Managing Stress Effectively After TBI, Part I

Debbie West and Jeff Kreutzer, The National Resource Center for Traumatic Brain Injury, Virginia Commonwealth Model Systems of Care
Managing Stress Effectively After TBI, Part I

Brain injury causes sudden, unexpected, and drastic changes in the lives of survivors and family members. Learning to effectively manage the stress associated with these changes may be one of the greatest challenges faced by family members after brain injury.

What is stress? For most people, stress is that uncomfortable feeling you get when you know there is something you should be doing and you’re not doing it. Stress is often a “vicious circle.” The more a person feels they have to do, and the more that people are telling them what to do — the more stress they feel. People also feel more stress if they worry about failure.

Think of stress as like “carrying a stuffed backpack up a big mountain.” Climbing the first hundred feet, your pack may not seem heavy at all. Though nothing gets added to the pack as you go, the weight seems heavier and heavier as you keep climbing without resting. If you’re not careful, the bag gets so heavy you can’t walk any more. Seriously, intense stress, over time, can have disastrous effects on your health.

Stress is a part of daily life. With or without being touched by brain injury, everyone will face stress at some point in his or her life. Through interviews and surveys, researchers have learned a lot about stress by studying people’s everyday lives. Below is a list of life events that surveys show are rated most stressful.

  • Spouse's retirement
  • Single parenting
  • Moving
  • Spouse’s illness
  • Change in financial state
  • Child’s illness
  • Depression
  • Raising teens
  • Parenting parents
  • Child returning home
  • Marital separation
  • Fired at work
  • Chemical dependency

Here is a list of things that we’ve heard from survivors and family members. Do any sound like you or someone you know?

  • My mother’s been afraid to leave my father at home since his injury. Sometimes my mom asks me to watch him when she goes out.
  • My brother’s drinking problem got a lot worse after his injury. Now he drinks every day.
  • To help with finances, we sold our house and moved to an apartment.
  • My son was living in a dorm at school before the injury. He lives with us again and we’re not sure when he’ll go back to school.
  • We were married for nine years before the injury. Three years after he got hurt, we separated. He’s living in an apartment and I’m living in our home.
  • Since my wife’s injury, I am basically raising our 4- and 5-year-old girls by myself. She really can’t handle them alone.
  • Frank and I were arguing all the time since the accident. I had to move in with my sister because I couldn’t take it anymore.
  • My husband was fired from his job. He prefers to call it “retirement.”

The effects of stress can be sneaky. You may not even notice at first, or you may chalk up the problems to something else. Let’s look at how your life might be affected by stress:

Stress Overload Signs

  • Disorganization (forgetting your keys, losing things, making a lot of “dumb mistakes”).
  • Daydreaming about spending a few days somewhere, even in the hospital - to sleep, read, be taken care of.
  • Trouble making even small decisions (having difficulty figuring out what to wear, feeling stumped about what to have for lunch).
  • Feeling depressed (wanting to curl up on a bed, pull the covers up over your head, and sleep for a week).

Still not so sure whether you need to worry about stress? We’ve come up with a brief questionnaire that can help you identify your levels of stress. Get a pencil out and circle the “T” for statements that are true about you or “F” for statements that are not true. Be honest. Nobody’s grading this thing but you.

QUESTIONNAIRE: 13 Item Stress Test.

T F   I have a lot to do.

T F   I have more to do than I can handle.

T F   I’m not being productive.

T F   I’m trying really hard but getting nothing done.

T F   I’m feeling unhealthy.

T F   I can’t afford to take breaks or time off.

T F   I’m pushing myself too hard.

T F   I don’t sleep very well.

T F   Too many people are telling me what to do.

T F   I am not treating people the way I want to be treated.

T F   I feel totally exhausted.

T F   Nobody is happy with what I do.

T F   I can’t stand living like this.

Pencils down! Well? What’s the verdict? If you answered all F’s then you’re stress free or maybe fooling yourself. The more T’s you circle, the greater your level of stress and the more you need to think about taking steps to change. Here are some ideas to help you better deal with stress. Try them out and use the ones that work best for you. Think, talk to other people, and try to come up with more ideas.

  • Check your “pressure gauge” often.
  • Practice effective problem solving. Brainstorm ways to solve problems and try out different solutions.
  • Have a back-up plan.
  • Take time for yourself; do things you enjoy
  • Tell yourself to relax, breathe slowly and deeply.
  • Seek support from trusted friends and family.
  • Close your eyes, imagine yourself in a pleasant situation or place.
  • Keep up a healthy lifestyle — exercise, eat right, and avoid caffeine, alcohol, drugs, and tobacco.
  •  Talk to others about how they cope successfully.


This column was written by Debbie West and Jeff Kreutzer from the VCU TBI Model System Program. For more information about outpatient rehabilitation services and VCU research programs, please contact Jenny Marwitz by phone at 804-828-3704, toll free at 1-866-296-6904, or by email at

Posted on BrainLine July 25, 2008.

From the National Resource Center for Traumatic Brain Injury, Virginia Commonwealth Model Systems of Care. Reprinted with permission.

Comments (6)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

because of this condition I have lost everything. he divorced me and our grown boys took his side. it is my fault he hit me and done this. Even the doctors, friends, whole family has left me alone to cope. Sometimes I cannot tolerate everyone going away and at age 69, I must beg for everything. I have lost interest in every part of life.

was assaulted 4+ years ago and suffered a TBI. I am debilitated and disabled, but since it is an invisible disability, no one thinks there is anything wrong with me. I think it is easier fir them this way, but I feel that its a "damned if you do, damned if you don't" situation. on the one hand, it is terrible to have to bare yourself to others and then be their pity project, and if they don't help/make accommodations you get upset bec. they know that you're struggling but do nothing, but if they are doing something for you, you feel like a charity case or a burden; and on the other hand, you don't say anything to anyone so they don't know, but they look at you like some mentally retarded, sluggish, weight gaining, unbalanced person who they would never choose to get to know if they didn't know you from before. either way, aside for all of the physical pain and emotional anguish there are major financial issues, help issues and hardships that render you very much alone.

Absolutely on overload for ages and I knew it already, keep telling people and asking for help but get told I must help myself which I always try to do but now keep failing plus hated bad where I live for 8 months but can't move = mega depression and now fall to bits very often. 12 true out of 13. WHY no help for me?

Very bad story of a head on have given your happiness to that crash. Your anger has smothered any joy in your life. I have a head injury from a car that smashed into the back of me whilst stationary at traffic lights. I am having to change solicitors as the co op have left me abandoned after nearly two years. My girlfriend is cheating on me. I get angry..I have lost my home as ai cannot work. I struggle to breath daily as I have brain stem injury...yet I have hope and when I walk past the graveyard with my lovely Labrador..I am very pleased that ..I AM ALIVE...I will keep my deep un breakable faith that things will is exhausting yet I will not despair...😉

I've been overly stressed and depressed since 2 cars of teenagers were road raging, and in the process, hit me head on in a car accident while I was 9 months pregnant. It left me in chronic pain (unable to resolve)along with a brain injury which was left undiagnosed for the better part of 25 years. I live on medicare and a small pension, making me ineligible for any public aid. I don't have funds for counseling, am in debt up to my _ss for all the on-going medical bills, no medications that help my depression, suffer with Fibromyalgia. I have no family or friends for support or understanding. I hate taking the pain meds that I am prescribed for my back injury,neck injury, head injury and brain injury. I can sense the distain from the pharmacist, the judgement of family, and flat out being called a drug-addict. I have a severely disabled adult son as a result of this car accident, along with 2 healthy, yet selfish, adult children. I left my abusive husband. I cry every day when no one is home and want to run away. I'm unable to take care of my home, let alone my own needs. I can't remember what I've read or a movie I've watched. I get lost when driving somewhere, am overwhelmed at the thought of taking care of daily chores, like shopping, cooking, etc. I want my friends back, but they don't want to take the time it takes to understand my limitations, and just get irritated with me. Am I really supposed to ask for help from family when they have treated me like a hypo- chondriac and call me a _uckin' moron, while the rest of the family pretends like nothing hurtful was ever said? My hurt feelings don't matter, so they're left unadressed. Heaven forbid there are no confrontations. The best apology I received was "we feel bad." No stress in my life! LOL
I took this test, I don't know if I agree with the answer I got, i feal verry stressed and my answer said that i am bassically stress free. I had 9 T's and 3 F's