Ask Kathy M. Archives
A Collection of Questions and Answers from TBI Advice Expert - Kathy Moeller

Topic: Miscellaneous - Difficulty Initiating Activities


Dear Kathy M.,

I have trouble getting started. By this I mean I seem to need cues (or something) to get me into action. This isn't a huge problem for me, but I struggle with it sometimes. I was wondering how others deal with it. Are there any common strategies people use? I write things down, and am constantly rehearsing in my mind what needs to be done. What do you think?

Dan W.
Garnerville, N.Y.

Kathy's Response: Dear Dan,

This is an excellent question, Dan! Commonly referred to as having difficulty with initiation, it's a real problem for many persons with brain injury. In my experience, the act of initiating activities ("getting started") just doesn't seem to be automatic, any longer. It's not necessarily a matter of motivation or even energy. Sometimes I just can't get started!

Yes, there are a couple of strategies persons with brain injury use to "get going." My favorite is to break the task down into smaller parts and schedule each part at a specific time. Then, as long as I faithfully stick to my written schedule, and mark off each part as "Done" as soon as I do it, big tasks magically end up getting completed, even though I never really felt like I "initiated" doing the whole thing.

An example I can think of from my own person experience is "going grocery shopping." I struggled with this for months early in my recovery -- sometimes to the point where I would end up hungry, with no food in the house, but still not being able to initiate the act of "going shopping." I solved this particular problem by breaking the task into smaller parts and telling myself (giving myself permission) to only do the first part (for example, perhaps just writing out the shopping list and then getting into the car). I allowed myself to decide at the time I got into the car if I really wanted to drive to the store (notice, I said "drive to the grocery store" not "go grocery shopping").

By the time the relatively daunting task of "going grocery shopping" was broken into individual parts, it looked something like this:

10:00 Write out grocery shopping list
10:30 Get into the car
10:31 Decide if I want to drive to the store
10:45 Decide if I want to enter the store
10:46 Park the car (noting where the car was parked in relation to the door I would enter)
11:00 Enter the store
11:01 Decide if I want to get the first three items items on my grocery list, etc., etc.

When this was an issue for me (circa 1991), I seldom initiated "going grocery shopping," but I could do the first step. . . then the next step . . . and the next step. Expecially if I could see the steps in front of me listed in my planner for doing specific times.

A similar example is breaking down the steps for "doing the laundry." For example:

2:00 Put 1 load of dirty clothes in laundry basket
2:15 Take laundry basket to laundry room
2:20 Wash 1 load of clothes
2:40 Take clothes out of washer and put into dryer
3:15 Takes clothes out of dryer, fold them, and put them in laundry basket
3:30 Take clean clothes back to apartment
3:40 Put clean clothes away

This is not the only strategy that works for people. Sometimes the problem with getting started is more related to the fact that a person doesn't know what the first step is for doing a task (even what used to be a so-called "simple" tasks). This is also common and hopefully people don't get so frustrated by not knowing that they give up trying altogether.

In situations like this, a useful strategy may be to list on a piece of scratch paper all the steps that do come to mind, and work from there by adding and arranging sub-steps, ultimately putting all the steps in order and then scheduling the parts in their planner.

There's no simple answer, and there are other strategies too (probably ones I haven't heard of yet too). I know one person who always cleans up her schedule when she gets "stuck." Somehow, the act of doing something familiar and orienting, just gets the momentum inside her going, and she can get started with whatever it was she was having trouble initiating.

Hope this helps,
Kathy M.

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