Archive for category Caregivers

[BLOG POST] The gamble of socialising after brain injury

The gamble of socialising after brain injury

I used to enjoy socialising with my friends, at work or an evening out. But even now, almost 2 years after my traumatic brain injury, I struggle with groups. There are so many reasons why this is difficult for me. I hate it needing to turn down kind offers for events, but I have to.

Socialising in groups means too many conversations to follow

Trying to get used to having a massively shortened attention span, like me, and following what someone is saying is tough. But add in several conversations happening at the same time, and it’s too much. I find I get distracted by hearing a word or two that someone else said. Then I’m trying to workout what they might be talking about. Oh but the conversation I’m having isn’t over. Yes you’ve lost me now, what did you say?

Socialising with a brain injury isn't always fun

I’m not stupid, I’m just slow

As many of my brains pathways are damaged, thinking and processing takes a lot more effort than before. It takes me time to think about what you said, let alone a reply. I get there, and other than the fact I struggle to find the words I’m looking for, my response is still the same. But when you have met up with friends, and the buzz is flying as this group are excited about socialising, you don’t want to be stuck with me. I suck the energy out of the flow as I slow it down so much. So I can’t blame people when they start up conversations with others, and I’m left like the lemon that I am.

All the concentrating wears me out

I get tired, and although adrenaline might carry me through the event, I pay for it later. The headaches and eye aches are awful. coupled with the cognitive fatigue, it can wipe me out for a week. And I mean I’m struggling to even get out of bed I’m so bad. I can’t string a thought together, not even that I should try taking some more painkillers.

This aftermath is the part that only my partner James sees. If I do decide to go to something, I know he’s thinking of both sides. Yes it’s good it have that social contact, but he knows it’s probably going to cost me more than dinner.

Socialising with a brain injury

I can cope with a couple at a time so much better. It means there’s just one conversation for me to follow. And I don’t mind if they do most of the talking, in fact it takes the pressure off me. It’s not that I’ve gone off socialising. I just have to weigh up the pluses and minuses of each situation. That’s pretty much the same for everything when you are living with a brain injury, you have to choose your battles.

Another thing to consider when thinking about going to an event is the environment. You can read why in Light and Noise Sensitivity.

Other articles you like like:

Do you find socialising in groups works for you? Please share any good tips.

Source: The gamble of socialising after brain injury | No memory of the day that changed my life

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[WEB SITE] Anxiety Disorders and Panic Attacks 

Alison Sommer graduated from Carleton with a degree in Asian Studies, and now works as an academic technologist at Macalester College. She believes that awareness is the first step to improving problems within mental health care, and will be speaking about anxiety disorders and panic attacks based on her own constantly evolving understanding of her anxiety disorder, OCD. Alison’s greatest loves are her family, hockey and Star Wars.

My first goal here today is not to have a panic attack right on stage.  I have an anxiety disorder called Obsessive Compulsive Disorder or OCD. Obsessive Compulsive…I have a form of Obsessive Compulsive Disorder that causes me to become anxious or frightened when something wrong or unexpected happens. Like if somebody sits at my seat at the table.

It also causes intrusive thoughts. These are thoughts that come unbidden to my head about things that I’ve done in the past or things that I might do. Things that could happen by chance or because everybody secretly hates me.

As you might imagine, these intrusive thoughts are really quite anxiety producing. And this anxiety can manifest in different physical and emotional responses, one of which is the panic attack which I’ll be talking about more in depth later.

But, the thing that made me really hyper aware of the effects of my OCD and made me determined to spread awareness about anxiety disorders in general is that my own symptoms were not always this severe.

So, I want to start at the beginning. As long as I can remember, I’ve always been sort of an obsessive-minded child. I would take a thing, good or bad, and roll it over in my head…over and over.

I was also really shy and awkward and I know, especially at Carlton, a lot of you are thinking, “yeah, me too.” Because, you know, there are a lot of shy, awkward people and all of us have our little obsessions. I don’t know if there is a scale for being shy, awkward and obsessive, but I always felt like I was toward the high end of the range.

“Weirdo” and “freak” were terms I readily accepted as a teenager. And when all the other girls my age were really into the Backstreet Boys, I’m dating myself, I was obsessed with Star Wars. I sort of still am. Like, I got in trouble for coming home late for curfew once as teenager and as punishment my parents took away my Star Wars stuff. And I thought that the world had collapsed.

I also had on again/off again issues with anxiety and depression. And, you know, anxiety and depression really go hand-in-hand, like two best friends who like to corner a third person and make them feel like shit.

So, there I was, this anxious, awkward, obsessive and sometimes depressed girl and that was life. That was my normal.

When I got a little older and started coming out of my shell and meeting people with similar interests to me, like the folks here at the Sci-Fi House at Carlton. Benton House, anyone? Woo.

I started actually opening up and talking to people about my feelings. And I started to realize that there were other people like me that suffered from anxiety and depression. And suddenly I went from feeling, instead of like a freak, I felt like just kind of a normal, anxiety/depression story with a little obsessive behavior thrown in for good measure. And that actually felt pretty cool. So, that was my life.

I also started to get a little help then, I saw my first psychiatrist, got my first meds. And, you know, things were going pretty good. And then I got a really bad concussion while playing hockey. Love the sport, still play it, but it was bad.

That’s when things took a nosedive from me feeling like “normal/runs in the family crazy” to like “scary crazy.” That’s when the intrusive thoughts started getting louder and louder. And it was bad. It was really, really bad. I was angry  all the time. It mostly came out at my husband, but my road rage was also pretty epic.

While I was being an ass to other people, I was also being an ass to myself. I was not eating. I was down to a size zero and that monkey was saying, “you can get skinnier.” I didn’t want to accept that I had a problem. I wanted to feel like I was kicking ass. But, I knew deep down that there was something wrong, because I wasn’t sleeping and my marriage was going through the shitter. But, trying to even think about changing my habits, like, really thinking about changing any of my habits would give me massive anxiety. And this anxiety was leading to panic attacks. Panic attacks are one of the most frightening manifestations of anxiety.

I know if you’ve never had a panic attack, the name sounds kind of lame. We all have those moments of panic, like: “oh, did I leave the oven running” or “my kid just bolted out into the middle of the street.” Or maybe more for you: “I forgot to study for that test.” But, none of these are panic attacks.

The Mayo Clinic’s website says that “A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When a panic attacks occurs you might think you’re losing control, having a heart attack, or even dying.” That’s a pretty good definition, but what does it really feel like? That’s what I’m going to try to show you.

So, it’s a pretty normal day, but maybe a little bit stressful, like at a performance evaluation for work or packing for vacation. I’m doing something pretty normal and I start to feel “off.” I know something’s not quite right. I’m getting tingly. A tingling numbness creeps up my neck and all over my face, and seeps into my head. I feel dizzy. So, I sit down. Sometimes I think maybe I just didn’t eat enough today, so I grab for some crackers or a candy bar or whatever I have. My head is feeling fuzzy. As I’m sitting there, sometimes I think “oh my gosh, it’s a seizure or heart attack or…” But, I know better. I know it’s a mounting panic attack when my heart starts beating harder, not faster really, just hard. Like the heartbeat in the background of a horror film.

Now I’m getting scared thinking, “no, no, not here. Not now.” Right now, the right medication might help, might bring this crescendo back down and end the panic attack, but sometimes even the right medication doesn’t always help.

I feel off and I want to sit still, but my body just won’t listen, so I pace. I lash out. The tears come now. Broken, dry cries. Weak, angry shrieks break through and my brain is screaming,

“Shut up! Shut up! Shut up!”

Not a real cry, nothing that could be cathartic can come out. It all gets caught in my throat and in my head. Oh…I get angry. Mad at this feeling, myself, everything! I pound my head with my fists. I want to bang it against the floor. I want to smash my skull and make it all end!

Sometimes I do, I just hit myself and I can’t hold back and it feels like relief suddenly. That physical pain, and I crave physical pain: cuts, burns, bruises. And then that scares me even more.

I look up at my shelf of pill bottles and I think, “I could take them all. I could end it right now.” But, I don’t. I don’t. Real tears come now. So sad. Tears. But, now I can lay down. Just wait for it to be over. Eventually, it ends. It always does end.

And I’m still here. And with my sanity coming back, with my head clearing, I’m grateful to still be here and that it always stops eventually.

This is not an easy thing to live with, knowing that it could happen at any moment, any place, at home, at work, at the tattoo parlor…that’s happened.

And not a lot of people talk about it even though a lot of people go through it. When I first posted to my blog about my experiences with panic attacks, I was surprised when people started contacting me from all corners of my life…on the internet, to tell me about their experiences. And to thank me for speaking out and told me I was brave.

It got me thinking. These days everything seems to have an awareness month or a ribbon or some picture you can share on Facebook to spread awareness.

I’ve made this sort of my panic attack awareness effort and now I hope you all know a little bit more about they really feel like.

As for me, my husband did finally get me to see a doctor. It turns out that my anxiety and obsessive tendencies had basically been give steroids by the concussion.

And I was diagnosed with severe OCD and we started the dance of trying to find the right combination of meds and therapy. We’re still figuring it out.

I still have panic attacks, but luckily, thanks to some wonderful people and some magical chemicals, they are fewer and further in between. And blogging about it and talking about it is part of my therapy too.

I’m very blessed to have such a wonderful support structure here in my life. And to have been given these opportunities to talk openly about my anxiety disorder.

40 million adult Americans, according to the National Institute for Mental Health, have anxiety disorders. That’s just over 18% of the population, so chances are you know someone with an anxiety disorder, whether it’s a friend, a colleague, or even yourself. Of the 40 million who have anxiety, 15% of them experience the terror of panic attacks and it’s twice as common in women as in men. 

When I’m having a panic attack, the best thing people can do for me is to just be with me and let me know they’re there for me and will do things I ask that I say I need, whether that’s to open a window, or let me run away from the room, or turn out the lights… none of which you can do on an airplane, by the way, it turns out.

So, if you’re there when someone you know is having a panic attack, it’s hard to breath in the middle of an attack, much less speak, so instead of asking them over and over,

“Are you ok? What’s wrong? Are you ok? What are you panicking about? What can I do? Are you ok? Are you ok?”

Just be there. Let them know you support them and sit with them as they ride out those waves of panic because… you can’t tell a panicking person to calm down. That’s like trying to tell someone with a gaping wound to just stop bleeding.

But, what you can do is let them know you’re there for them. It may make you feel helpless, but your presence is more comforting than you may realize. And then when it’s over, then you can ask what you can do for next time, if anything really.

But, one thing we can all do, is work together to end the stigma surrounding mental health disorders like anxiety, so that everybody who needs help can feel safe in asking for it.

You can help by showing respect to people who seek the aid of therapists, psychiatrists and medications. Instead of telling someone to work harder or worry less, tell them that you’re there for them and that you understand these things can be a struggle.

If you have anxiety, it’s not your fault.

Help is available in many forms. I started getting help by working with my primary care physician, but there are also hotlines and websites such as The Anxiety and Depression Association of America at http://www.adaa.org.

In short, if you or someone you know has an anxiety disorder, give help, get help, speak out.

You’re not alone.

Source: Anxiety Disorders and Panic Attacks – Artificial Intelligence and Magnificent Brain

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[BLOG POST] Gist reasoning – The most invisible loss of mild TBI

Broken Brain - Brilliant Mind

catching-up-6I am thinking a lot about losses, these days. Loss of friends, loss of doctors, loss of family, loss of jobs, loss of money, loss of hope.

I’ve been actively working on my brain injury recovery since 2007 — nearly 10 years. I got hurt at the end of 2004, so it’s been over 11 years since my last TBI. And my expectations and hopes have varied, during that time.

I always expected to be able to build back my abilities to at least some extent. I expected to be able to be able to retrain my brain to build back my memory, to address my distractability, to handle my fatigue, and basically all-round get myself back to where I wanted to be.

But that hasn’t happened. The one area where I have significantly improved, is in my gist reasoning, which is really the biggest “functional” deficit I had. Not…

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[Abstract] Subjective complaints after acquired brain injury: presentation of the Brain Injury Complaint Questionnaire (BICoQ)

Abstract

The objective of the present study was to present a new complaint questionnaire designed to assess a wide range of difficulties commonly reported by patients with acquired brain injury. Patients (n =  619) had been referred to a community re-entry service at a chronic stage after brain injury, mainly traumatic brain injury (TBI). The Brain Injury Complaint Questionnaire (BICoQ) includes 25 questions in the following domains: cognition, behavior, fatigue and sleep, mood, and somatic problems. A self and a proxy questionnaire were given. An additional question was given to the relative, about the patient’s awareness of his difficulties. The questionnaires had a good internal coherence, as measured with Cronbach’s alpha. The most frequent complaints were, in decreasing order, mental slowness, memory troubles, fatigue, concentration difficulties, anxiety, and dual tasking problems. Principal component analysis with varimax rotation yielded six underlying factors explaining 50.5% of total variance: somatic concerns, cognition, and lack of drive, lack of control, psycholinguistic disorders, mood, and mental fatigue/slowness. About 52% of patients reported fewer complaints than their proxy, suggesting lack of awareness. The total complaint scores were not significantly correlated with any injury severity measure, but were significantly correlated with disability and poorer quality of life (Note: only factor 2 [cognition/lack of drive] was significantly related to disability.) The BICoQ is a simple scale that can be used in addition to traditional clinical and cognitive assessment measures, and to assess awareness of everyday life problems.

The figure shows the most frequent complaints (in decreasing order) reported by patients with acquired brain injury (traumatic brain injury or stroke) and by a close relative, using the Brain Injury Complaint Questionnaire (BICoQ). These complaints indicate a combination of cognitive difficulties and behavioral and personality changes.

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[BOOK] Rehabilitation for the Unwanted: Patients and Their Caretakers – Βιβλία Google

 

Routledge29 Σεπ 2017 – 242 σελίδες
This book is a study detailing what happens to people and what life is like in a rehabilitation program. The program discussed is embedded in an institution, called “”Farewell Hospital”” by the authors, that was designed to fill a demand for facilities for those judged unable to live on their own. Due to physical or mental handicaps and no family, friends, or other social agents who are willing to make a home for them outside of a public institution, these patients were placed in a rehabilitation unit.Most patients were placed with the rehabilitation unit as a brief interlude before their permanent placement in the custodial unit of the vast institution where they would live out their lives. This work deals with the question of what happens to patients once they are rehabilitated and the non-therapeutic rules and practices of the health and welfare structure of which they are a part. In this case, the rehabilitation specialists and ward workers set themselves the task of improving the life chances of their clients by treating their ailments when possible and by improving their physical functioning so that they were better able to care for their own needs.The authors examine the effects of the organizational relationships on rehabilitation outcomes and on the lives of the people who make hospitals their home. The text attempts to sustain feeling for the historical context of their study the “”problem”” of larger numbers of disabled, poverty-stricken persons, who are no longer wanted by anyone and asserts that a “”solution”” must be found.

Source: Rehabilitation for the Unwanted: Patients and Their Caretakers – Elizabeth Eddy – Βιβλία Google

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[WEB SITE] TBI Basics – BrainLine

A TBI can happen to anyone, whether it happens while playing sports, at work, or just slipping on an icy sidewalk. Injuries can range from “mild” to “severe”, with a majority of cases being concussions or mild TBI. The good news is that most cases are treatable and there are several ways to help prevent injury.

What You’ll Find Here

You Are Not Alone

You Are Not Alone

See how others are navigating their post-TBI lives. Check out personal stories and “life after TBI” blogs, or join the conversation with our Facebook community.

Source: TBI Basics | BrainLine

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[WEB SITE] Stress and Stress Management Post-TBI – BrainLine

Stress and Stress Management Post-TBI

Question: 

Why does stress bring back my TBI symptoms with a vengeance? It feels like a knife reopening a wound. What goes wrong in the brain after injury that makes this happen?

Answer: 

Stress occurs when there is a gap between the current task demands and the resources you have to meet those demands. Your brain interprets this as a threat. Acute stress — as in immediate physical danger — produces a physical reaction (the fight-or-flight response) that includes increased pupil dilation, perspiration, increased heart rate and blood pressure, rapid breathing, muscle tension, and increased mental alertness. However, less immediately threatening or prolonged stressors, such as ongoing money problems, too many things to get done in one day, even something like unexpected company, will produce these reactions. They may occur to a lessor degree, but ongoing stress reactions, even mild ones, will result in your body preparing for a long-term protective response.

Fatigue, concentration lapses, irritability, and lethargy result as the stress continues without relief. You probably recognize these as some of the TBI symptoms you feel coming back with a vengeance. Having experienced a TBI makes you both more susceptible to these symptoms, and these symptoms make it more difficult for you to effectively use whatever coping or compensatory strategies you may have developed to manage your TBI symptoms.

Learning to manage stress is important for all of us, and of particular importance to the recovery process after TBI. Techniques such as relaxation, time management, goal-setting, organization, cognitive-behavioral techniques, and lifestyle modifications can all be helpful in managing stress. It is recommended that you get some help and support in figuring out which of these techniques will be most useful for you from a mental health provider, a case manager, a life coach, a support group, or even a good friend if the stress levels are not overwhelming or seriously affecting your life. There are plenty of resources available for stress management, and a lot of information online, but sifting through it and tailoring it for your particular needs may be challenging without some support.

For more information on stress and stress management, click here.

Source: Stress and Stress Management Post-TBI | BrainLine

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[BLOG POST] 7 Things You Should Never Say To Someone With TBI or PTS

If you have a friend or loved one who is suffering from a psychological health condition like TBI, it can be hard at times to express your compassion through general words. It’s important to be sensitive when speaking to them about their struggles, and it is crucial for them to have your support during this challenging time.

While there is no doubt that you mean well, just a few simple words that don’t mean much to you can actually be painful for them to hear.

“You don’t look sick.”
Not showing physical symptoms of being ill doesn’t mean that illness is not there. While there can sometimes be slight, but noticeable changes in appearance, many of the changes are mental, such as feeling emotionally numb, experiencing panic attacks, and having suicidal thoughts.

“You’re lucky! It could’ve been worse.”
There is nothing that is lucky about living with a psychological health condition. Every day can come with a new set of challenges.

“Are you sure it’s not just all in your head?”
As previously stated, it can be hard for someone to understand what a person suffering from TBI is going through because those symptoms and changes aren’t physical. This battle is internal and is a very real illness. Saying this can just make them feel as if their psychological health conditions aren’t real and could prevent them from seeking the professional help they need. It can also lead to giving them unnecessary stress and anxiety. Read more about the stigma of mental illness.

“Maybe you should just get out more.”
Certain social situations can be overwhelming for those who suffer from psychological health conditions. Loud noises and crowds can often be a stress-inducing trigger, so avoiding them can be better for their health.

“Just look on the bright side!”
While positivity and optimism play a key role in getting better, “looking on the bright side” won’t treat psychological health conditions alone.

“What if you just stop thinking about it?”
When someone experiences a traumatic event, it’s hard to erase that impactful moment from their life. Oftentimes, that moment will replay itself in that person’s head over and over again. Experiencing these flashbacks can lead to destructive behavior to try and block out the memory.

“Have you tried _________?”
There are many ways to help treat psychological health conditions, but leave it to the experts to find what works best for the patient. (Unless you’re asking them if they’ve tried to seek professional treatment. Then by all means, please encourage that!)

The greatest things that you can say to someone who is fighting TBI are genuine words of support. Let them know you’re there for them and that you believe that what they’re going through is a real illness. They’ll appreciate that more than anything else.

Source: Intrepid Fallen Heroes Fund – 7 Things You Should Never Say To Someone With TBI or PTS

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[WEB SITE] Couples’ Relationships After Traumatic Brain Injury – BrainLine

Couples' Relationships After Traumatic Brain Injury

Although some of the relationship changes after TBI are difficult and can be painful, there are many things that couples can do in order to enjoy each other and their relationship in new, positive, and meaningful ways.

Couples’ Relationships and TBI

A TBI can significantly change a couple’s relationship. There are different degrees of brain injury severity, and milder injuries such as concussions do not always result in significant or long-term relationship changes. However, after severe, moderate, or complicated-mild brain injury, both survivors and their spouses or partners must often change many parts of their lives. The following life changes typically affect intimate relationships:

  • Changes in responsibilities
  • Changes in relationship roles
  • Changes and challenges in communication

Brain injury survivors often have new personality traits, challenges, fears, and limitations. Survivors are often surprised by how these changes also mean that they will feel and behave differently in their relationships. These changes have led many spouses to say they feel like they are “married to a stranger.”

The intimate partners of survivors may have new concerns or fears related to both the incident that caused the injury and the new behavior traits of the survivor. Also, partners often change the focus in their lives in order to manage the multiple challenges that arise for their family after an injury.

These changes in the survivor’s personality and the life focus of both partners often result in a feeling that partners do not know what to expect from one another. Uncertainty can increase stress and anxiety within the home.

How Are Relationships Typically Affected?

Responsibilities

After a TBI, survivors must focus their energy on getting better and developing new skills. As a result, the assignment of responsibilities in the home must change. This means that everyone in the family is involved in learning new skills and taking on new jobs.

How do responsibilities typically change?

  • Survivors often give up many responsibilities, including work expectations and household chores, while they focus on getting better.
  • Partners often must take on many responsibilities formerly managed by the survivor, such as:
    • Yard work and physically maintaining their home through chores and repairs
    • Managing household finances
    • Planning and organizing activities for the family
  • There are also new tasks for both survivors and their partners, such as managing the health care of the survivor.

What happens when responsibilities change?

  • Any time people have to take on new responsibilities and learn how to handle new tasks, they will also experience more stress.
  • In addition to the stress of injury and recovery, the stress of changes in responsibilities can increase tension between partners.
  • Partners who have significantly more responsibilities will also have less time for other things. In contrast, survivors who are focusing on getting better may feel like they have more time. This can result in different expectations about how much time partners have to spend together.

Tips to improve relationship issues related to responsibility changes

  • Be understanding about each other’s new responsibilities. This can have a positive impact on a relationship. Although it is natural to focus on oneself when a person is overwhelmed, partners must take time and effort to note all of the new responsibilities their partner is managing. Noticing and talking about these challenges can reduce tension within your relationship.
  • Say “thank you.” Make a commitment to yourself to thank your partner at least once a day for attempting to manage new responsibilities.
  • Schedule opportunities to take breaks from responsibility. These breaks may be short and may not be as frequent as desired. However, when couples and families schedule time off for each adult family member and honor that commitment both practically and emotionally, thankfulness and respect are more likely to grow in the relationship.

Relationship Roles

In all families, people take on roles that often define how they behave. After brain injury, the challenge of recovery nearly always results in some changes to the roles within a family. While the person with TBI is in the hospital, their partner may need to make decisions that are usually made by the survivor. For example, a husband may make decisions about child care that his wife usually makes, or a wife may calm the family when everyone is upset, although that is something her husband has always done.

How do relationship roles change?

  • Although people often take on many different roles in their relationships over the course of a lifetime, TBI results in dramatic role changes that occur instantly, and without preparation.
  • Early on in recovery, it may seem to couples that role changes are temporary. However, as time progresses, couples often find that these role changes may last for years or even be permanent.
  • Commonly, partners take on more leadership roles in the relationship. Depending upon who is hurt and how the family did things before the injury, this may mean some small shifts for the couple, or it may mean drastic changes.

What happens when relationship roles change?

  • The more role changes that occur, and the more dramatic the changes are, the harder it may be for a couple to adjust to the changes.
  • Certain family dynamics may also make the role changes more challenging:
    • Couples who keep tasks separate instead of alternating who does what may find it more challenging to adjust to new roles.
    • Couples who have just recently begun a new phase of their relationship, such as being newly married, having children, or being a new “empty nest” couple, may have a more difficult time with changes in roles.
  • As each partner learns how to operate in his or her new role, there will be a period of adjustment for both people. Uncertainty and frustration during this time can result in increased criticism between partners.
  • People close to the couple may not understand the need for role changes and sometimes incorrectly believe that such changes slow recovery. For example, family members may say “Let her talk to the kids’ teachers. She will never get back to her old self if you don’t let her do her job.” This can cause tension between the couple and their family and/or friends.

Tips to improve relationships when roles have changed

  • Identify where role changes occur and talk about these changes openly. Partners should try to be sensitive to the feelings of survivors. For example, the survivor may have felt pride in his or her role before the TBI and may feel sad or frustrated when asked to step aside.
  • Partners can serve as mentors and consultants for one another. Couples can ask one another, “What works best for you when you are in this situation?” Although survivors may not be able to manage a former role, such as being the financial decision maker, they can share their knowledge with their spouse. Both partners will benefit when this approach is taken.
  • Couples must be conscious of not criticizing the partner who is taking on a new role. For example, it is unlikely that a girlfriend will handle a challenge in the same way her boyfriend would have handled it. Partners should work hard to support one another in their new roles. This includes being patient with the time it takes for everyone to feel comfortable in their new roles.
  • Family and friends may need to be taught about brain injury and the changes it brings. Children who live at home will also benefit from direct discussions about these changes: “I know mom used to be the person who checked your homework every day, but she and I have decided that it will be better for now if I do it.” Without open communication about role changes, others may not understand why things feel so different and why supporting those differences can help the whole family to heal.

Communication

Communication is the foundation of a relationship. Many people think only of talking when they hear the word “communication,” but couples are actually communicating through gestures, facial expressions, emotional reactions, and physical interactions as well. In studies on relationships after brain injury, communication is often reported as the biggest change people notice.

For spouses:

  • Additional responsibilities and the uncertainty of recovery can cause spouses to feel very overwhelmed. When overwhelmed, people often change their communication styles. Some common changes can include talking less, talking more, and/or communicating more intensely or urgently than before.
  • Spouses may be unsure how best to communicate with their partner after injury. This discomfort may cause spouses not to communicate as often or as openly with the survivor.

For both people:

  • Increased stress levels often affect communication for both partners.
  • Both people may be afraid that sharing their negative thoughts or feelings will burden their partner.
  • When either person in a relationship changes how he or she communicates, both people will behave differently.

What happens when communication styles and patterns change?

  • Changes in communication between partners can result in both people feeling alone and isolated. Couples may feel they no longer understand what their partner is thinking or feeling.
  • Difficulty communicating can sometimes cause people to pull away from their relationship, choosing instead to handle challenges with friends or other family members. Sometimes, people choose not to communicate their feelings with anyone at all.
  • Communication struggles can impact all other parts of a relationship, including responsibilities and roles, and make it difficult to adjust to changes together.

Tips on improving a couple’s communication

  • Both partners should make a commitment to improve communication.
  • Listen patiently to what your partner is saying.
  • Listen for points where you can agree rather than focusing on disagreement.
  • When you do disagree, think about what you might say before you say it.
  • Remember that survivors will likely need more time to think about what their partner is saying, or about how they want to communicate again, patience is key.
  • Take notes on your thoughts during conversations rather than immediately saying what comes to mind. Come back to these points later, after you have had time to reflect.
  • Exchange bulleted lists of important points for big discussions. When you have something you would like to say, write it down before a discussion and use it as a guide. Trading these lists after a conversation helps with memory and allows more time to digest and think about the information.
  • When a topic is likely to cause a disagreement, practice what you would like to say before you start the conversation.
  • Practice in front of a mirror. Look at facial expressions, gestures, and body language, while also choosing your words carefully. When you talk, try to stick to what you practiced.

Physical Intimacy/Sexual Relationships

Most couples notice significant changes in their sexual relationship after TBI. There are many reasons for these differences, including changes in:

  • Hormone levels due to injury
  • Roles in the sexual relationship
  • Appearance, self-confidence, and or attraction
  • Areas of sexual interest

*For more information on physical intimacy and sex after TBI, see the MSKTC factsheet on BrainLine “TBI & Sexuality.”

Tips for Improving Intimate Relationships

Find a therapist

Therapy can give couples support and ideas to improve their specific situations. Different types of counseling are available, including individual counseling for either the survivor or partner, couples counseling, or family therapy.

Seek out a counselor or psychotherapist who has expertise in brain injuries. If there are no therapists locally with brain injury experience, couples should provide their therapist with information about injury and common relationship challenges that can accompany injury. The Web sites on this factsheet can be a good place to start.

Try a support group

Many communities have support groups for both survivors and caregivers/partners, which are often listed in the newspaper or advertised by State brain injury associations. These groups can help couples establish new friendships, find local information and resources, and provide time apart from their partner for reflection.

When local support groups are unavailable, try Web-based chat groups and support communities. These groups are an excellent option when in-person groups are either too far away or when transportation is a challenge.

Finding a therapist or a support group

To find a support group or counselor in your area, start with your State brain injury association. If you do not know how to reach your State brain injury association, you can either a) contact the Brain Injury Association of America (1–800–444–6443 or on the Web at http://www.biausa.org or b) use an online search engine (Google, Yahoo, Bing, etc.) to find one by typing in “Brain Injury Association” and the name of your state.

Online support groups are available on Facebook and throughout the Web. Use the search feature on Facebook and type “Traumatic Brain Injury” to find different groups that you may like. Or use an online search engine such as Google or Yahoo and search the term “Traumatic Brain Injury Support Groups.” There are many different options, so look around to find the one that best fits your needs.

Changing the relationship environment

At home, make a commitment to establish a positive environment. Looking for progress in recovery instead of ways in which a relationship is not succeeding can improve how people feel about each other. Additionally, part of having a positive home life comes from the opportunity for fun as a couple.

Scheduling a “date” on the calendar to take a walk, watch a movie on television, or play a game like cards can be an inexpensive strategy that may make a big difference in reducing tension. When fun time is scheduled, consider it to be as important as a doctor’s appointment—something that cannot be ignored or rescheduled.

Considerations in new relationships

If you are in a new relationship, the process of recovery can be more complicated. For example, if an individual is injured while he or she is in the early stages of a relationship, the couple may not know what their roles are yet. This can result in confusion and uncertainty and may lead some people to ask, “Who am I in this relationship?” or “Who are we together?”

Any couples who are new to their relationships can work to take a positive approach to recovery. Although role uncertainty may be a challenge, it also provides the couple more freedom by not being tied to old ways of doing things.

Considerations in nontraditional relationships

There are also a growing number of adults who choose to live in unmarried monogamous relationships. For cultural, financial, social, or other reasons, these couples may not be in a “traditional marriage.” Individuals who identify as gay, bisexual, lesbian, or transgender, as well as people who identify as heterosexual and in an unmarried relationship may have more complicated issues to deal with.

For example, they may not have access to their unmarried partner’s insurance, bereavement, pension, or other benefits. Other challenges can include the inability to be represented in health care decisions, lack of recognized family leave from work, or even having to choose to “come out” as a result of the injury. In addition, the lack of acceptance or awareness in their community with regard to nontraditional relationships may impact a couple’s ability even to seek or obtain care. These complications can influence a couple’s success or failure in a relationship.

Tips for nontraditional couples to manage challenges

  • For caregiving partners, building relationships with the survivor’s family members who are supportive can be very helpful. Partners may want to make working on these relationships a top priority as a way to stay involved in a survivor’s care.
  • Psychotherapy or counseling is likely an important component of recovery for nontraditional couples. Because partners may have even less support than couples in traditional relationships, finding a therapist who can provide this support and guidance is an important part of healing.

Concerns About Divorce or Separation

You may have heard that divorce or separation is likely after TBI. Although no one knows for sure what will happen in any relationship, some studies suggest that divorce and separation rates may actually be lower after brain injury than for the rest of the population. Rather than focusing on the possibility of divorce or separation, couples do best by focusing on improving the quality of their relationship with one another.

Recommended Reading

  • Healing Your Marriage After Brain Injury. Published in “The Challenge,” a Brain Injury Association of America publication. Written by Jeffrey S. Kreutzer, Ph.D., and Emilie E. Godwin, Ph.D.
  • Learning by Accident. Written by Rosemary Rawlins
  • Brain Injury Survivor’s Guide: Welcome to Our World. Written by Larry Jameson and Beth Jameson
  • Blog: Starting Marriage Over After a Brain Injury (survivor and caregiver stories). Available at http://www.marriagemissions.com/starting-marriage-over-after-a-brain-injury/
Posted on BrainLine April 17, 2013

Couples’ Relationships After Traumatic Brain Injury was developed by Emilie Godwin, PhD, Jeffrey Kreutzer, PhD, and Stephanie Kolakowsky-Hayner, PhD in collaboration with the Model System Knowledge Translation Center. This health information content is based on research evidence and approved by experts from the TBI Model Systems.

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

Source: Couples’ Relationships After Traumatic Brain Injury | BrainLine

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[WEB PAGE] Stressed out? Try talking to yourself in the third person

New research shows that talking to yourself in the third person may help to relieve stress and anxiety.

From meditation to physical activity, there are various things that we can do to regain control over our emotions during stressful times. But what if there was an easier way of doing that? New research investigates the effect of talking to yourself in third person on emotion management.

A team of researchers, led by scientists from Michigan State University in East Lansing and the University of Michigan in Ann Arbor, set out to examine the neuropsychological effect of talking to oneself in the third person on controlling one’s emotions.

The researchers’ hypothesis was that talking to oneself in the same way that one would about others would provide some much-needed psychological distance, which may help to control emotions.

The new study – which is published in the journal Scientific Reports – consists of two neuroscientific experiments that tested this hypothesis.

Using an electroencephalograph

In the first experiment – which was conducted at the Clinical Psychophysiology Lab and led by Prof. Jason Moser, of Michigan State University – participants were asked to look at emotionally aversive images (for example, a man pointing a gun at their heads) and neutral images.

They were asked to view these images in both conditions: the first-person condition, and the third-person condition.

In the former, the participants asked themselves, “What am I feeling right now?” But in the latter condition, they asked themselves, “What is [participant’s name] feeling right now?”

The participants’ brain activity was monitored using an electroencephalograph.

Referring to themselves in the third person reduced the participants’ brain activity across the neural mechanisms that are known to be involved in emotional regulation – and it did so almost immediately, within 1 second.

Interestingly, the brain activity – as recorded by the electroencephalograph – did not show an increase in cognitive control markers, which suggests that the strategy is effective at managing stress in a cognitively effortless way.

Talking to oneself inside an fMRI machine

In the second experiment, participants were asked to recall emotionally distressing experiences from their past in both first-person and third-person conditions.

This time, however, their brain activity was monitored using a functional MRI (fMRI) machine.

The second experiment revealed decreased activity in the medial prefrontal cortex, an area known to be a marker for self-referential emotional processing.

So, the third-person technique decreased activity in the brain area involved in processing painful autobiographical emotional memories.

However, reinforcing the findings of the first experiment, the second experiment did not reveal increased activity in the brain network involved in the cognitive control of emotions, the frontoparietal network.

This suggested, once again, that talking to oneself in the third person may be a simple and cognitively inexpensive way of reducing negative emotions on the spot.

Essentially, we think referring to yourself in the third person leads people to think about themselves more similar to how they think about others, and you can see evidence for this in the brain. That helps people gain a tiny bit of psychological distance from their experiences, which can often be useful for regulating emotions.”

Prof. Jason Moser

“What’s really exciting here,” says the leader of the second study, Ethan Kross, of the University of Michigan, “is that the brain data from these two complementary experiments suggest that third-person self-talk may constitute a relatively effortless form of emotion regulation.”

“If this ends up being true – we won’t know until more research is done – there are lots of important implications these findings have for our basic understanding of how self-control works, and for how to help people control their emotions in daily life,” concludes Kross.

Source: Stressed out? Try talking to yourself in the third person

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