WHAT IS PERSEVERATION?
Practically everyone knows what it’s like to have a song stuck in their head, where no matter what they do, it won’t leave. This can be an irritating experience, but overall doesn’t have a big impact on day-to-day function. Perseveration is similar to this concept, though unlike having a song stuck in one’s head, it tends to be a thought or series of thoughts that stays stuck in the forefront of their mind, and can be detrimental to one’s well-being. These perseverative thoughts often involve negative self-talk and can even be as extreme as to involve suicidal ideation.
Perseveration, while potentially crippling, is actually quite common among patients who have suffered from traumatic brain injury (TBI), stroke, concussion, PTSD, or anxiety.
These perseverative thoughts are a symptom of an underfunctioning frontal lobe–as a result of a brain injury or chronic mental health condition–and can actually prevent a patient from recovering, due to the negative mindset that they perpetuate. By keeping the patient locked in a thought loop about the past or worrying about the future, perseveration prevents the patient from being fully present in the moment and engaging in their day-to-day activities. This blocks joy and contentment, creates intense anxiety and depression, prevents sleep, and can cause damage in relationships.
WHAT CAUSES PERSEVERATION?
Perseveration occurs when one’s frontal lobe, the inhibitory lobe of executive function and emotional regulation, is damaged and cannot fully inhibit the compulsive, repetitive thoughts. In a healthy brain, the frontal lobe will recognize when thoughts are running rampant, and can effectively shift awareness to something other than those same negative thoughts to keep the mind in check. It doesn’t necessarily suppress the negative thoughts, but it can recognize that they are not serving the person in a positive way and can move onto the next thought with little difficulty.
When the frontal lobe is struggling as a result of injury, however, it cannot “turn off” these negative thoughts.
Instead, they play on a loop endlessly and can spiral the patient into manic states, periods of severe depression, or harmful behavior when not kept in check. It is important for the patient to recognize that it is not their fault this is happening, and that it is in fact a neurological condition that can be treated successfully with the right effort.
CAN PERSEVERATION BE TREATED?
In addition to neurological treatments that target the frontal lobe, such as repetitive transcranial magnetic stimulation (rTMS) and certain eye exercises (ex: anti-saccades), an important step in getting rid of perseverative thoughts is creating awareness of these thoughts and beginning to recognize when one is caught in a perseverative loop.
When someone is stuck in these thoughts all day and night, he or she may not even recognize that it’s happening because the thoughts are all-consuming.
However, through awareness practices such as mindfulness meditation and journaling, one can begin to identify these perseverative thoughts and “come up for a breath of air,” so to speak. Through consistent awareness practice and the strengthening of the frontal lobe and its connections to the rest of the brain, one can notice the perseverative thoughts more quickly and use certain techniques to try to shift your thoughts toward something more positive.
It’s as if the person is swimming and they have been sucked into a whirlpool, and they’ve been spinning in circles for hours. All of a sudden, in a moment of clarity, they notice they’re stuck in a whirlpool, so they can begin to swim away. As awareness increases and the frontal lobe recovers over time, the person will notice they’ve been sucked into the whirlpool much more quickly, and swimming away is much easier. Continuing even further, they will eventually notice the tug of a whirlpool before it even pulls them in, allowing them to change course and swim freely without getting stuck in it. The moments of relief and clarity extend longer and longer until the whirlpool is simply a gentle wave in the water rather than a tumultuous, inescapable vortex.
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