutes, but if the situation continues, then the feelings associated with it can last longer than this. Once the situation is over, your body needs approximately 20 minutes to reset your endocrine system and get you back to where you were before anything happened.
Fig 3: Emotion curve
Lots of us struggle to understand our moods and emotions and indeed get the two muddled up, the way I see it, your moods and emotions inform each other in a continual loop. I quite often describe moods as being like the sky (it’s always there) and your emotions are like the weather (very changeable!). The illustrations I use with my clients are reproduced in Figure 4. Dr Steve Peters’ book “The Chimp Paradox” is very good if you want to understand more about your emotions and how to deal with them.
Fig 4: The links between mood and emotions
Top tip: Try mood-mapping
Develop an emotional lexicon – your own dictionary of terms that describe how you feel. You can start very simply, just ask yourself whether you feel one of the following emotions in Table 2. If none of them is really accurate, then ask yourself what other word you would use to describe the feeling.
Table 2: Emotion response set
We’re moving on now to consider how stress affects us. Stress can be either chronic (i.e. long-lasting) or acute (i.e. short-lasting). When it’s short-lasting, say the kind of stress you get when you realise you’re going to be late for something, the response follows the same pattern as we saw in the emotion curve (Fig 3).
Your stress response consists of three components: behavioural, autonomic (your nervous system) & hormonal (your body’s neurotransmitters). The initial instinctual behavioural component consists of the muscular movements that are appropriate to the situation. For example, a dog defending its territory will first develop an aggressive posture, growling and showing its teeth. If the intruder does not leave, the dog will run toward it and attack. Autonomic responses help the dog to sustain its attack and provide quick mobilisation of energy needed for vigorous movement. The dog will experience an increased heart rate, while changes in the size of blood vessels shunt the circulation of blood away from the digestive organs to the muscles. For this to happen there has to be an increase in the activity of the sympathetic nervous system and a decrease of the parasympathetic nervous system. Hormonal responses (in the form of neurotransmitters) reinforce the autonomic responses. The hormones secreted by the adrenal medulla (adrenaline & noradrenaline) further increase blood flow to the muscles and cause nutrients stored in the muscles to be converted into glucose.
All of these changes explain why after a stressful event, or a strong emotion our endocrine system needs a good 20 minutes to sort itself out! Animals often take themselves off somewhere quiet to recover after experiencing something stressful, something we humans could learn from them, perhaps?
Stress is known to cause disruption to short term memory function. Interestingly, the language we use can enhance the effect. So, if you say to yourself, “I must remember to pick milk up on the way home from work”, the word “must” can act as a stressor with the ultimate effect that you forget to pick up the milk. That said, some stress is good for us. Actors have known for years that some stress is useful to help them give a good performance, and recent research with students has shown a similar effect. What matters is the amount of stress and your attitude to it. The students did best when they faced their exams in a familiar environment (so they weren’t exposed unnecessary stress of dealing with somewhere new), and where they were told that the stress could improve their exam performance.
The repeated exposure associated with chronic stress (e.g. where we’re continually exposed to a very difficult situation) can cause our threat system to become permanently active. Unchecked stress can easily turn into anxiety. You might start out only reacting in the situation (that’s your stress response), but then the situation starts to play on your mind and then you start to find that you can’t get off to sleep or you’re waking in the early hours with your mind racing (now it’s anxiety). If that continues unchecked you can end up experiencing extreme anxiety, all the way up to panic attacks.
Top tip: Do some forward planning – you don’t need to do it for everything, but thinking through the things that you know are coming up and thinking about what you need in order to cope can be very helpful. You can’t avoid all stress, but forward planning can help you avoid some of it.
Find some form of relaxation (e.g. hobbies) that you can enjoy.
Try to smile, even if you don’t feel like it, your body reads the muscle changes in your facial muscles and starts to release endorphins (feel-good hormones) in response.
While we’ve covered a lot of ground in relation to short term memory, we’ve yet to address the particular issues faced by pituitary patients, or indeed some of the other vulnerabilities that can affect short term memory such your life stage, thyroid problems and medication side effects. The final article in this series will seek to explore these issues.