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Mini: Restless Leg Syndrome · Why We Do What We Do

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  Speaker 1: You're listening to Why we do what we do. Welcome
• 0:15
  Speaker 1: to Why we do what we do Mini. I am
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  Speaker 1: your host Abraham and I'm Shane. We are a psychology podcast.
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  Speaker 1: We talk about the things that humans and non human
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  Speaker 1: animals do, and sometimes we talk about the somewhat involuntary
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  Speaker 1: seeming things that they do. And this is a mini
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  Speaker 1: which means it's short. We're into a quick discussion of
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  Speaker 1: that thing and then be done and go about and
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  Speaker 2: Yeah, so so far we have been pretty successful with
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  Speaker 2: this challenge. Not always, but for the most part, I
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  Speaker 2: think we do a pretty good job.
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  Speaker 1: Yeah. Usually, I think it shakes out about that way.
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  Speaker 1: talk more about those things at the end of this discussion.
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  Speaker 1: They're more preamble before we jump into it. I think
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  Speaker 1: I said everything.
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  Speaker 3: I think you said everything. I think you got it covered.
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  Speaker 1: All right, Great, maybe I said if you're new, but
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  Speaker 1: if you're returning, also welcome back. I think that's important
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  Speaker 1: part of it. Yeah, yeah, anyway, I think yeah, I
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  Speaker 1: did say that. Okay, never mind, we're good. I want
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  Speaker 1: to start with a quick disclaimer. So we are talking
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  Speaker 1: about restless leg syndrome, which is kind of like a
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  Speaker 1: unique thing for a psychology podcast to talk about. Hopefully
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  Speaker 1: the reasons for that will become more clear here in
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  Speaker 1: a moment, but I want to start with a quick cya,
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  Speaker 1: which is this is not intended to diagnose or treat
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  Speaker 1: any disorders. Please consult your physician and psychologists when making
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  Speaker 1: any decisions about your medical care and possible diagnoses. So
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  Speaker 1: just no going into that. This is not something you
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  Speaker 1: walk away with and you have a new diagnosis. Ideally
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  Speaker 1: you do not, But just wanted to talk about this
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  Speaker 1: as a thing that happens. Also, please try to avoid
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  Speaker 1: leaving this episode having suddenly developed restless legs syndrome by
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  Speaker 1: hearing us talk about it. There is a tendency to
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  Speaker 1: do that sometimes, and I'm hoping to dissuade that from
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  Speaker 1: happening if possible.
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  Speaker 3: Yes, yes, so let's go ahead and get into it.
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  Speaker 2: And I mean, those are perfectly appropriate disclaimers, just given
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  Speaker 2: that some people are very easily influenced. So just be mindful,
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  Speaker 2: go get to a doctor and all that.
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  Speaker 3: So all right.
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  Speaker 2: Restle's leg syndrome is a condition in which the sufferer
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  Speaker 2: experience is a powerful urge to move their legs. People
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  Speaker 2: with ROLS often report discomfort in their legs, which is alleviated,
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  Speaker 2: at least temporarily by moving their legs around or walking.
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  Speaker 1: Now, the discomfort that they report is extremely varied. It
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  Speaker 1: ranges from things like them saying that they have cramps
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  Speaker 1: or numbness, to throbbing, aching, itching, pulling, and I left
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  Speaker 1: out about a half a dozen more or maybe a
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  Speaker 1: dozen more. Really, the only thing that's pretty consistent, or
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  Speaker 1: is it completely consistent across these is the urge to
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  Speaker 1: move their legs. That's the feature that is the same
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  Speaker 1: regardless of the onset the prevailing experience that makes that
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  Speaker 1: urge valuable, if you will.
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  Speaker 2: Right, And this potentially underscores our lack of ability to
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  Speaker 2: attackt our private sensations well or consistently with other people,
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  Speaker 2: because we can't tell what someone else is actually feeling
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  Speaker 2: when we start trying to label that feeling for them,
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  Speaker 2: So they develop their own associations with what labels go
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  Speaker 2: with what experience is. What is a cramp to you
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  Speaker 2: might be tightness to me, and so on and so forth. Right, So,
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  Speaker 2: like we can kind of see how people language differently
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  Speaker 2: around what could be similar sensations.
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  Speaker 1: Yeah, and this is I think a common feature of
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  Speaker 1: things that we like to talk about with private experiences
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  Speaker 1: is like when you are having some kind of pain
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  Speaker 1: inside of you, we often lean on metaphors to describe
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  Speaker 1: that pain. A sharp pain is a reference to like
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  Speaker 1: how things feel that are sharp that we can touch
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  Speaker 1: and know that they feel sharp. A dule pain is
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  Speaker 1: like something where we might gain and think of something dull,
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  Speaker 1: and we think of like sparkling as a metaphor to
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  Speaker 1: relate to random bursts of pain maybe that are small,
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  Speaker 1: or it doesn't have to be pain either. It can
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  Speaker 1: just be like random pops of sensation. So anyway, we
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  Speaker 1: use these sort of metaphorical language because it's really difficult
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  Speaker 1: to know how to label them because we don't have
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  Speaker 1: anybody around us who can tell us how we're supposed
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  Speaker 1: what that feeling is, because they can't tell what we're feeling.
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  Speaker 1: So when kids are growing up learning these things, they
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  Speaker 1: develop their own sort of regional and familial relations with
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  Speaker 1: what those sensations are. Anyway, all that is to say,
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  Speaker 1: patients are most likely to report and experience restless leg
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  Speaker 1: syndrome when they're sitting or lying down for long periods
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  Speaker 1: of time. This actually is kind of the crux of
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  Speaker 1: why we think this is interesting to talk about from
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  Speaker 1: a psychological perspective. It's the specific setting event here where
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  Speaker 1: you're sort of immobile for a period of time and
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  Speaker 1: you have this urge then to move your legs. To
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  Speaker 1: this end, though, a period of time where you were
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  Speaker 1: often sitting or lying down with very little motion is
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  Speaker 1: when you're sleeping, and therefore this is a condition that
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  Speaker 1: sometimes interrupts or prevents people from being able to get
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  Speaker 1: adequate sleep.
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  Speaker 2: Right now, restless leg syndrome is experienced by five to
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  Speaker 2: ten percent of adults around the world, with women experiencing
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  Speaker 2: it more than men. It is associated with other conditions
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  Speaker 2: such as depression and anxiety.
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  Speaker 1: Now, this actually can develop at any age, and it
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  Speaker 1: does tend to get worse with time. Possible causes include
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  Speaker 1: things such as nerve damage either genetically or from an injury,
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  Speaker 1: kidney failure, spinal injuries, iron deficiency, kidney disease, diabetes, peripheral neuropathy, anemia,
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  Speaker 1: substance abuse, and Parkinson's. All of these have been related
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  Speaker 1: or associated with the experience of restless leg syndrome or URLSS,
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  Speaker 1: which sometimes called.
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  Speaker 3: It yeah yeah Now.
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  Speaker 2: Depending on the cause, treatments may include iron supplements if
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  Speaker 2: the person is iron deficient, physical therapy, dopamine agonists and
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  Speaker 2: anti seizure medication, warm baths, good sleep, exercise, massage, heat pads,
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  Speaker 2: and avoiding stress, as well as avoiding substance such as caffeine, alcohol, nicotine,
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  Speaker 2: and particularly avoiding those before bed.
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  Speaker 1: Yes, okay, So that sort of I think gives some
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  Speaker 1: understanding to some of this contextual variables related to the
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  Speaker 1: onset of this experience, as well as because we understand
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  Speaker 1: those contextual variables, that presents the opportunity for solutions to
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  Speaker 1: help mitigate that experience. Unfortunately, we don't have as readily
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  Speaker 1: a solution to mitigate ADS.
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  Speaker 3: Oh it's always ads.
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  Speaker 1: We are back, Okay, So I wanted this next part
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  Speaker 1: I think is important. So, as we mentioned, we were
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  Speaker 1: speaking to the contextual variables as they relate to the
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  Speaker 1: conditions under which this is likely to occur. And that's
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  Speaker 1: relevant for thinking about this because if there are environmental variables,
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  Speaker 1: then that's well within the wheelhouse of sort of what
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  Speaker 1: behavior analysts focus on and emphasize when working up treatment
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  Speaker 1: and interventions to support things that are behavioral. Important to
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  Speaker 1: say that there's not really any evidence to suggest that
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  Speaker 1: this is explicitly behavioral. That's not to say that it
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  Speaker 1: won't ever exist, but up until this point it really
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  Speaker 1: has not been treated or looked at in that way.
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  Speaker 1: And I think it's really a lack of opportunity to
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  Speaker 1: study and consider those environmental variables and the behavioral approach
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  Speaker 1: to them that may contribute to the development, onset, and
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  Speaker 1: maintenance of URLs. So I do think personally looking at
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  Speaker 1: these descriptions of rols, understanding the conditions of URLs speak
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  Speaker 1: pretty clearly to a behavioral condition, to a point. There
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  Speaker 1: are medical conditions here that should be looked at first,
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  Speaker 1: but I do think there are some behavioral situations and
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  Speaker 1: factors that would be very beneficial to consider, and so
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  Speaker 1: we're going to talk through what we think that those are.
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  Speaker 1: Are Again understanding that right now this is this is speculative,
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  Speaker 1: but I do think it's very within the realm of
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  Speaker 1: reasonable speculation and hypothesis given what we understand about this
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  Speaker 1: condition and about behavioral variables.
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  Speaker 2: Right, So let's consider, for example, stress and anxiety. Right,
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  Speaker 2: these are evoked by setting events that can have or
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  Speaker 2: that do have an aversive context, such as a work deadline,
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  Speaker 2: first date, major test, court appearance, constant reminders of a
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  Speaker 2: persistent fear. What we're saying here is situations in which
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  Speaker 2: all stimuli indicate a high probability of aversive outcomes.
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  Speaker 3: Right, That's that's what we're looking at here.
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  Speaker 2: And this contributes to stress and anxiety in lots of
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  Speaker 2: different ways, which again is part of what could be
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  Speaker 2: causing RLS for some folks.
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  Speaker 1: And that's whether or not this is like an experience
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  Speaker 1: someone had or like perceive that they may have. Like
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  Speaker 1: it could be like there is a difference between someone
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  Speaker 1: who is staring down the barrel of a gun, and
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  Speaker 1: someone who is afraid of staring down the barrel of
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  Speaker 1: a gun, even though they never have, but those can
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  Speaker 1: manifest and similar ways in terms of how they experience
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  Speaker 1: that fear. So that is an important thing here. So
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  Speaker 1: situations like this make behaviors that escape from or distract
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  Speaker 1: from the aversive event more valuable and rewarding. Sorry it's
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  Speaker 1: my Russian accents coming out revolding. We call these motivating
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  Speaker 1: operations in our behavioral world, and that is to say,
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  Speaker 1: like they make certain outcomes more valuable, they make them
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  Speaker 1: something that we would seek. So in these situations where
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  Speaker 1: we have that sort of experience where we have like
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  Speaker 1: something that indicates an aversive or something fidgeting, picking, wandering,
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  Speaker 1: other activities that pull our attention away from the unpleasant
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  Speaker 1: situation or otherwise stimulate our nerves so it gives us
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  Speaker 1: some sort of input, these are more likely to occur
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  Speaker 1: in times when we are particularly worried about some aversive event.
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  Speaker 1: That's relating it to stress specifically, But I think you
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  Speaker 1: could think of this also when there's some amount of boredom,
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  Speaker 1: like lack of stimulation means that now any stimulation added
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  Speaker 1: is going to be more valuable. If you're already over stimulated,
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  Speaker 1: adding more is probably not going to help. But like
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  Speaker 1: I said, these are more likely to happen in low
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  Speaker 1: activity mode. And for some people when they're in that situation,
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  Speaker 1: they might have the feeling that they should be doing something,
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  Speaker 1: but they're otherwise disengaged, and so then you have sort
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  Speaker 1: of these persistent thoughts and feelings of like obligation that
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  Speaker 1: weigh on you. And in these these moments again like
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  Speaker 1: engaging in something, fidgeting, moving, pulling like that starts to
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  Speaker 1: feel like it's moving in the direction that is wanted
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  Speaker 1: when you sort of feel like you're you're a little
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  Speaker 1: bit disengaged. Yeah, And just trying to make trying to
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  Speaker 1: pay the picture here that I think and make sure
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  Speaker 1: this is clear that like we want to appreciate what
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  Speaker 1: the setting event and motivating operations are at play, where
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  Speaker 1: we're in a situation where movement now becomes valuable. And
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  Speaker 1: as I said, like we think about like even in
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  Speaker 1: these medical conditions, if they're mostly manifesting restless legs syndrome
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  Speaker 1: when they're not actively engaged in something, then that tells
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  Speaker 1: you that that is a setting event that is likely
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  Speaker 1: to occasion that behavior, which tells us there is something
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  Speaker 1: behavioral about that experience.
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  Speaker 2: Yeah, Like a way that I look at that is
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  Speaker 2: like maybe I think of it like this, right, So,
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  Speaker 2: so me sitting at a chair for a long period
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  Speaker 2: of time, Like let's say I'm on a plane and
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  Speaker 2: I have to fly for like a great distance.
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  Speaker 1: You've never had that experience.
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  Speaker 2: I've never had the experience ever. But I'm just just
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  Speaker 2: just hazarding a guess, right, Like, sitting down for a
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  Speaker 2: long period of time can create some level of discomfort
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  Speaker 2: just by the nature of like you're sitting and not
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  Speaker 2: moving right like, so, like there is a point where
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  Speaker 2: it becomes uncomfortable because human beings are naturally reinforced by
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  Speaker 2: movement in some way, right.
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  Speaker 1: At particular intervals. I mean it's like, yes, if you're
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  Speaker 1: moving non stop like that becomes pretty exhausting. But it's
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  Speaker 1: like you also don't want a huge amount of downtime,
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  Speaker 1: Like you want to have intervals where you have like rest,
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  Speaker 1: relaxation and in activity intermittently.
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  Speaker 3: Yeah.
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  Speaker 2: I think for the most part, people can relate to
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  Speaker 2: the experience that like, yes, I've been saying down for
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  Speaker 2: a long time. It's uncomfortable. That is not restless lag
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  Speaker 2: syndrome that is just like the need for movement cold case,
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  Speaker 2: Like we're talking about people who are experiencing high levels
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  Speaker 2: of discomfort, pain, aching, tingling stuff. That's like a little
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  Speaker 2: bit different than just kind of like, oh, I have
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  Speaker 2: a sensation that I need to move a little bit,
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  Speaker 2: you know.
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  Speaker 1: Yeah, that's great, and yeah, I think that just really
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  Speaker 1: trying to highlight here, like if we can pinpoint environmental
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  Speaker 1: context in which this takes place, that gives us an
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  Speaker 1: opening for where it might make sense to include as
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  Speaker 1: part of your treatment some behavioral health things. Yeah, what
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  Speaker 1: that might look like will be variable depending on what
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  Speaker 1: your exact situation is. Like For people who anxiety and
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  Speaker 1: stress are the thing, than dealing with that will make
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  Speaker 1: more sense than someone who is like bored, you know,
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  Speaker 1: and like just spending too much downtime, Like we just
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  Speaker 1: want to figure out like make sure they're getting enough
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  Speaker 1: exercise or something like that. Yeah, one percent, all this
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  Speaker 1: is to say, like this is not going to be
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  Speaker 1: the case for all people with RLS, and these situations
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  Speaker 1: also will not reliably produce URLs. However, it just may
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  Speaker 1: be a relevant factor to consider. So for instance, if
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  Speaker 1: we're teaching coping skills and relaxations, that's going to be
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  Speaker 1: more helpful for someone who experiences rols without any other
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  Speaker 1: underlying risk factors or conditions, and for whom like stress, anxiety,
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  Speaker 1: and worry tend to be how they show up in
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  Speaker 1: those situations. But like it is a low cost, low
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  Speaker 1: invasive strategy and it's a great sort of first step
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  Speaker 1: to include before you start moving to more intensive interventions.
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  Speaker 1: And like I said, I do think you want to
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  Speaker 1: make sure you've ruled out neurological medical things first because
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  Speaker 1: those could be very serious problems. So like go get
• 13:36
  Speaker 1: those checked out. But like if you're if you don't
• 13:39
  Speaker 1: have major underlying conditions and you're experiencing this, then before
• 13:43
  Speaker 1: you start going onto things like surgery and mechanical devices
• 13:48
  Speaker 1: and whatnot, like there might be some behavioral solutions to
• 13:51
  Speaker 1: help to at least try and see if those help
• 13:53
  Speaker 1: first before you go the more intensive, expensive and invasive route.
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  Speaker 3: Yeah, agreed, one hundred percent.
• 13:58
  Speaker 1: All right, Well we did that one justice that's restless
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  Speaker 1: like syndrome. I don't remember why we brought this up.
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  Speaker 1: That was like we mentioned in an episode or something.
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  Speaker 2: Yeah, I came up somewhere at some point in time.
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  Speaker 2: So yeah, that's usually how our topics show up here.
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  Speaker 1: Fair enough, true? True? That all right? Well, hey, we
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  Speaker 1: hit our fifteen minutes. We're right about there at least,
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  Speaker 1: so hopefully the timing worked out correctly. Once we're all
• 14:19
  Speaker 1: said and done with everything. Thank you so much for
• 14:20
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• 14:23
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• 14:48
  Speaker 1: Thank you to my team of people without whom I
• 14:49
  Speaker 1: could not make this episode. Thank you for recording with
• 14:51
  Speaker 1: me today, Shane anytime. Emma Wilson is our social media
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  Speaker 1: coordinator and our recording tech and sound engineer. Maestro is
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  Speaker 1: Justin so thank you.
• 15:00
  Speaker 3: Justin yes, so great.
• 15:02
  Speaker 1: All right, anything that I missed with you? You like to
• 15:03
  Speaker 1: add before we say goodbyes for this here Minnie, Uh nope,
• 15:06
  Speaker 1: I think that covers it perfect. Thank you all for listening.
• 15:09
  Speaker 1: This is Abraham and this is Shane. Why We Do
• 15:11
  Speaker 1: What We Do? Mini is out.
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