Multitasking: A Challenge for Patients with CFS

By Gudrun Lange, PhD
Pain and Fatigue Study Center, UMDNJ-New Jersey Medical School
Excerpted from the Bulletin of the IACFS/ME, Volume 17, Issue 1, 2009
Full text available at:
http://www.iacfsme.org/BULLETINSPRING2009/Spring09LangeMultitaskingChallenge/tabid/366/Default.aspx

As a researcher and a practicing clinical neuropsychologist, my task is to assess cognitive function in CFS patients. Very often the findings are consistent with decreased information processing speed and poor working memory while overall intellectual function is usually intact. These results are supported by increasing research evidence.

Frequently during the feedback session I am told about problems like, “Since coming down with CFS, food shopping has become an increasingly difficult task for me. I used to be so organized and enjoyed going shopping once a week for all my family’s needs; it made me feel good. Now I get so confused and exhausted if there is a lot of traffic, I have to stop and then turn around. Once I could not remember where I had to turn and even got briefly lost. I just sat in my car and cried.”

This CFS patient describes an event that most people, healthy or sick, consider an everyday, commonplace activity. We do not generally think of all the separate steps involved to accomplish the overarching goal to go food shopping. If healthy, we achieve the goals of the sub-tasks involved successfully, because task execution is performed almost automatically. For instance, most individuals do not tend to spend much focused attention on the mechanics of driving a car while monitoring traffic and thinking ahead to the next goal, which they fully expect to achieve once initiated after they navigated the well-learned road to the store and parking the car. Many individuals even manage to simultaneously rehearse their shopping list while driving, listening to the radio, and answering the cell phone plugged into their ears.

In terms of cognitive science, the everyday food shopping event described above is anything but simple. For successful completion, it requires an individual to “multitask,” now a term familiar to almost any adult and an activity coveted as necessary to perform successfully in today’s society. Multitasking requires top down control by what some cognitive scientists theoretically call the supervisory attentional system (SAS) or the central executive. These executive control systems are thought to provide assistance in doing multiple tasks simultaneously, promoting one, while inhibiting action on another, screening out irrelevant distractions, all the while integrating streams of new information and updating online an individual’s “mental computer.” Doing this assures successful completion of subgoals, while delaying the initiation, execution, and completion of future goals ultimately contributing to a successful completion of a larger event, such as food shopping. A smooth functioning executive control system results in an individual’s perception of being able to perform the food shopping event effortlessly and almost automatically. Importantly however, for this to occur, information processing speed and working memory have to be intact. This is not the case for many CFS patients. If the executive system is not effectively supported by these essential cognitive components, it will not be able to do its job. Effortless tasks become effortful, interfering events and stimuli are not screened out successfully, setting priorities appropriately becomes difficult, overall task execution and completion is jeopardized. Less effortful top-down processing turns into more effortful bottom-up processing.

Poor processing speed and working memory manifest in daily life, but the question that remains to be answered is possibly more important: “What can I do about it?” Following are some tips I usually advise my patients to consider:

1. Do not continue to try and complete ‘everyday’ tasks, such as food shopping, the same way you did before you became ill. A paradigm shift is in order.
2. Unlike the perpetuated myth that multi-tasking saves time, it does not for patients with CFS; instead unsuccessful multi-tasking takes more time, adds anxiety and frustration, thus compounding the problem. Many CFS patients encounter difficulties multi-tasking. Instead of continuing to try and do multiple things at the same time, do them serially. It will enhance the number of reasonable goals you can achieve successfully.
3. Instead of developing a shopping list in one sitting trying to remember all the things you thought you or your family members needed, write them down in a dedicated notebook that sits on a dedicated spot on a shelf or counter, as you think of them. Your notepad should have 3 categories to help you prioritize your list to facilitate shopping when you get to the store, taking into account that you may just feel up to getting the most urgently needed items. These categories are: RED (urgent need), YELLOW (needed in near future), GREEN (stock item, long-term need).
4. Depending on how you feel once you get to the supermarket, prepare yourself mentally that you might only get the items in one category. This counts as a successful trip to the store.
5. Do not push the cart through every aisle; it will interfere with your goal-oriented approach and tire you out unnecessarily. Instead, shop selectively for the items you need. If you are not familiar with the store, try and figure out a select way of shopping by studying the aisle designations. If all else fails, sit down and ask a store attendant to get you the items in a select category that is written in your notebook.
6. Do not drive to the store during rush hour; avoid any additional distractions while driving. The action of driving and monitoring traffic is not as automatic as it used to be and thus requires more attention and more effort. Do not hesitate to ask someone to drive you to the store.
7. Remembering where the car is parked on a big parking lot is a concern that comes up frequently. Try to park your car in the same parking lot area every time you go optimally next to an easily recognizable landmark on the lot. This will reduce the need to rehearse the location while shopping and further enhance a successful shopping experience.

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