*UPDATE* Psychological Effects of Heart Rate Monitor Use Study

12/21/2010: Preliminary results were reported at Indoor Cycle Instructor in October 2010. Manuscript in preparation. Once published, results will be made available on this site and at ICI.

Saturday, September 19, 2009

"Own Your Discomfort" - a 75 minute profile

We all have uncomfortable moments in our worlds -- as athletes, as coaches, and human beings. As a second-year medical student who, despite knowing a ridiculous amount of useful, important medical things, knows really quite little about how to actually help really sick people in the clinic or the hospital where she spends time, I have a lot of them. I debuted a ride last night based on the past few months of my world, very specific efforts to ponder the concept of "discomfort" and what to do (or NOT do) about it. It turned out to be the most rewarding and successful ride I've ever presented. So clearly, I have to write about it.

Pardon the long background -- but I thought it was important to frame where this ride came from, so that you can inhabit it enough to devise your own personally meaningful cues if you use this training session for yourselves or your classes. Otherwise, it's not going to be any different from any other profile. This is a ride that comes from pain, self-doubt, and inadequacy. That's hard to describe in a paragraph.


As a med student, I spend 70% of my clinical training feeling anxious, useless, and awkward. When I experience these emotions, my sympathetic nervous system fires off a crazy storm of catecholemines. I'm tachycardic, sweaty, stuttery, and a big ol' mess. When I try to "squash" these uncomfortable sensations by reasoning myself out of them, however, I find that I get all the more awkward. I'm consumed by "my awkward." My brain shuts down, and I am distracted from soaking up the important subtleties of the world around me -- not to mention unable to remember any useful content once encoded into the archives of my memory, which is what typically triggers these episodes in the first place. While I acknowledge that this discomfort is normal/common/expected, that doesn't make it less uncomfortable.

As an athlete preparing for my first Century ride this summer, I knew that "discomfort" was my #1 challenge. I knew how to keep my heart rate low under exertion. I knew how to eat and hydrate effectively. I knew that my rate-limiting factor was going to be how COMFORTABLE I could train myself to be with being INSANELY UNCOMFORTABLE. So I trained for it. In addition to long rides outdoors, I included regular 3 hour, 4 hour, 5 hour training sessions on a Spinner (more tedious than spending the same length of time outdoors). I did not attempt to convince myself that I wasn't uncomfortable. I was completely miserable. Could I have reasoned my way through it -- that I wasn't ACTUALLY miserable, that I was doing so much of what I loved? Could I have done a pros/cons analysis to conclude that there was more evidence to suggest that I was actually happy? Maybe. But I didn't. I talked myself through every minute of those AWFUL trainings while explicitly acknowledging how miserable I was, and why I was doing it. What purpose would serve? What did I want to learn? What did I want to master? What would I be uniquely qualified to do for having completed this? What would the difference be between 4:59 and 5:00? I knew that if I could get through those 5 hours, there would be NOTHING that could ever possibly arise on my Century that I couldn't handle. On The Big Day, I reminded myself of that over and over and over again. "Remember your discomfort. Re-experience it. Re-inhabit it. You lived through THAT. Are you as uncomfortable as that moment? No. There is no evidence to suggest that you cannot conquer this moment."

One of the ways we treat patients suffering from panic disorder and others on the anxiety spectrum is to gradually expose them to known triggers, under safe conditions where they can experience their uncomfortable, undesirable symptoms in such a way that they learn that these experiences aren't the "worst thing that could ever possibly happen" to them. I've extended this theme to my medical school life now. I'm training myself to be comfortable with discomfort. I've started using the phrase "OWN YOUR AWKWARD," which I apply not only to awkwardness but perceived incompetency, inadequacy, and all sorts of horribly uncomfortable, negative emotions. I specifically seek out experiences that will trigger discomfort: interpreting an EKG in front of 114 people (despite knowing that I was terrible at this), giving a patient medical advice about chest pain in front of the specific attending physician (whose opinion of me matters to me more than most people in the world), asking the same character if I could accompany him to the hospital in the middle of the night JUST because it made me anxious to be there (he found this endearing). Through all of these experiences, I was awkward, anxious and inadequate. I didn't attempt to convince myself otherwise. "You are awkward. Yes, you are awkward. Roll with it. Own your awkward."

Over time, I'm actually a little bit more comfortable with being uncomfortable. So when I have these moments, my brain doesn't shut down. I acknowledge that I am uncomfortable, give myself permission to be uncomfortable, and keep on with my life. When I say something stupid/wrong/embarassing in front of 115 people, I feel the same catecholemine storm -- and I don't try to breathe it away. It's not "Shit! Panic attack starting. Breathe. Don't be anxious. STOP being anxious." Instead it's more like: "Look, catecholemines! There they are. Own them." And then they pass, pseudo-instantly. Fascinating.

Last Sunday, I rode my 2nd Century. I dedicated it to the concept that it was the ULTIMATE discomfort immersion. That somehow it would represent every aspect of discomfort that could exist -- and that, looking back on it over the next weeks and months, it would remind me that I could indeed accept discomfort and endure whatever came my way.

I wanted discomfort, and I got it. 1 mile in, my chain started squeaking and I was riding on false flats in my lowest gear (I didn't see anything visibly wrong with it, so I kept going -- miserably). At the 5 mile mark, it started pouring. By mile 10, I was soaked and freezing. At the 20 mile mark, my injured tibialis anterior tendon started spasming. I'd forgotten my sunglasses, which didn't occur to me until mud-slicked gravel started flying up into my face. I intentionally started out at 7:30AM in the middle of nowhere (50 miles from home -- I'd ridden out the day before and stayed overnight at the cottage where I lived for the summer near the clinic) so that I would be less tempted to give up and call for "rescue." At the 60 mile mark (see also: civilization), I went to a bike shop and got Triumph fixed (a spring had popped -- I didn't even think to LOOK there!) and had a hot meal (life-altering). I bought a dry shirt, new sunglasses, and a big ol' tube of chamois cream. Life was good -- for another 10 miles at least. Miles 71-85 were some of the most MISERABLE moments of my life. They never ended. It occurred to me that I was in some parallel universe where time and distance simply did not coincide. I couldn't get my HR up past 70% MHR. The friction rub on my left thigh (from my rain-soaked shorts) was getting unbearable. I hated my bike. I hated my mission. I hated EVERYTHING about this moment.

"You wanted this. You wanted to be so uncomfortable that you couldn't bear it, so that it can apply to situations that are far less uncomfortable than this one. You wanted to demonstrate your strength and patience. You wanted to learn that this "concept" you've taken on as a life theme really will carry you through every challenge of your day. This is precisely the unique condition that will best allow you to train for what you need."

Then suddenly, I saw it. A sign that, for all intents and purposes, said "HOME: 12 miles."
It was a moment I will never forget for the rest of my life. I have the chills as I write this, in fact.
A rush of warmth and gushing energy surged throughout my entire body, and I started BAWLING. I mean literally, bawling. For the first time in the ride, it was 100% undeniable that I would actually complete my second 100-mile conquest. For the first time in the ride, I justified EVERYTHING I'd been through: my emotional outpour demonstrated that this hasn't been "all talk." I'd wondered how "real" my belief that a bike ride symbolized some sort of great life truth, or whether that was just a gimmick I'd brainwashed myself to perpetuate to get myself and others to ride their bikes. No. Every tear came directly from my reality.

I was so close to realizing my goal that, suddenly, the discomfort was transformed. It became my "new comfort zone." From there on, it wasn't self-talk about how present discomfort would translate into comfort in the rest of my life. I didn't notice the discomfort. I was so comfortable with my discomfort, that it no longer inhibited my ability to achieve my goals. I owned it.

The Ride
When one of my regulars as a birthday, I invite them to select a "life theme" they want to process mindfully on a Spin bike. (This sounds nuts, I know -- but in the parallel universe in which I am fortunate to coach, I've trained people to actually enjoy this "life training through Spinning" construct I employ). So with a 75 minute session scheduled on the day of one woman's birthday, it was her turn. "How about self-acceptance?" she asked me.

A ride about the specific concept over which I've been obsessing for the past 3 months? Uhh, YES.

So here goes:

We all have situations and moments where we are uncomfortable. We all have various strategies to minimize discomfort, with various levels of success. Sometimes we invest so much time trying to deny our discomfort -- to talk ourselves out of it -- that we allow our discomfort to distract us from accomplishing the things we want in life. So today, we're going to practice another approach. Instead of talking ourselves out of discomfort, we're going to acknowledge that discomfort.

(Before class, I'd had each participant write on an index card "something that makes them uncomfortable that they're willing to invest time exploring during this ride." They taped the cards to their water bottles, for them alone to see. I do this index card auto-cueing move for every training session I coach that is longer than an hour. People LOVE it. For riders new to my long training sessions, I acknowledge its cheesiness up-front before they have a chance to write me off as "un-relatable" and tell them that this "surprisingly" REALLY helps people by the end of the ride when they're exhausted. "Surprisingly," my ass. It's enforcing that they set goals! Of COURSE this helps.)

This ride has 3 blocks:
1) Dabbling in Discomfort
2) Commiting to Discomfort
3) Owning Your Discomfort

WARMUP (5 minutes)
* Progressive loading to "4 out of 10" on RPE scale. Shoulder rolls/stretches. Cue mindful orientation to breathing, upper/lower body form, and pedal stroke.
Think about what you wrote on your index card. Why did you choose it? What is it keeping you from doing? What does it mean to you?

(18 minutes)
* Progressive loading to 80% LT ("5 out of 10"). When you reach it, maintain it -- subtle bits of resistance, lengthened exhalations, keeping the heart rate exactly where it is. When you reach the point that this place feels completely and utterly comfortable despite adding more resistance at the same level of intensity, that you are willing to entertain the concept that you can hold this all day and be perfectly happy to do it, then keep going.
* Progressive loading to 20 beats below LT ("6 out of 10")-- same.
By loading the intensity so gradually, you are training your body to allow you to get more work done without working harder. You are accepting each new challenge, adapting to it, establishing it as your "new comfort zone," and readying yourself for your next choice.

Focus on your deliberate, fluid breathing. In through the nose, long and concentrated out the mouth. Synchronize your breathing with your pedal strokes -- maybe breathing in for 2 strokes, breathing out for 3 or 4 strokes.

* Surges to 10 beats below LT ("7 out of 10"): 4x (30 seconds), 1x (60 seconds).
From the baseline of 20 beats below LT, 5 "surges" -- your choice of challenge: change in speed, resistance, or position. Recover "20 below" in between.

Focus on breathing more deliberately when you surge. FORCEFUL breaths out the mouth to keep the heart rate from exceeding 10 beats below LT. It's uncomfortable but it's a challenge that you choose to accept, and can conquer confidently.

* Recover to 80% LT. Progressive loading - subtle bits of resistance added but heart rate stays the same. When you're confident that this is your new comfort zone, progressive loading to 20 beats below LT. When you're confident that THIS is your new comfort zone, keep going.
* Find 10 beats below LT and commit to it, no matter what. If you're dropping, progressively load the resistance. If you exceed, back it off. If you need to stand up out of the saddle to accomodate a new load or new pace, do it. Drop back in when you can.
Demonstrate your patience, your willingness to make decisions to honor your commitments to yourself.

Surge: 1 minute (LT - "8 out of 10")
Your choice of the challenge that means something to you: speed, resistance, position, or no change at all. When you surge, surge with confidence. With pride. With the genuine belief that you will conquer what you decide to conquer.

BLOCK 3: OWN YOUR DISCOMFORT -- combining the two (30 minutes)
You have learned that your previous discomfort -- 10 beats below LT -- isn't actually all that bad if you a) accept it gradually (i.e., hitting all the heart beats in between); b) monitor your breathing to fuel your efforts. You've also learned that you are in complete control over defining your comfort zone. 10 beats below LT didn't feel so bad by the end of Block 2 as it did when you surged there in Block 1. (People nodded across the board, thank goodness!) So now we will build upon the skills you've developed, and apply your commitment and focus to re-define your comfort.

Same progressive loading from 80% LT ("5 out of 10") through 10 beats below LT ("7 out of 10")
Take your time over the next 5 minutes to gradually accept the challenge at hand. Spend time at each stop along the way, mindfully acknowledging your physiological sensations at each level of intensity. Does your breathing change? Does your pedal stroke change? How is your upper body? Is every aspect of your experience contributing to your ability to commit to this challenge?

* 5 surges to LT ("8 out of 10") -- recovering to 10 beats below LT ("7 out of 10") in between
Efforts: 90 seconds, 2 minutes, 90 seconds, 2 minutes, 3 minutes
Recoveries: 5 minutes, 4 minutes, 3 minutes, 2 minutes
Technical purpose: lactate clearance intervals. By spending time in incomplete recovery just below LT, your body is learning to clear lactic acid more efficiently -- because it has to!
Larger purpose: You are uncomfortable. You are SO uncomfortable. But your active "recovery" is a comfort zone you defined yourself. You believe in your ability to be successful there. When you choose to accept a new challenge, breathing your way through it, you know that you can and WILL achieve it.
You're uncomfortable, but you lack not in confidence and determination

We alternated 90 seconds/ 2 minutes/ 90 seconds/ 2 minutes for the LT intervals because I knew that half my class didn't have HRMs, and I wanted quality control over how hard they were pushing. I described that at 90 seconds of "8 out of 10," they should NOT feel spent. Burning in the legs might have started but they should feel like they can still get a few words out, no chest discomfort, NO inability to control their breathing, and a clear appreciation that they could have kept going. At 2 minutes, they should experience close to the same -- still NOT spent.

I talked about the scientific process of modifying lactate threshold, to increase the point at which they are still using mostly fat for fuel. Reminding them of the technical purpose for their discomfort, I felt, was important. But then I also cued them to look at the index cards on their water bottles and re-affirm their commitment to spend time making peace with where they are.

Own your discomfort. Own your self-doubts, your perceived inadequacy. Own your potential.
3 minutes - LT - OWN it.

And, daaaaaaaaaaaaamn, did they ever.


Anonymous said...

Incredible. Im trying this profile today with a renewed purpose in teaching spin!! Cannot wait. It's just what I was looking for.

Melissa Marotta said...

Your post makes me SO happy! Utterly thrilled. You made my day. Please let me know how it goes!