Mental health and brain injury

Anxiety is feelings of worry and fear about the unknown. It activates a person’s fight or flight response. It’s normal to experience some anxiety, especially after a brain injury—but it becomes problematic when it’s unmanageable and/or doesn’t match the situation.

There are a few different types of anxiety a person can experience[3].

General anxiety means a person experiences persistent and excessive anxiety over various parts of life, including work and home life. They find their anxiety difficult to control and may even experience physical symptoms including restlessness, fatigue, muscle tension and sleep disturbance.

Here are some tips to help someone cope with anxiety in the moment:

• Have them practice deep breathing – do it with them to help them through it
• Gently guide them back to easy, routine tasks that are comfortable and familiar
• Ask them if they want to talk about what’s making them anxious – the act of sharing can be cathartic
• Acknowledge their feelings and remind them it’s okay to experience these feelings

With social anxiety, a person is fearful, anxious about, or avoids social interactions and situations that involve the possibility of being watched. This includes meeting unfamiliar people, situations where they are eating/drinking, or situations where they may perform in front of others. Individuals worry about being embarrassed, rejected by others or of offending people.

Social anxiety can lead to staying in and isolation. For more information on social isolation and coping tips, visit our social life and brain injury page.

Panic attacks are abrupt surges of intense discomfort that reach a high within minutes. They are accompanied by physical/cognitive symptoms. They can be expected or unexpected. Expected panic attacks are connected to a typically feared item or situation. Unexpected panic attacks occur for no apparent reason. Individuals who experience panic attacks are regularly worried about having more panic attacks. They may also change their behaviour to avoid attacks, which can impact them negatively (i.e. skipping exercise, avoiding new places). Panic attacks are often a sign that someone has an anxiety disorder.

There are a few key ways to identify if someone is having a panic attack:

• Feelings of choking, chest pain, nausea, dizziness
• Feelings of detachment or unreality
• Heart palpitations
• Hot or cold flashes
• Numbness or tingling
• Shakiness or trembling
• Shortness of breath
• Sweating

A panic attack can be brought on by different things, but often happen when a person is feeling trapped or overly anxious about something. Some people spend a lot of time scared they may have another panic attack and try to isolate themselves or stick to ‘safe’ environments. This is difficult and impacts both you and the person with a brain injury.

Ways to help someone cope with panic attacks can include:

• Practice calm breathing with them
• Practicing body relaxation – talk them through relaxing different parts of their body, giving them something else to focus on
• Talk to them about what happened leading up to the panic attack, identifying the cause
• Use positive visualization
• Visit a therapist
• Help them slowly build up a tolerance to the things that start their panic attacks

It takes a lot of time and dedication but managing panic attacks is possible with the right tools.

Depression affects many Canadians every year. Individuals with brain injuries are particularly susceptible to depression due to the intensity of life changes, shift in sense of self, and the process of adjusting to a new reality. This is incredibly difficult to cope with and can result in elevated stress and feelings of depression. Depression can also be caused by injury to the area of the brain that controls emotion, pre-existing genetic factors, and situational influences[4].

Symptoms of depression include:

• Changes in eating patterns
• Changes in sleep
• Changes in weight
• Feelings of sadness
• Focus on the emotions of loss and grief
• Helplessness, worthlessness and guilt
• Irritability
• Less interest or pleasure in things or activities previously enjoyed
• Loss of sexual interest
• Physical aches and pains
• Poor concentration
• Tiredness or loss of energy
• Thoughts of death and suicide
• Withdrawing from friends and family

Please note: A person can have some of these symptoms and not have depression. Talk to their doctor or psychotherapist about any emotional or physical symptoms they may be exhibiting. You can keep track in a daily journal.

If your loved one is diagnosed with depression, this can have an impact on their recovery, their daily lives, and on you. They may be more fatigued, have trouble engaging with people, experience bouts of anger and irritability or find participating in rehabilitation more difficult. They might also have trouble recognizing they are depressed and not have the skills to cope with it in a constructive way.

The most common treatments for depression are prescribed medications and talk therapy. Some things you can do at home to help your loved one cope with depression include[5]:

• Helping them eat a balanced diet
• Exercising
• Making sure they avoid using substances
• Find enjoyable hobbies they can do on their own or with others
• Make sure they get an appropriate amount of rest
• Try mindful activities like meditation

While there is a high risk of individuals with brain injury experiencing depression, there is also a risk that as a caregiver, you will experience depression. Visit our coping with caregiving page to learn more about taking care of yourself as well as your loved one.

Depression is a complex challenge that will most likely be long-term. There will be good days and bad days: the important thing is that treatment is consistent and that both you and your loved one have the support you need to speak openly about it.

Post-traumatic stress disorder (PTSD) is a mental health disorder that occurs in people who have suffered a traumatic event. It’s common in individuals that have experienced assault, accident survivors, and people in the military. Symptoms of post-traumatic stress disorder include:

• Anxiety
• Increase in negative thoughts, feelings, and beliefs stemming from the trauma
• Disassociation – the person loses touch with the present and feels like they are experiencing the trauma again
• Hallucination flashbacks
• Nightmares
• Avoidance of certain situations that may recall (trigger) the trauma
• Feeling on guard all the time
• Not remembering parts of the trauma
• Sleep problems

Not every person who suffers a traumatic brain injury will have post-traumatic stress disorder. Additionally, not everyone with post-traumatic stress disorder will have a brain injury. It is dependent on the person, injuries, and how the trauma was processed. Only a licensed professional – for example, a psychologist or psychiatrist – can diagnose post-traumatic stress disorder.

• More information on post-traumatic stress disorder from Anxiety Canada

A person with a brain injury may not realize or be able to acknowledge they have post-traumatic stress disorder, and it can be difficult to bring up the subject with them. It might also cause them to be unintentionally hurtful towards you: it’s important to remember that individuals with brain injury can’t always control their behaviour, and post-traumatic stress disorder can be a contributing factor. While difficult, try not to take it personally.

Therapy and prescription medication are two of the most common ways to help treat post-traumatic stress disorder. Other things that can be done to support someone with post-traumatic stress disorder include[6]:

• Attend public support groups with them – their doctor or therapist can direct you to one if it’s available in your area
• Exercising and taking care of physical health
• Find activities that make them feel good
• Identify what triggers their post-traumatic stress
• Limit substance use

Post-traumatic stress disorder does not have a ‘cure’ – like most mental health challenges, it requires lifelong commitment to continuing care and management.

• More ways to help with post-traumatic stress disorder

After an acquired brain injury, the person may experience lasting changes to their personality, abilities, relationships, and how they process information (including impulse control and decision-making). These changes are difficult to cope with, and can leave a person feeling alone, hopeless and angry. In some cases, these mental and environmental factors can lead to a higher risk of suicidal thoughts.

Signs of suicidal thoughts include:

• Statements about dying or wishing to have died
• Isolation or withdrawal from others
• Intense feelings of hopelessness and helplessness – this often comes with feelings of depression.

If you suspect someone is experiencing suicidal thoughts, you should talk to your doctor or a mental health professional immediately.

Suicidal thoughts and tendencies are a complex issue that may be long-term. A person with a brain injury may make multiple attempts or experience these feelings episodically months or even years after the injury. This means that there needs to be a supportive, multidisciplinary team of caregivers, family and mental health professionals dedicated to continuing care and development of a community plan. Examples of long-term support include antidepressants, counselling, behaviour therapies, and monitoring by caregivers.

There are helplines and crisis centres available across Canada you can call if you need immediate support.