Survivors of traumatic brain injury are often left to deal with unforeseen changes and symptoms. Impact to various regions of the brain, such as the area responsible for regulating emotions, can cause survivors of TBI to sense a lack of control over their feelings. Adjusting to life after brain injury may also trigger stress and lead to adverse emotional states. Below are some of the emotional symptoms that may manifest following traumatic brain injury:

• Mood Fluctuations: Depending on the area of impact, TBI can cause sudden shifts in mood, such as fluctuating from content to irritable without any triggering event. In some instances, survivors of TBI may find themselves laughing for extended periods or experiencing sudden bursts of crying. This can be particularly challenging to manage because the emotional expression is often incongruent with the individual’s internal feelings. In other words, the individual is unable to control or cease laughter, when in actuality, they are feeling down or depressed. These exaggerated shifts in mood are referred to as emotional lability. This symptom can be concerning to both survivors and their loved ones due to its unpredictable nature and the individual’s lack of control over the expression of emotion.

• Anger: Irritability is another common emotional change following TBI. Impact to brain regions that control emotional expression, in addition to difficulty adjusting to changes in recovery and experiencing intense pain, may all contribute to increased irritability and anger. Some survivors have diminished patience and find it difficult to control their temper. Regardless of the individual’s temperament prior to injury, angry outbursts may include yelling or screaming, using profanity, threatening others, and throwing or slamming things. These feelings can be unfamiliar to some survivors of TBI who had rarely experienced or expressed them in this manner prior to the onset of injury.

• Depression: It can be particularly difficult to distinguish symptoms of depression from the symptoms of brain injury. Sudden onset of symptoms may be attributed to the injury, whereas gradual onset tends to point to depression. General feelings of sadness can be expected throughout the recovery process, given the experience of significant life changes. However, when feelings become overwhelming or impair functioning, they may be indicative of depression. Depressive symptoms may include low mood, loss of pleasure in activities, lack of motivation, changes in appetite, sleep disturbances, isolation, fatigue, hopelessness, and thoughts of dying. Feelings of guilt may complicate this experience, as survivors may feel that they are to blame for their injury or that they should have gratitude for surviving the event.

• Anxiety: Survivors of brain injury may become more sensitive to stimuli and find that daily tasks, such as making decisions about what to wear, are stressful. The pressure of not being able to return to work or modifications in daily routines due to sensory overload can trigger anxiety. Feelings of anxiety may be physiological (increased heart rate, difficulty breathing) or cognitive (excessive worry, difficulty concentrating). Survivors of TBI may even suffer from panic attacks, which occur suddenly and unexpectedly without any particular trigger, causing behavioral changes (avoidance). Given the significant life adjustments following injury and throughout the recovery process, anxiety may be a temporary response. However, it is wise to consult with a professional in order to determine the cause of anxiety, as well as the appropriate interventions.

Managing Emotional Symptoms

 

Communicating feelings can seem unfeasible when individuals cannot quite understand what it is that they are feeling or experiencing. It is nevertheless important to express needs and feelings to loved ones/caregivers who may also observe these emotional changes but are uncertain about what they can do to help. Isolating from others can compound problems and make the symptoms feel increasingly unmanageable. It is crucial to ask for support when needed. Survivors of TBI may find peer support, either in the form of mentoring or TBI support groups, more effective than leaning on loved ones. Consulting with medical providers about symptoms can provide clarity regarding treatment options, which may include medication management or counseling services. It is important to note that each individual’s experience with TBI is unique, resulting in distinct needs that require tailored interventions.

Clinicians at PNBC use empirically-based interventions and psychoeducation to help TBI survivors distinguish the symptoms of injury from symptoms that may be indicative of a mood disorder. The clinicians’ diverse backgrounds and specializations enable clients to receive care attuned to their needs. Examples of interventions include cognitive behavioral therapy to address negative thought processes and manage pain, relaxation strategies such as grounding techniques or progressive muscle relaxation to reduce anxiety, and trauma-informed approaches that may relieve post-traumatic stress. Therapy can increase insight into symptoms, reducing the unknowns and making the recovery process feel more manageable.

Written by Beverly Sharifian, MA, APCC.