Psychological first aid - how cyclists can mentally recover from A traumatic BIKE CRASH
Psychological First Aid for Cyclists Who Have Recently Crashed
It is a truth universally acknowledged that if you ride a bike, at some point you’ll fall off. Maybe the wheels slid out from underneath you on gravel or ice. Maybe you were knocked off by another person or vehicle. Maybe other cyclists were involved, and it was a race situation. However it happened, the risk of crashing is also the risk that makes cycling more exciting than many other sports.
Just like physical first aid, it is important that cyclists become aware of the psychological first aid options available to them, for one very good reason…. You want to enjoy cycling again!
The human mind consists of both conscious and subconscious parts. It’s much the same relationship as a beautiful 5 ton elephant, being ridden by a person sat on top. The person is the conscious brain, believing they’re in control. After all, they have the power of speech and rational thought. But in a stressful situation there’s nothing stopping a 5 ton elephant from stampeding through the jungle, crushing everything in its path, to keep you safe.
Ultimately your subconscious is like that 5 ton elephant. Its duty is to keep you safe, and there’s very little that your conscious brain can do, in the heat of the moment, to over-rule it.
The subconscious is a very powerful, amazing and special part of who we are. It only has your best interests at heart, so the first stage of psychological first aid is to accept that something traumatic has happened, and understand that your elephant brain will want to process this event in the most memorable way, so that it can protect you from repeating the same pain. Elephants never forget, but it turns out that you can shape the memory of your crash so that it is less traumatic as it gets stored away in your subconscious.
Think of an old metal filing cabinet. Remember those before we had unlimited data storage in a cloud?? The cabinets had large drawers that slide out, containing hundreds of paper documents.
Our memory is much like that… millions of instructions on how to behave, based on the experiences that our subconscious has been storing away since we were born. Your subconscious is so amazing, that even though you haven’t directly experienced an event, your filing system will fill in the gaps and you’ll even be able to imagine a scenario that someone else is experiencing, as if it was you. It’s called empathy, and you wouldn’t enjoy a film without having this wonderful capability.
So if we allow the elephant to process your crash on its own, it will process that memory in intense detail, in red writing, with an alarm system so that whenever you find yourself in a similar cycling situation the template on how to behave will be easily found…. Brake… this is dangerous… don’t go round that bend so fast…. That car will pull out any second…. Be on high alert! You can imagine how unenjoyable cycling will be, with all of this stressful thinking going on… as your mates merrily cycle off into the distance.
And then there’s the relationship between elephant and rider. The conscious brain is thinking “look this is ridiculous… I should be able to sweep around this bend like everyone else… why can’t I just do it !?!? I just can’t stop feeling so nervous about crashing again…” With every thought and internal remark, the rider is whipping the poor elephant for doing its job of protecting you.
So what can be done?
Well, understanding this process can help you to be kind to your elephant – after all it is doing its evolutionary best to keep you alive.
There are also some first aid activities you could apply, which may soften the way that your elephant stores this traumatic event, so that when you are able to ride your bike again, your mind is less traumatised, enabling you to find enjoyment (or race just as hard) as you did before.
The latest research from the Karolinska Institutet with Oxford University, suggests that there is an optimal 6 hour window to shape the memory before the subconscious starts to process it into long term memory. Try Steps 1-4 as soon as is practically possible after your crash, maybe in A&E, or once you are physically settled. If possible, work through these activities before you sleep for the night. The subconscious stays awake to keep you safe all night, whilst your conscious brain rests, so it will do most of its memory processing at night. If you have a suspected brain injury only complete Steps 1&2.
***Health & Safety warning – please don’t do these activities if your injuries are too acute, or if doing the activities themselves will make your condition worse***
Step 1
Breathe
A simple way to de-stress and restore calm. The aim is to lower the adrenalin and cortisol levels. Take some deep breaths in through your nose and out through the mouth. Try to lower your breathing rate to enable you to count to 4 slow seconds on the in-breath… then hold for 4 seconds…. And then release the breath for the count of 8.
It may take a while for you to slow your breathing down to this rate. Go with a count-rate that feels comfortable for you
Step 2
Play Tetris
Find a safe place. Play some free games of Tetris on your smartphone. You can use any visual/spatial activity that requires your brain to work out shapes and moves your eyes around the screen. Whilst playing this game, verbally speak the key moments of your crash out loud.
I know this sounds strange, but I assure you there are no candid cameras filming you! It works on a similar principle to EMDR (eye movement desensitisation and reprocessing). This therapeutic intervention has helped many people (especially those with PTSD) to reduce the flashbacks, panic attacks and anxiety from traumatic events. It works on recalling the trauma whilst moving one’s eyes from left to right. How amazing is your brain!! The memory becomes re-processed in a less intense way. If your crash was days or weeks ago, and your cycling enjoyment is still being affected, try seeking the help of a qualified EMDR therapist to help you feel calmer about cycling again.
Step 3
Hypno-healing
Hypnotherapy can also be a useful addition to your psychological first aid strategy, although finding a hypnotherapist within the first 6 hours of your crash could be a challenge. Hypnosis could still be beneficial beyond the 6 hour window. Hypnosis is a very relaxing and calming process whereby a qualified professional will simply tell your conscious brain a story to help it drift off into a dream, leaving your subconscious (which is always awake) open to positive suggestion.
Given that your mind and body are inter-dependent (ie your body can affect your state of mind and vice versa), hypnotherapeutic visualisation can improve the healing process and reduce the attachment to pain signals. Visualisation has also been shown to reduce muscle wastage and hasten the recovery time.
I have recorded a hypnotherapeutic session for use as first aid only.
***WARNING****
YOU SHOULD ONLY LISTEN TO THIS IN A SAFE PLACE, WITH SOMEONE OBSERVING YOU, WHERE YOU CAN RELAX IN COMPLETE SAFETY. By listening to this, you acknowledge and accept full responsibility for the effects thereof, and waive the right for legal redress, should any harm come to you. Do not listen to this recording if you have suspected concussion or any suspected head injury ***WARNING***
CLICK THE AUDIO TO START PLAYING:
Step 5
Imagine The Perfect Version of Events using Mental Imagery
This can be practised both within the 6 hour recovery window, and thereafter. The more times you can visualise a better version of events (with every detail as accurate and clear as possible), the more opportunity for the subconscious to process a less intense memory. Visualisation works on the idea that using your imagination to ‘see’ and ‘feel’ things going very well can have a positive effect on the reality. Many Elite sports professionals use visualisation to improve performance.
1) Find a place you can concentrate and be uninterrupted
2) Take a couple of deep breaths to connect your body, mind and senses – be present
3) Adopt a similar bike position (but using a chair)
4) Breathe deeply to retain your calm
5) Begin your imagery by imagining yourself in the moments before the critical incident – dial up the pleasant experience beforehand (see the colours, enjoy the feeling, notice the smells and sounds) make this a pleasurable experience
6) Bringing these sensations with you, play the imagery tape forward (slower than real time so you can control the scene) see the perfect line, feel the bike leaning, spot the gap. See and feel everything going well.
7) Pause the image at the critical moment(s) to notice every element of your body position from head to toe. Marvel at the perfection of this image and how good it feels.
8) Breathe deeply and restore calm.
9) Play the remaining mental movie slowly to maintain the ideal outcome and finish the scenario at a place of calm.
10) Repeat as often as you can.
Repeat your ‘ideal’ mental imagery regularly within the 6 hour window, and daily thereafter.
To enhance the benefit of this imagery work, and help translate it into the real world experience, create a calming phrase and repeat it throughout your visualisation. For example “I’m so calm and relaxed sweeping around this bend”.
Step 5
De-sensitisation
This stage requires your body to have fully recovered from injury, and your mind to be ready to ride again. The threat detection radar of your subconscious will be on high alert for the first few times you ride again post-incident. Take it steady initially and re-connect with the joy of cycling to remind your subconscious that good things happen when you ride. Pick a sunny day, a friendship group or some amazing countryside to encourage the endorphins, oxytocin, serotonin, dopamine to get flowing again. As you are cycling along, visualise all of these wonderful hormones being released as you enjoy the experience.
When you feel ready to build your confidence, start by making a de-sensitisation plan. List anywhere between 5 and 10 stages of increasingly more challenging scenarios, so that 1 is your easy next step, and the uppermost scenario is where you would like to be.
For example – here’s a 6-step de-sensitisation list for being able to corner in the wet (after crashing whilst cornering on wet roads):
1) Solo bike ride on flat roads whilst raining – super slow around corners
2) Solo bike ride on wet hilly route – super slow around corners
3) Steady group ride on wet flat route at the back of the group around corners
4) Steady group ride on wet flat route at the mid/front of the group around corners
5) Faster group ride on wet flat route at the back around corners
6) Faster group ride on wet hilly route at the mid/front of the group around corners
Apply your own timeline to the plan – when you feel comfortable with each stage move on to the next. You could also transfer your mental imagery skills from the previous stage into reality. As you approach a stressful moment, scan your body for tension and breath some relaxation into that part of your body, allowing yourself to relax through the arms. You may choose to repeat a calming phrase as you go through the triggering moment (see previous step)
Step 6
Talk It Through
Share your fears and talk through your worries about what might happen as you cycle again. Ask someone you trust if you can get things off your chest. Verbalising your worries could help you to rationalise things. Your subconscious is always listening so avoid berating yourself! Select someone who will listen well, not judge you, and will ask questions rather than telling you what to do. This conversation is more likely to take place in the cycling café during the rehab / healing phase rather than within the 6 hour window.
Many cyclists regain confidence and enjoyment of cycling over time. The subconscious will come to realise that it doesn’t have to put you on high alert so frequently, or with such intensity. Often there will be residual anxiety, so the situation becomes manageable rather than disappearing completely. For now, sleep easy with the expectation that you will heal both physically and mentally. Allow yourself some time, take positive mental and physical action to heal a little more every day, don’t be too hard on yourself, and take comfort in the knowledge that you will regain your composure and enjoyment for cycling again.