Brain Injuries & Mental Health
Please note: this blog is not meant to replace the advice or expertise of mental health and medical professionals. Consult with medical providers on concerns or treatment.
Brain injuries can have long lasting emotional, behavioral, and cognitive impacts. While brain injuries are not a mental illness or a mental health diagnosis, they can be linked to new mental health concerns or worsening preexisting mental health symptoms (source). In this blog, we hope to highlight the relationship between brain injuries and mental health. However, it is important to note that this is an under-researched topic. We have done our best to compile educational information and resources, however this is not exhaustive.
Mental Health and Brain Injuries
(Above: a table showing the overlapping symptoms of a brain injury and mental health concerns. Image Source.)
It is important to acknowledge that mental health is not simply defined by the presence or absence of a diagnosable mental illness. Mental health is affected by many factors, both externally and internally. It is important for everyone to take care of their mental health since everyone can experience changes in their overall mental well-being.
When a brain injury, such as a TBI, occurs, individuals may experience changes in their mental health including new or worsening symptoms. Furthermore, mental health concerns such as anxiety and depression can make recovering from a brain injury more difficult (source). Someone with a TBI may also feel anxious in places or situations that did not cause anxiety prior to the brain injury. Situations where there are sudden changes in plans or in crowded, fast-paced places require “a lot of attention, fast thinking, or processing a lot of information at the same time,” which can lead to feeling overwhelmed.
With a brain injury, a person may experience some of the same symptoms as depression (i.e., fatigue and frustration) and anxiety (i.e., fear and overwhelm) but not have a diagnosis. Emotions such as grief and sadness are common after sustaining a brain injury, which may go away with recovery. Since symptoms can overlap, it is important to recognize when these symptoms interfere with the individual’s recovery or daily life. If interference occurs, the person may be experiencing a diagnosable mental health concern (source). It is important to consult with medical professionals to determine the best next steps.
If a brain injury impacts the part of the brain that controls emotions, it can affect how their emotions function (source). This leads to changes in how someone experiences and expresses emotions. Brain injuries can also lead to a loss of independence and changes to a person’s role in their family, job, or society at large. Changes like this can lead to feelings of “frustration and dissatisfaction.”
Behavior Changes after a TBI
Some common behavioral changes among individuals who have a TBI are:
Difficulty with managing emotions such as sudden mood changes or extreme emotional responses to a situation.
Restlessness such as fidgeting, pacing, or other repetitive movements like swaying.
Difficulty with social behaviors such as avoiding others, interrupting, or saying things that are hurtful or don’t fit the current conversation.
Refusal to do tasks.
Feeling unmotivated or face difficulty doing an activity (even if they understand the benefit of doing it or why). It is important to acknowledge this is not caused by fatigue or laziness.
Difficulty starting a task or conversation (even with things they want to do).
(Source.)
It is important to remember with brain injuries, behavioral changes can happen immediately or across a stretch of time. The severity of the injury can also impact how long these behavioral changes last.
Additionally, individuals with TBIs may not be aware of issues that need attention or support, such as following “recommendations or restrictions that are meant to help them be independent, keep them safe, and help them recover.” For example, refusing mobility aids or going to scheduled therapeutic services.
It can be difficult for a person to control their behavior when living with a TBI. This is especially the case when they are in stressful situations.
Tools to Support Mental and Behavioral Health
A-B-C Framework (source)
A method to help keep a problem behavior from occurring, starting with identifying the behavior. This may involve consulting a mental health professional, family, and friends.
A stands for “Antecedent.” This is the trigger for what happens before the problematic behavior occurs. When identifying this, take notes on everything you remember. Sometimes it is not immediately evident what the trigger is and notes can help you identify a pattern. Common triggers are pain, fatigue, noise, etc. Click here and scroll to “Follow the A-B-C approach” for a list of questions to ask yourself. (Our previous blog post on anger management also has suggestions for how to keep an anger diary to help track behavior and triggers. Read more here.)
B stands for “Behavior.” Examine the problem behavior(s): describe the problem in as much detail as possible.
C stands for “Consequences.” This is what happens after the problem behavior has occurred. This can include other people’s reaction, things changing in the environment, and more.
Mindfulness and Structure
On top of treatment that includes medical support (medicine, counseling, psychotherapy, etc.), it is important to avoid situations that are stressful and stress in general, as it can lead to emotional distress. Try using techniques “such as deep breathing or muscle relaxation, schedule breaks, and practice mindfulness activities.”
Developing a structured schedule for each day can be helpful for reducing distress. This includes structured activities like “exercise, puzzles, or games.” Try using calendars, weekly planners, or virtual calendars (like Google Calendar) to keep track of your schedule and plan structured daily tasks. You can also aim to keep a schedule like always going to the grocery store on Saturday at 8:00 am or always going for a walk at 5:00 pm.
Self-Care
Self-care is the steps someone takes to take care of their body and mind. Self-care can apply to anyone, not just someone living with a brain injury. However, self-care can look different for different people and takes in consideration a person’s social, physical, mental, spiritual, and financial needs. The Brain Injury Association of America listed these self-care tips for people with brain injuries:
Create a morning and nighttime routine. This can include your normal routine but could include stretching, mindful breathing, meditating, journaling, or reciting affirmations.
Prioritize sleep. Stick to a schedule and ensure you get enough sleep and reduce exposure to blue light from screens (TVs and phones, for example).
Try to exercise each day. This does not mean you need to go to the gym or run everyday. Exercise can also look like taking a walk or doing yoga.
Keep lists to help you stay on track with weekly goals, grocery needs, and to-do lists for the day.
Focus on one thing at a time. Thinking about too much at once can be overwhelming.
Ask for help when it’s needed. It’s okay to ask friends and family for help with tasks.
For Families and Caretakers
It can be difficult to stay calm when a loved one with a brain injury is expressing their emotions in a way that is difficult or hurtful. It is important to remember that these changes are caused by the brain injury and are not personal. It is encouraged for loved ones and caretakers to take breaks and avoid arguing back when angry or hurt. It is also important to not give into demands in an attempt to calm down someone with a brain injury. Doing so can “have the opposite effect of rewarding them for expressing their emotions in a non-helpful way.”
Caretakers and loved ones can help by giving the person with the brain injury space to take a break and calm down. If possible, provide a quiet space away from stressors where the person with the brain injury can calm down. Caretakers and loved ones can also give the person with the brain injury space to vocalize their emotions.
Reach out to your local Brain Injury Association (NC) to get connected to resources such as support groups and peer mentors.
More Information on This Topic
Butch Alterman Webinar: Resilience & Moving Forward After Brain Injury (Webinar)
Making Life Work After Brain Injury - A Family Guide for Life at Home (PDF)
Understanding and Coping with Irritability, Anger, and Aggression after TBI (Online Article)
Sources
Brain Injury and Mental Health by Brain Injury Association of Virginia
