As soon as you can make an appointment with your doctor and ask for a referral to a professional specialising in trauma management following a brain injury.
Stressful, frightening, or disturbing events can leave people feeling helpless and out of control causing many people to isolate themselves.
It can take a while to get over the emotional pain of trauma, especially when you have cognitive and executive impairments that may be affecting your ability to self-reason and process the events. However, by getting help early on, or by addressing difficulties before they get out of control, people can speed up their recovery from the trauma.
It is best not to let things linger following a traumatic brain injury (TBI). Pre-injury you may have known that you need to give yourself time to adjust to any upsetting or traumatic event and the general mindset, therefore, would have been to allow yourself a few months to see how you got, on and perhaps to only seek help if symptoms became out of hand. It is essential to recognise the differences in circumstances pre and post TBI. Post TBI you may be struggling with a number of symptoms and outcomes that impair your thinking and ability to think things through and monitor yourself.
There are many outcomes of TBI that can cause you to underestimate the emotional and psychological impact an incident had on you. It may also be challenging to know whether to relate emotions to the injury itself, or the event that caused it.
Dealing with traumatic memories can take persistence, and it is best to find professional support in the form of trauma therapy or to speak to your neuropsychologist if you have one. Specialist therapies can help, but it is crucial to work with someone who has experience of TBI. Early intervention can also minimise depression and anxiety.
Traumatic experiences do not always cause PTSD. Many people self-diagnose believing that anything that creates a sense of panic or discomfort is PTSD. Self-diagnosis can undermine the experiences of people who do have a professional diagnosis. There are varying criteria for panic and stress disorders, and it is better to get an expert opinion so that you and others know what you are dealing with and need to manage.
From the inside
Unresolved traumatic memories can leave many people feeling helpless and emotionally out of control in general or in particular circumstances. Their disorientation can be exacerbated by, and confused with, the symptoms and outcomes of their brain injury. For example, feeling overwhelmed, difficulty concentrating, anger, irritability, mood swings, depression, anxiety and fear can all happen even when there are no traumatic memories to contend with after a brain injury.
Other symptoms of unresolved trauma may be persistent shock or numbness/disbelief and can include guilt, shame, self-blame or denial.
People living with brain injury may not be able to fully or directly describe the cause of their fears and may struggle with adding understandable detail or being able to relate their feelings in a specific way.
From the outside
When, a few days, weeks or months later, they are not over the event that caused their injury, people can assume that they are malingering or attention-seeking. These assumptions can lead to those on the outside running short on tolerance and patience, and they may try to coax someone to get up and get on with things without realising how deeply someone is hurt or how extensive not only the cognitive and executive damage might be, but also the psychological disturbances.
People may think they can see ‘woe-me self-pity victim mentality,’ and again, this often results in them ignoring people or leaving them to get on with things.
When people have been given a proper evaluation and diagnosis following a brain injury, the attitudes of families and friends can be drastically different. A significant number of people ‘fall through the medical net’ and don’t get a follow-up appointment or referral for evaluation and very often there is no information given, all of which makes it very difficult for families to understand.
The best thing to do is listen, take your loved one seriously and make sure they get professional help from a therapist experienced in working with people following trauma resulting in brain injury.
Try to bear in mind that it’s not the objective circumstances that determine whether an event is traumatic, but the subjective emotional experience of what happened. The more frightened and helpless someone feels, the more likely they are to be and feel traumatised. It is also helpful to remember that responses are normal reactions to abnormal events.
At any time
Trauma disrupts your body’s natural equilibrium, and if untreated can freeze you in a state of hyperarousal and fear. Many people soldier on and try to manage as best they can without help, and no matter how long you have been like this there are several things you can start to do to help yourself feel better.
Exercise and fresh air
As well as burning off adrenaline and releasing endorphins, exercise and movement can help repair your nervous system.
Try to exercise for 30 minutes or more on most days. Or if it’s easier, three 10-minute spurts of exercise per day are just as good.
Any exercise that is rhythmic and engages both your arms and legs is good and can help with balance and coordination.
Try adding a mindfulness element to a walk, such as thinking about the complexities in the way nature has designed plants or flowers or try to listen to and focus on bird song and other natural sounds. Try to think about your body and how it feels as you move. For example, try to notice the sensation of your feet hitting the ground, the kind of surface you are walking on, and the differences in sound different surfaces make. Perhaps you could think about the rhythm of your breath or the feeling of the sun or breeze on your face.
All of these things will give your brain time to relax and release tension, persistent inner chatter and feelings of fear.
Use a journal to note down your thoughts or use strategies for coping after a TBI in your quiet time. Isolation can make things worse, so try to be mindful of why you are retreating, and either undertake an activity in the time you are alone or take a nap if you need to. Again, don’t dwell on things on your own.
Connecting to others face to face can be awkward for many reasons. For example, some people find it humiliating that they can’t do things the way they could before, and others may feel embarrassed or that they are to blame for what happened to them.
These kinds of issues need to be addressed with your specialist so another thing you can do in your quiet time is to make lists and add explanatory notes so that you can recall the things you are struggling with when you do get to speak to someone.
If you can, try to make an effort to maintain your relationships – it might be beneficial to have the people around you look through this website and to do further research to help them understand you. It can be challenging to be concise and accurate in describing how it feels to live with the symptoms and outcomes of trauma after a brain injury, but trying is practice, and practice brings improvements.
A TBI can also cause people to get stuck in their own world following trauma – a bit like a needle getting caught in a scratch on a vinyl record. It is also very common for people to simply forget that other people have interests or troubles themselves not only because dealing with trauma can be very absorbing but also because of cognitive impairments.
You may need to explain to others that you can’t always remember or process details during a conversation. Try to be willing to listen to relatives and friends as a distraction rather than wanting to help. A passive role can give you time to think of questions you can ask other people about themselves. Focusing on other people also helps improve flexible thinking following a TBI. Talking to other people about their lives can also be refreshing and as well as distracting.
Remember that you have a choice. Many people feel obligated to conform and fit in after trauma and may even forget that they can make conscious choices, or even know how to.
In these cases, it can help to remember that you don’t have to talk about the trauma or anything else you don’t want to. TBI doesn’t take away your right to make personal choices, but a brain injury can fray the edges in understanding what is acceptable and appropriate. You need to be aware of this, and if you are worried, ask for and listen to feedback.
Connecting with others doesn’t have to involve talking about the trauma if you don’t want to and being mindful of your instincts and taking a moment to pause can help you make mentally healthful decisions. Feeling engaged with and accepted by others can be tremendously heartwarming and can increase endorphins that make us feel better about ourselves. Give yourself chances to enjoy contact whenever you can and ask people to be gentle with you, to slow down and be thoughtful about the topics they introduce.
Ask for support
Ask people if they have 10 to 20 minutes to listen attentively without judging you and if at the end they can think about any feedback that may help to discuss with you when you are ready. It may be better for you if you have a break between talking and receiving feedback, and in many ways, this encourages memory skills as well.
Participation in social activities, even if you don’t feel like it, can help your brain to learn to be calm and to filter again. It can also show a willingness on your part and can help people to understand that they are still important to you. Sometimes you may be too tired or emotionally overwhelmed to participate, and it is essential to let people know that you need to rest and if possible will join in later. Doing other things brings moments of reprieve from internal chatter and worry.
A lot of people find joining in with activities too much because of light and noise sensitivities which can aggravate psychological trauma as well as TBI symptoms. With a little out-of-the-box thinking and flexibility, it can be possible to find solutions such as being in a room close by and having people come to see you so that you are still involved.
You may need to go out in quieter times rather than busy lunchtime rush periods to avoid feeling overwhelmed or perhaps find somewhere where there are no bright lights or music, for example. Try and consider your cognitive and energy limits and don’t do too much in one day.
Online support groups can be a great way to connect and to participate in conversations on your own terms. Many people find the empathy and understanding of others to be just what they need.
Groups can also be a great place to vent but make sure you let people know this is what you are doing. When you are communicating with other people who have brain injuries or are working through resolving their trauma, it is important to try and be as clear as you can.
Local support groups can also be an excellent way to meet people who are going through similar experiences, and it can make a massive difference to your self-esteem to know that you are not alone.
These types of connection are also great learning opportunities and help us to practice awareness and attention skills.
Connecting with others who are facing the same problems can also help reduce any sense of isolation, and hearing how others cope can help inspire you in your own recovery.
Whenever you are feeling disoriented, confused, or upset, practising mindful breathing is a quick way to calm yourself. Take some deep breaths and make them deep enough that you can feel your rib cage and diaphragm expand. Let your breath out slowly and repeat until you feel calmer and more centred. If you feel sceptical, try it out, and you will find it helps. Although not prescribed in clinical practice, a good quality turmeric supplement can also help with immediate physiological effects of trauma and anxiety.
For some people petting and smoothing an animal or listening to music works as a distraction technique and can also have a calming and soothing effect. You don’t have to be a ‘victim’ of your fight and flight automatic brain – take back control by making purposeful choices and be the captain of your ship as often as you can. Focus on healing and leave the ‘solving’ to time.
Making conscious choices can help with dealing with trauma outcomes because it brings a sense of control and also has the added benefit that it helps with improving brain function. Make plans, organise, prioritise, choose.
Keep practising with making choices and write down your options so you can see them in black and white. This method can also help you with attention and focus and using your imagination – these are all things that help you heal.
Everyone responds to sensory input differently following a TBI, so experiment with different ideas to find what works best for you. Do some research about other techniques for stress relief as this will encourage your brain to think beyond the moment. We feel more empowered when we work things out under our own steam.
For some people standing on the grass or sand on a warm day can help them feel more grounded. Some alternative treatments also help with this.
Slow things down by learning to take regular pauses and allow yourself to feel what you feel when you think it, acknowledgement and acceptance of your feelings as they arise can help you address confusion. Learning to notice that your thoughts have returned to your trauma can help you decide whether this is something you want to deal with now or later.
Addressing these feelings is best done with pen and notebook so that you are expressing and dissipating more of the pent-up energy. Talking and writing releases more energy than thinking alone.
To improve your health post-TBI there are a number of things you need to consider seriously:
After any traumatic experience, unsolved questions or worry can disturb your sleep patterns. A lack of restorative sleep, which means you need to be in REM sleep for at least three hours a night, can exacerbate your TBI and trauma symptoms making it harder to maintain your emotional balance and control.
Avoid alcohol and drugs
The use of alcohol and drugs will always worsen your TBI and trauma symptoms. They will also exacerbate any feelings of depression, anxiety, and isolation and make it much more difficult to think.
The use of alcohol and drugs as a way to avoid feelings and to hide from responsibilities is widespread. However, if you want to get better, you need to make the most of every moment and be as self-responsible as you can be from as early on as possible.
This means acknowledging and accepting your emotions. These may feel like something that you want to escape from, but the reality is that all emotions are signals from your body that something needs to be addressed.
Your brain and body use your emotions in the same ways that prescription drugs use side effects to tell you that something is going awry.
If you fail to listen and to consider what is going on, then you will prolong it. Facing something and dealing with it is healthier and safer than pushing it away.
Eat for nutrition
Eating small nutritional meals throughout the day will help you keep your energy up, minimise mood swings, and will support your adrenal systems. The adrenal glands can take a battering following TBI because of the biochemical cascade that happens during the secondary outcomes of brain injury. Adrenal fatigue exacerbates brain fog and difficulties with thinking and coming to terms with changes and trauma.
Anything that can help you feel relaxed is worth a try such as meditation, yoga, or tai chi and many other alternative treatments and supplements can also help you to feel more in control. Don’t forget to get creative and give time to the things you enjoy doing. Not only are these activities distracting while you are waiting for professional help, but they are also cognitively beneficial in many ways.
Always get professional help with managing trauma as soon as you can.
Typically, things do not ‘get better’ on their own, especially following a brain injury. A specialist may offer alternative strategies to try and because we are all unique what works for or helps one person may not do the same for another.
Listen to your instincts. Sometimes people do end up being referred to someone who doesn’t have the expertise they need. If you have any doubts voice them and if possible take a relative or friend with you to the first appointment so that you have someone to bounce your thoughts off. Your own way of experiencing people may have been undermined by the brain injury so getting support and help from someone you trust can be very useful in the early stages of treatment.