Emotional Problems After Traumatic Brain Injury Tessa Hart, PhD and Keith Cicerone, PhD, Model Systems of Knowledge Translation Center Page 1 of 3

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  Produced by Victoria Tilney McDonough and Brian King. This marriage and family therapist talks about common issues after TBI. Transcript of this video.
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  Meet Sabrina — a teen talking to other teens about her experience after brain injury. From Lash & Associates Publishing Training Inc. Used with permission. For more information on this entire video, go to www.lapublishing.com.  Transcript of this video.
• Personal Story: Teens Talking to Teens

Brain injury and emotions

A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems.

Difficulty controlling emotions or “mood swings”

Some people may experience emotions very quickly and intensely but with very little lasting effect. For example, they may get angry easily but get over it quickly. Or they may seem to be “on an emotional roller coaster” in which they are happy one moment, sad the next and then angry. This is called emotional lability.

What causes this problem?

• Mood swings and emotional lability are often caused by damage to the part of the brain that controls emotions and behavior.
• Often there is no specific event that triggers a sudden emotional response. This may be confusing for family members who may think they accidently did something that upset the injured person.
• In some cases the brain injury can cause sudden episodes of crying or laughing. These emotional expressions or outbursts may not have any relationship to the way the persons feels (in other words, they may cry without feeling sad or laugh without feeling happy). In some cases the emotional expression may not match the situation (such as laughing at a sad story). Usually the person cannot control these expressions of emotion.

What can be done about it?

• Fortunately, this situation often improves in the first few months after injury, and people often return to a more normal emotional balance and expression.
• If you are having problems controlling your emotions, it is important to talk to a physician or psychologist to find out the cause and get help with treatment.
• Counseling for the family can be reassuring and allow them to cope better
• on a daily basis.
• Several medications may help improve or stabilize mood. You should consult a physician familiar with the emotional problems caused by brain injury.

What family members and others can do:

• Remain calm if an emotional outburst occurs, and avoid reacting emotionally yourself.
• Take the person to a quiet area to help him or her calm down and regain control.
• Acknowledge feelings and give the person a chance to talk about feelings.
• Provide feedback gently and supportively after the person gains control.
• Gently redirect attention to a different topic or activity.

Anxiety

Anxiety is a feeling of fear or nervousness that is out of proportion to the situation. People with brain injury may feel anxious without exactly knowing why. Or they may worry and become anxious about making too many mistakes, or “failing” at a task, or if they feel they are being criticized. Many situations can be harder to handle after brain injury and cause anxiety, such as being in crowds, being rushed, or adjusting to sudden changes in plan.

Some people may have sudden onset of anxiety that can be overwhelming (“panic attacks”). Anxiety may be related to a very stressful situation — sometimes the situation that caused the injury — that gets “replayed” in the person’s mind over and over and interferes with sleep (“post traumatic stress disorder”). Since each form of anxiety calls for a different treatment, anxiety should always be diagnosed by a mental health professional or physician.

What causes anxiety after TBI?

• Difficulty reasoning and concentrating can make it hard for the person with TBI to solve problems. This can make the person feel overwhelmed, especially if he or she is being asked to make decisions.
• Anxiety often happens when there are too many demands on the injured person, such as returning to employment too soon after injury. Time pressure can also heighten anxiety.
• Situations that require a lot of attention and information-processing can make people with TBI anxious. Examples of such situations might be crowded environments, heavy traffic or noisy children.

What can be done about anxiety?

• Try to reduce the environmental demands and unnecessary stresses that may be causing anxiety.
• Provide reassurance to help calm the person and allow them to reduce their feelings of anxiety when they occur.
• Add structured activities into the daily routine, such as exercising, volunteering, church activities or self-help groups.
• Anxiety can be helped by certain medications, by psychotherapy (counseling) from a mental health professional who is familiar with TBI, or a combination of medications and counseling.

Depression

Feeling sad is a normal response to the losses and changes a person faces after TBI. Feelings of sadness, frustration and loss are common after brain injury. These feelings often appear during the later stages of recovery, after the individual has become more aware of the long-term situation. If these feelings become overwhelming or interfere with recovery, the person may be suffering from depression.

Symptoms of depression include feeling sad or worthless, changes in sleep or appetite, difficulty concentrating, withdrawing from others, loss of interest or pleasure in life, lethargy (feeling tired and sluggish), or thoughts of death or suicide.

Because signs of depression are also symptoms of a brain injury itself, having these symptoms doesn’t necessarily mean the injured person is depressed. The problems are more likely to mean depression if they show up a few months after the injury rather than soon after it.

What causes depression?

• Depression can arise as the person struggles to adjust to temporary or lasting disability and loss or to changes in one’s roles in the family and society caused by the brain injury.
• Depression may also occur if the injury has affected areas of the brain that control emotions. Both biochemical and physical changes in the brain can cause depression.

What can be done about depression?

• Anti-depressant medications, psychotherapy (counseling) from a mental health professional who is familiar with TBI, or a combination of the two, can help most people who have depression.
• Aerobic exercise and structured activities during each day can sometimes help reduce depression.

Emotional Problems after TBI was developed by Tessa Hart, PhD and Keith Cicerone, PhD, in collaboration with the Model Systems Knowledge Translation Center. Portions of this document were adapted from materials developed by the UAB TBI Model System, the Mayo Clinic TBI Model System, the New York TBI Model System, the Carolinas Rehabilitation and Research System, and from Picking up the Pieces after TBI: A Guide for Family Members, by Angelle M. Sander, PhD, Baylor College of Medicine (2002). Copyright © 2010 by University of Washington/MSKTC. 

Please check the MSKTC site for any recent updates on this article.

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