Category: Survivor

Statistics

The source for each statistic (or statistical statement) can be found on the source page at this link. Each number next to a statistic below correlates to the appropriate source.

Despite the prevalence of brain injury in Canada, it is difficult to gather accurate statistics on a regular basis because we rely on hospital and doctor reporting. Many brain injuries are not actually reported at the time of injury (or at all), which impacts the statistics.

A key part of Brain Injury Canada’s advocacy plans is to bring more attention to brain injury, its impact, and the need for more up to date information. We have compiled currently available statistics related to brain injury on this page to help those researching or reporting on brain injury in Canada. If you will be quoting any of these statistics, please include proper sourcing back to this page and Brain Injury Canada.

Topics for statistics on this page include:

Traumatic brain injury

Traumatic brain injury (TBI) general statistics
By 2031, traumatic brain injury (TBI) is expected to be among the most common neurological conditions affecting Canadians, along with Alzheimer’s disease and other dementias, and epilepsy [1].

Traumatic brain injury (TBI) is a leading cause of disability globally. In Canada, 2% of the population lives with a TBI, and there are 18,000 hospitalizations for TBI each year. One-third of individuals with a TBI are women, and TBI is particularly common early in the reproductive years (15-24 years), with intimate partner violence and accidents being major causes. Women with TBI are more likely than men to experience mental health problems post-injury [2].

Please note: The following series of stats has been extrapolated from United States data to the population of Canada.

TBI occurs at an annual rate of 500 out of 100,000 individuals.  That is approximately 165,000 in Canada. This equals 456 people every day, or one person injured every 3 minutes in Canada [3].

TBI occurs at a rate of 100 times that of spinal cord injury [4].

When injury due to stroke or other non-traumatic causes is included, close to 4% of the population lives with brain injury. That equates to over 1.5 million Canadians living with acquired brain injury [5].

A comparison of TBI and other prevalent disease, illness or injury
26,900 Canadian women will be diagnosed with breast cancer [6].

An estimated 4,300 new cases of Spinal Cord Injury occur each year in Canada [7].

4015 Canadian will be diagnosed with Multiple Sclerosis in the next year [8].

165,000 Canadians will have a traumatic brain injury this year [9].

Indirect economic costs due to working-age disability will increase and will be greatest for hospitalized traumatic brain injury (rising from $7.3 billion in 2011 to $8.2 billion in 2031) [10].

Falls are the leading cause of traumatic brain injury (TBI) among seniors [11].

Teens, young adults and seniors are at higher risk of TBI as a pedestrian. Across the life course, the data provided evidence of increased TBI risk among pedestrians leading up to and during the teenage years; risk declined during early adulthood before increasing in middle-age and climbing to high levels among seniors [12].

Female pedestrians have a higher frequency of TBI than males, although the highest risk group is males aged 65 years or older [13].

Brain injury is also identified as a risk factor for Alzheimer’s disease and other dementias in men, and for epilepsy in both sexes [14].

  • Falls are the most frequent reason for TBI hospitalizations and emergency department (ED) visits among children under 5 years of age.
  • Among children and youth aged 5 to 19, sports and recreational activities emerge as a leading cause of TBI-related hospitalizations and ED visits.
  • Assaults are a leading cause of TBI hospitalizations and ED visits among males 20 to 39 years of age.
  • From age 40 years and onward, falls not related to sports and recreation take over as the predominant mechanism of TBI-related deaths, hospitalizations and ED visits, with especially high rates among those 85 years and older [15].

Concussion

Current statistics on concussion are most likely an underestimate of the true burden of concussion. This “invisible injury” is under-reported due to a lack of public education and awareness. Many concussions are seen in doctors’ offices and walk-in clinics, placing them outside of the standard hospital reporting data collection surveillance process; some are ignored and are not reported at all.

Please note: many of these statistics are related to sports

Children & youth
Ice hockey was the most common sports and recreation-related activity with reported concussions or other TBIs among males aged 5 to 14 years. Rugby was the most common for the older males.

Ringette was the most common sports and recreation-related activity with reported concussions or other TBIs among females aged 10 to 19. It is also worth noting that among females in all age groups shown, equestrian sport/horseback riding was also among the most common non-contact sport with reported concussions or other TBIs.

Sledding/tobogganing was among the most common sports and recreation-related activities with reported concussions or other TBIs for children aged 5 to 9 years (3rd most common after ice hockey and physical education class among boys, and 2nd after ice hockey among girls).

All-terrain vehicle (ATV) use was the leading cause of moderate to more severe TBIs (i.e., showed the lowest percentage of concussions among all TBIs) among almost all children and youth, with the exception of females aged 5 to 9 (for whom it was equestrian sport/horseback riding) and males ages 10 to 14 (for whom it was baseball) [16].

In 2013, Hockey Canada implemented a new rule to prohibit body checking in the peewee age group (11 and 12-year-olds) and younger. This change has resulted in a 70% reduction in the risk of concussion, or about 4,800 fewer concussions across Canada [17].

Children under five were the most likely demographic to experience a concussion, followed by women over the age of 65 [18].

The number of physician office or emergency room pediatric visits for concussion-related complaints has quadrupled in Ontario since 2010 [19].

General concussion statistics
There are 200,000 concussions annually in Canada [20].

Sports-related concussion is “among the most complex injuries in sports medicine to diagnose, assess and manage [21].”

There is no single test that can definitively provide a diagnosis of concussion. There is no blood test, no saliva test, no picture test or even no eye-tracking, pupil size or balance test. None exists yet that on its own can objectively diagnose concussion [22].

People living in more remote communities were significantly more likely to experience a concussion than those based in cities, noting rural rates could be as high as 1,400 per 100,000 people [23].

Stroke

General stroke statistics
Stroke is the third leading cause of death in Canada [24].

Stroke is the tenth largest contributor to disability-adjusted life years (the number of years lost due to ill-health, disability or early death) [25].

Stroke predominantly affects older people with about 10% of adults aged 65 years and older having experienced a stroke [26].

The absolute number of people having survived a stroke continues to increase mainly due to population growth and aging [27].

First stroke and all-cause mortality rates have shown a steady decline in recent years. Raised awareness, better stroke care and improvements in the management of risk factors have likely contributed to this decline over several decades [28].

Stroke in women vs. men
The occurrence and rate of first stroke are consistently higher among men than women over time. However, more women than men have a stroke each year, in part because women have a longer life expectancy [29].

The following group of statistics is from the report “Lives disrupted: The impact of stroke on women.”

  • More than 62,000 strokes occur in Canada each year; over 30,200 of these happen to women.
  • One-third more women die of stroke than men in Canada; of all deaths from stroke, 59% are women, 41% are men.
  • Women who have had a stroke have worse outcomes than men; there are more activity limitations and lower overall levels of mental and physical well-being.
  • Women are less likely to go home after stroke; almost twice as many women as men go to long- term care instead.
  • Approximately 405,000 people in Canada are living with the effects of stroke of which 214,000 are women and 191,000 are men.
  • Less than half of stroke survivors who participate in rehabilitation are women (46%), putting them at a disadvantage for making the best recovery possible.
  • Elderly women are particularly over-burdened by stroke and are missing out on access to treatment, care and rehabilitation [30].

Brain tumour & cancer

Tumour statistics
It is estimated that 55,000 Canadians are surviving with a brain tumour.

There are over 120 different types of brain tumours, making effective treatment very complicated.

In the first year after diagnosis, it is estimated the average patient will make 52 visits to their health care team (could include surgery, radiation, chemotherapy, blood work etc.).

Non-malignant tumours account for almost two thirds of all primary brain tumours.

The most common type of primary malignant brain tumour is glioblastoma. Average survival, even with aggressive treatment, is less than one year.

Metastatic brain tumours occur at some point in 20-40% of people with cancer. The incidence of metastatic brain tumours is increasing as cancer patients live longer.

Brain tumours are the leading cause of solid cancer death in children under the age of 20, now surpassing acute lymphoblastic leukemia. They are the third leading cause of solid cancer death in young adults ages 20-39.

Because brain tumours are located at the control centre for thought, emotion, and movement, they can dramatically affect an individual’s physical and cognitive abilities and quality of life [31].

Brain cancer statistics
In 2020, an estimated:

  • 3,000 Canadians will be diagnosed with brain and spinal cord cancer.
  • 2,500 Canadians will die from brain and spinal cord cancer.
  • 1,700 men will be diagnosed with brain and spinal cord cancer and 1,400 will die from it.
  • 1,350 women will be diagnosed with brain and spinal cord cancer and 1,050 will die from it [32].

Hydrocephalus

It is estimated that 120,000 Canadians are living with hydrocephalus. 90% of people with spina bifida, also have hydrocephalus [33].

Caregivers

According to a 2019 study published by the Ontario Caregiver Organization (OCO) and health policy think-tank The Change Foundation, more than half of caregivers admit feeling overwhelmed by their responsibilities. Slightly more than half of the 800-plus caregivers who took part in the study also said they felt anxious or worried, while more than 40% struggled with feelings of frustration [34].

An estimated 8.1 million Canadians aged 15 years and older provided care to a chronically ill, disabled, or aging family member or friend [35].

The following statistics are form the Workplace Mental Health issue brief

•    Over 40% of Canadian physicians report that they are in the advanced stages of burnout.
•    An equal percentage of Canadian nurses reported burnout.
•    14 percent of general nurses have tested positive for symptoms of post-traumatic stress disorder.
•    Healthcare workers are 1.5 times more likely to be off work due to illness or disability than people in all other sectors [36].

Brain injury in the Indigenous community

Indigenous populations are disproportionately affected by traumatic brain injury [37].

Injuries are the leading cause of potential years of life lost in indigenous population, with rates 4 times higher than in the rest of Canada [38].

Aboriginal status appears to be negatively correlated to recovery, with poorer outcomes for Aboriginal people possibly attributable to fewer formal and informal supports, such as professional translators or the loss of social support when a patient relocates away from their home community [39].

The risk of poor outcomes after injury increases, due to factors such as geographical isolation, socioeconomic status, and psychosocial factors, which all already affect the health needs of Aboriginal peoples [40].

A survey of health care practitioners exploring rehabilitation challenges for Aboriginal clients recovering from acquired brain injury (ABI), identified the following areas of interest and concerns that surround Aboriginal communities:

  1. Practitioners’ experience with brain injury;
  2. Practitioners’ experience with Aboriginal clients;
  3. Specialized needs of Aboriginal clients recovering from brain injury;
  4. Culturally sensitive care; and
  5. Traditional healing methods as part of recovery [41].

A key challenge experienced by Aboriginal peoples recovering from ABI was that protocols for rehabilitation and discharge planning are often lacking for clients living on reserves or in remote communities. Other challenges included lack of social support; difficulty of travel and socio-cultural factors associated with post-acute care; and concurrent disorders [42].

The following group of statistics is from the report “Lives disrupted: The impact of stroke on women.”

  • Although the rate of stroke and heart disease has been declining in Canada among most age groups, the opposite is happening in Indigenous populations where prevalence and mortality are increasing. Rates of cardiovascular disease among Indigenous women in Canada are rising and are nearing or surpassing those of non-Indigenous women.
  • First Nations, Métis and Inuit peoples are more likely to have high blood pressure and diabetes – both risk factors for stroke – and are at greater risk of stroke than the general population, and twice as likely to die from it[43]

Incarceration statistics

The incidence of incarceration was higher among study participants with prior traumatic brain injury (TBI) compared with those without a prior TBI. Men and women who had sustained a TBI were about 2.5 times more likely to be incarcerated than men and women who had not sustained a TBI [44].

TBI is more prevalent among males than females in incarcerated populations [45,46] .

Majority of the incarcerated study sample reported having a TBI prior to their first criminal offence  [47,48].

The average age of first TBI was 19.6 years for men and 21.9 for women inmates. 55% of women reported TBI prior to first crime. 41% of men reported TBI prior to first crime [49].

Mental health statistics

In a national population health study of neurological disorders, illness and injury, the highest prevalence of self-reported diagnosed mood disorders was seen in those with a traumatic brain injury (38.3%) or brain tumour (35.5%) [50].

An individual has a significantly greater chance of developing a diagnosable mental illness after sustaining an acquired brain injury (ABI)  [51, 52].

About half of all people with TBI are affected by depression within the first year after injury. Even more (nearly two-thirds) are affected within seven years after injury [53].

Traumatic brain injury is reported to increase the risk of post-traumatic stress symptoms [54].

A Canadian longitudinal cohort study found adults with concussion committed suicide at three times the population norm [55].

50% of patients experience personality change, irritability, anxiety, and depression after concussion. These neuropsychiatric symptoms are not unique, but part of the natural course following concussion [56].

Employment statistics

Indirect economic costs due to working-age disability will increase, however. These costs will be greatest for hospitalized traumatic brain injury (rising from $7.3 billion in 2011 to $8.2 billion in 2031) [57].

The majority of individuals (estimates range from 73-88%) who experience mTBI are able to return to their principal occupation within a year of the injury [58].

TBI’s that occur in the workplace are highly gendered. Serious and fatal injuries occur predominantly among males, however, when all levels of severity are included, women make up more than 40% of injuries [59].

The Ontario Workplace Safety and Insurance Board’s (2016) Statistical Report showed that injuries coded as ‘concussions’ have increased from 0.6% in 2002 to 5% in 2015, indicating an 800% increase [60].

Male workers – especially those in the youngest and oldest age groups – working in the primary (e.g., agriculture, forestry, mining) or construction industries were more likely to sustain a work-related TBI, with falls being the most common mechanism of injury regardless of injury severity [61].

Homelessness and traumatic brain injury statistics

Research shows that over 235,000 people experience homelessness across Canada each year [62].

Approximately 50% of people experiencing homelessness have a brain injury [63].

A recent meta-analysis – which looked at 38 studies published between 1995 and 2018 — is the first to look at the prevalence of TBI in people who are homeless or in unstable housing situations. The results suggest that one in two (53% of) homeless people experience a TBI, and one in four (25%) experience a TBI that is moderate or severe [64].

53% of homeless adults with a history of mental illness have a reported history of brain injury. This population is more likely to:

  • Report unmet health care needs
  • Have contact with the criminal justice system
  • Be suicidal or have previously attempted suicide
  • Use emergency departments
  • Finding housing for people with mental illness and head injuries is essential to helping these people more forward with their recovery [65].

The lifetime prevalence of TBI is high among homeless and marginally housed individuals, and a history of TBI is associated with poorer health and general functioning [66].

Intimate partner violence (IPV) statistics

TBI is common amongst women survivors of intimate partner violence (IPV) [67].

35-80% of women affected by IPV experience symptoms of traumatic brain injury [68].

Up to 92% of IPV incidents involving hits to the head and face, and strangulation [69].

It is reported that up to 75% of women do not seek medical care for suspected brain injury [70].

Survivors and care providers can also mistake brain injury symptoms for the emotional distress brought about by the abuse itself [71].

Strangulation is one of the most dangerous forms of IPV, increasing the risk of death in following assaults. These results show non-fatal strangulation as a risk factor in homicide for women, underscoring the need to screen for non-fatal strangulation when assessing abused women in emergency department settings [72].

Strangulation can also cause brain injury, due to the brain being deprived of oxygen. Some victims can die weeks after being strangled because of the underlying brain damage, even if there is no visible injury [73].

Aboriginal women are 3.5 times more likely to experience violence than other Canadian women [74].

See sources

Journaling Workbook

Journaling is a beneficial tool for supporting an individual’s mental health. It encourages self-reflection and connection. This is especially important for people who have experienced significant changes in their lives, and may want to use tools to cope with those changes. This includes brain injury.

We have created journaling workbooks designed specifically for the brain injury community that can be viewed, downloaded, and used at your pace.

Journaling Introduction

This PDF guidebook explains the benefits of journaling; how to journal; and what you may expect from the journaling process.

Download the Introduction Guidebook

Watch this video from a journaling expert on the start of the journaling process

Acquired Brain Injury Journaling Workbook

Now that you have read the introduction, you are ready to begin. This workbook includes recommendations for journaling; guided prompts; and more journaling activities you can use after you have completed this book.

Download the Acquired Brain Injury Journaling Workbook

Watch this video from a journaling expert upon the completion of your workbook

Balance

Balance is the ability to keep yourself centered as you walk, sit, and engage in other movements. It allows you to control and adjust your body before, during and after movement to keep from falling.

Balance requires functional muscle strength, vision, vestibular function (inner ear), sensation in the skin, muscles, tendons, and joints (known as proprioception). It also requires cognitive function and movement planning. When you are keeping your balance, your brain is continually processing inputs and information from multiple senses and body parts. The brain then sends directions out to the body’s motor and sensory system (muscles in the arms, legs, core, and eyes) to keep you centered.

  • Common causes of balance problems after a concussion include:
  • Changes in blood pressure
  • The actual injury to the brain
  • Medications
  • Mental health issues like depression, anxiety, fear of falling, or fear of moving
  • Sensory impairments, such as blurry vision
  • Impairments in motor control
  • Dizziness, which is a sensation of light-headedness, spinning, or nausea.

Balance is important not only for walking but for doing all daily activities. Poor balance can keep you from taking part in activities such as sports, driving, and work. Issues with balance and dizziness can increase the risk of falls and injuries, including another head injury. It can have an impact on your abilities and your mental health and well-being.

How can I improve my balance?

Balance problems will usually improve over time with activity and exercises. The more you move, the more you improve. You may be referred to a physiotherapist or other specialist who can help you with your balance. Many people with a concussion will have problems with quick movements, running, sports, and high-level balance activities. Some people will recover completely, while others may have lasting deficits that change their daily lives.

If one or more of your balance systems are not working well, you can try to improve your balance by focusing on areas that are working. For example, if you have poor vision, make sure you have good shoes, optimal lighting, and vision aids

Other ways to cope with balance problems include:

  • Avoid alcohol or other substances that can impair your sense of balance
  • Clear high-traffic areas in your home
  • Hold onto a family member or caregiver’s arm if you feel unsteady
  • Use adequate lighting and nightlights (for example, smart lights that can be controlled by voice or by phone).
  • Use mobility aids such as canes and walkers, if recommended by a healthcare professional
  • Wear proper footwear (closed toe and heel, well fitting, flat-heeled)
  • Work with an occupational therapist to make changes to your home environment such as railings on stairs, installing railings and safety chairs in the bathroom, and removing rugs or other tripping hazards

If this is happening to you, start tracking when you get dizzy or lose your balance. Write down what you were doing and how you were feeling before the episode and share these notes with your doctor. They may want to complete tests to check your balance, coordination, vision, and hearing. Depending on your doctor’s findings, they may recommend some types of therapy or specific exercises

Circle of support

People living with brain injury often feel isolated and alone. This may not be the case immediately after acquiring a brain injury: people drop by to visit or deliver food, there are lots of appointments to go to, and many call and texts asking for updates. You may find that you’re getting a lot of attention.

As time goes by, you may realize your social circle has decreased significantly from what it was before your injury. Offers of help may have dwindled, and you may be spending a lot of time by yourself. This may lead to feelings of loneliness.

People who are in recovery and living with a brain injury most often need the support of others – but it’s easy to think you are alone when you can’t picture your support network. However, it’s likely you have a whole group of people who can all play a part in building what we call your ‘circle of support’.

An easy way to think of your circle of support is to draw a circle you at the centre. Depending on your relationships, your circle of support will have several different levels, like the diagram below.

Circle of support diagram. A heart at the centre with 3 rings around with icons of people

Inner circle

Your inner circle is usually those closest to you. This can include a spouse; a caregiver; children; parents; siblings; or close friends. These are the people you rely on the most and are more intimately involved in your recovery and care.

Middle circle

The next layer in your circle of care is the middle circle. These people are involved in your life, but perhaps not on a day-to-day basis. There may be a broad range of people here depending on your situation. Examples include:

  • Aunts and uncles
  • Grandparents
  • Friends and their spouses or partners
  • Neighbours
  • Family friends
  • Spiritual/faith-based supports
  • Peers or classmates and their families
  • Colleagues
  • Part-time caregivers
  • Rehabilitation therapists

Outer circle

The outer circle is made up of supports that may not be specific to you or used daily, but can still be relied on. These can include:

Additional circle of support members

Your circle of support can also include more formal supports such as paid caregivers.  Depending on where you are in your recovery, they may be in your middle circle (such as a case manager or personal support worker), or your outer circle (like a psychologist or your family doctor).

The following people could be considered formal supports:

  • Doctor
  • Nurse
  • Physiotherapist
  • Occupational therapist
  • Social Worker
  • Case Manager
  • Speech-Language Pathologist
  • Psychologist
  • Chiropractor
  • Community pharmacist
  • Lawyer

Identify your circle of support

To help identify your support team, list all the people who have been in your life and have shown an interest in maintaining a relationship. Ask for help from the people who are close to you.

Identify areas where you need help

Having a list of the tasks or activities where you may need support is helpful to have on hand. Break the list up into different categories such as daily tasks, weekly tasks, or occasional tasks. For example:

  • Help with getting to appointments
  • A one-to-one visit over coffee
  • Going outside for a walk
  • Help with caring for a pet

You may often hear people say, “let me know if there is any way I can help,” and not take them up on the offer. You may find that people DO want to help; they just don’t know what you need. Do not be afraid to let them know how they can best help you.

The individual person and your relationship with them will determine where they fit in your circle of support. If they can help with smaller occasional things such as picking up your mail; dropping off a meal; driving you to appointments; or fixing a broken item in your home, they may belong in your outer circle. If the person can help with things that happen more often such as activities of daily living (ADLs), such as meal prep, cleaning, and personal care, they may belong in your inner circle.

Fostering your circle

It’s important for your circle to come together and understand how important they are to you. If you choose, you could introduce members of your circle to each other. By doing this, you are turning your circle of support into a true community.

You can also foster your circle by helping people understand what you need. Friends, family members, and caregivers may not realize it can be more difficult for you to communicate in noisy and busy environments of that you get tired/fatigued more easily.

There are a number of resources that may be helpful for those in your inner circle:

We all need people who can support us and building a circle of care is one of the best ways to ensure that you get the support and compassion you need.

Journaling prompts for brain injury

Telling your story

You are the author of your life story. By understanding the power of story, you can change the way you carry your life circumstances, no matter what has happened to you… You have the power to shift your perspective from victim to victor, from survivor to thriver, from loser to winner.

— Sandra Marinella, MA, Med, The Story You Need to Tell

Journaling our stories is writing or recording thoughts, feelings, and experiences. Doing this can show us how we perceive and interpret what we have experienced. It can also help us shift our perspective on events to move forward more positively.

In their journaling workbook, After Brain Injury: Telling Your Story, Barbara Strahura and Susan B. Schuster write,

Telling your story helps you to cope with new situations and make decisions. It is also vital. You need to be able to express yourself in open and honest ways for your mental, emotional, spiritual, and even physical health.

They go on to write,

A brain injury can turn a life upside down. Before it, you had a story of your life. After it, you began a new and unfamiliar one. How do you learn to live within this new reality? If you can’t go back to the way you were, how do you figure out who you can be now? The answer: you tell your story, and it will show you how.

For many people who live with brain injury, journaling their story has provided the opportunity to build upon the strengths they have and helped them work towards goals.

Before you begin

Journaling is not just expressing the sad or traumatic events of your story. It’s important to write about that, but it may make you feel worse instead of better if that is all you include.

Make sure to include happy events and moments that took place. Including what you’re grateful for is an excellent practice, too.

By including all aspects of your story, journaling can help you begin to move through, forward, and further away from trauma, negativity, and sadness and towards a more optimistic, positive, and centred place.

Relaxation techniques

“…writing can make pain tolerable, confusion clearer, and self stronger.”  — Anna Quindlen, Newsweek, Jan. 22, 2007

There are a few things you should do before you begin journaling:

  • Before you begin, gather your journaling tools (journal or paper, pen or pencil, tape-recorder, or sit in front of your computer etc.)
  • Put on music, that you find soothing. If this is distracting for you, you can also focus on creating a silent atmosphere
  • Sit comfortably with both feet on the floor if possible and your hands in your lap
  • Close your eyes, and take a deep breath through your nose. Hold the breath for as long as it’s comfortable. Exhale through your mouth. Repeat this a few times
  • With your eyes still closed, let your breath return to your normal rhythm. Slowly begin to notice your body starting at the top of your head and travel down slowly to your toes. Relax any places that feel tense
  • Now, imagine the tensions, concerns, and anxieties of your day exiting from the top of your head and entering a balloon. When you’ve filled the balloon and your feeling calmer, seal the balloon and watch it float away
  • Know that you are safe, and that your journal is private and just for you if that is your choice. Take your time and begin when ready

Prompts for journaling

These journaling prompts will guide you in writing your story, exploring yourself, and your life to gain insights. They will help you to learn more about yourself each time you journal.

Remember to date each entry and revisit the relaxation techniques before you begin.

1. This is what it feels like to be me today…
Reminder: Begin with the relaxation technique and date your entry.

Try to use as much detail as you can. Write about what’s on your mind, what emotions you are feeling, how you feel physically, etc.

Examples:

What it feels like to be me today is, frustrated. I’d feel fine if people would just stop telling me I’ve changed. I’m just me. Most of the time, I don’t know what they’re talking about. Why can’t they realize that I can’t be anyone else? It’s frustrating, and it makes me really angry. Get over it, man. – Jerome
What it feels like to be me today is hopeful. Everything lately has felt really hard, but today I went for a 10 minute walk and I didn’t get tired. That made me feel happy– Anne

2. I wish I could feel this way today instead…
Reminder: Begin with the relaxation technique and date your entry.

It’s sometimes possible to improve your mood and outlook when you write about how you would like to feel. Also, it sometimes helps provide you with a roadmap to get there. Try to include something you’re grateful for.

Examples:

I want to feel like everyone has accepted the new normal. I guess it just takes time. I’m grateful things aren’t worse. – Jerome

I want to feel like there’s been more progress. There has been. It’s small, but it’s there, and I’m grateful for at least that. – Anne

3. Here’s how my brain injury happened
Reminder: Begin with the relaxation technique and date your entry.

Your brain injury happened as a result of an event. Record as much as you can, in as much detail as you can, about the event as you remember it happening. Begin just before the event took place. Stick to facts; feelings will be covered in the next prompt.

Examples:

I remember standing at the top of the mountain. It was a beautiful day, and I was excited to ski with my daughters. The next thing I knew, I was laying in a hospital bed. I was told a few weeks had passed since I was at the top of the mountain. I’d had a bad ski accident. I had a long cut on my face that had mostly healed. My chest was sore – they said I’d fractured my sternum. My face looked different in the mirror. They said I’d fractured my occipital bone, so one eye was a little lower than the other. Plus, they told me I’d had two brain hemorrhages in the front of my brain. I felt fine. Maybe I had a little left-side weakness, but that didn’t last long. One day I found my way to the rehabilitation floor on my own. That shocked them. I could cook my own breakfast, too. I was told I’d been in the hospital for more than a month. My brother had been there for two weeks. I don’t remember any of that. Next, I was sent to a rehabilitation centre. I didn’t think that I needed it. I wanted to go home to be with my family.. — Brian

I was reading at home one night and started feeling pain behind my eyes. I thought maybe the lighting was too dim & it hurt my eyes. I got up to turn on lights. I remember thinking that the ache had been there for a couple of weeks, now it felt stabbing. It was weird, but I kept reading. About 15 minutes later, I had to run to the toilet. I vomited. My head was spinning, and I started seeing double. Thank goodness for my husband. He insisted we call the ambulance. The siren was so loud on the way. I kept holding on to my head so it wouldn’t explode. Charles kept his hand over my eyes. It was so warm. The air conditioning when we got in the hospital felt like such a relief. I remember feeling like I could breathe better. Turned out I had a brain aneurysm with a subarachnoid hemorrhage. I was rushed into surgery that saved my life. I got some neurological problems now, but I’m alive.
—Dorothy

4. List what you recall feeling during and/or after the event that resulted in your brain injury
Reminder: Begin with the relaxation technique and date your entry.

List what you recall feeling during and/or after the event that resulted in your brain injury. Use the following categories if they apply:

  • Emotional
  • Mental
  • Physical

Physical feelings can be easy to identify and name. Emotions and mental states can be more complicated to identify and name. Here are a few examples of each:

Emotional:     Mad, sad, scared, afraid, peaceful, joyful, happy, overwhelmed, anxious, nervous, cheerful, hopeful, content, proud, optimistic, frustrated, calm, relaxed, curious.

Mental:      Foggy, confused, clear-headed, bewildered, disoriented, fuzzy, dizzy, coherent, alert, lucid, rational, levelheaded, well-oriented, balanced, clear-headed, numb.

Physical:    Tender, sensitive, bruised, achy, sore, tense, tight, nauseous, tingly, burning, prickly, twitchy, shivery, quesy, itchy, shaky, knotted, sweaty, cold, hot, numb.

An important step in telling your story is working to name what you felt and feel. This may come easily to you but if not, be patient with yourself. Give it time, and don’t linger if you find yourself getting distressed or frustrated: you may want to come back to this prompt later and add more.

Examples:

I can’t remember anything during the accident yet. The nurses say some of it might come back to me eventually.
Right now:

  • Physical: Itchy (leg in a cast), sore (laying in bed). Lower back killing me.
  • Mentally: Lost (can’t remember words a lot, sometimes I can’t sort out what day it is),
  • Emotional: Frustrated and mad for not being more careful. Scared about getting better in my head.

— Andy

How I felt during the accident:

Physical: I totally tensed up and froze when the headlights were coming at me. Then I felt something burning but couldn’t identify what. I felt myself kinda floating. I think that was me passing out.

Emotional: It happened too fast, I think, to be emotional. I was just stunned.

Mentally: Brain-freeze.

Afterward (in the hospital):

Physical:    Dry-mouth, but I was on too many painkillers at first to feel anything.

Emotional:    Kind of a weird peacefulness. A limbo.

Mentally:    Dazed, semi-conscious most of the time.
— Mandy

5. List anything good or positive recall feeling during and/or after the event that resulted in your brain injury
Reminder: Begin with the relaxation technique and date your entry.

List anything good or positive in these categories that you recall feeling during and/or after the event that resulted in your brain injury.

Emotional:

Mentally :

Physical

EXAMPLE:
I was and am grateful just to still be alive. Isn’t that the best thing?  – Mandy

My friends have been here for me. – Andy

6. Lost and Found
Reminder: Begin with the relaxation technique and date your entry.

Consider what you’ve lost because of your brain injury and make a list. Write numbers 1-10 and fill in as many as you can.

  1. My car
  2. Bunch of words
  3. My old personality
  4. Memories
  5. Balance (sometimes)
  6. Independence (for now, I hope)
  7. …
  8. …
  9. …
  10. …

Now consider what you’ve gained or learned because of your brain injury and make a list. Write numbers 1-10 and fill in as many as you can.

  1. The brains complicated
  2. How much my wife loves me
  3. What friends can handle this
  4. Got humble
  5. Better appreciation for my home
  6. …
  7. …
  8. …
7. Dialogue: Have a conversation with your brain about what caused your injury
Reminder: Begin with the relaxation technique and date your entry.

Dialogue is a journaling technique that has been utilized by journaling experts such as Ira Progroff and Kathleen Adams. The technique is having a (written) dialogue with an issue, subject, emotion, or person, and you ‘play’ both parts.

The technique can feel awkward at first, like talking to yourself. But trust the process: use your imagination, and stick with it. It will become more comfortable as you practice.

Begin writing by asking a question. Use the word “what” rather than “why.” This way, you’re prompting yourself to provide an answer and thus begins the two-way written dialogue.  Keep the conversation going as long as you can.

EXAMPLE:

ME:  I’ve made that move a million times in my (hockey) career. What the hell happened?

CRASH: The circumstances were just right for your helmet to fly off and you to hit the boards in that way.

ME:  Could I have avoided it? Was it my fault?

CRASH:  No. It didn’t just involve you. Other players were part of the circumstance.

— Stan

8. Who are you now?
Reminder: Begin with the relaxation technique and date your entry.

Write out what you know for sure about yourself at that given moment. Are you tall or short? A parent or a sibling? Employed? In therapy? These are details that can help ground you in your journaling and your day.

EXAMPLE:

I’m still a woman, Mom, single, daughter. Hard to be a good friend right now. I’m a patient in rehab. I’m not sure of much more than that, but I’m working on it. Guess that means I’m determined.
— Beth

9. Who do you want to become?
Reminder: Begin with the relaxation technique and date your entry.

EXAMPLE:
I’m thinking this means goals, maybe. So, independent – employable – nice. That’s good for now.
—   Jamie

More suggested journaling prompts
  • I will…
  • I feel…
  • I believe…
  • I won’t…
  • I can’t…
  • I can…
  • Yesterday was…
  • I’m most worried about……
  • My goal is…
  • I always feel sad when…
  • I always feel happy when…
  • I have recovered from…
  • I am getting better at…
  • I can’t help thinking about…..
  • It’s okay to keep thinking about…
  • My family is driving me crazy because…
  • My family takes good care of me by…
  • I have recovered from…
  • I believe in miracles because…
  • I am grateful for…
  • I am losing my temper because…
  • I am tired of…
  • I will be more positive because…
  • When things don’t go my way, I will…
  • A dream I had last night was…
  • I wish I could explain…
  • I understand that…
  • In the future, I will…

“In my journal, I don’t just express myself more openly than I could to any person; I create myself.”
—    Susan Sontag

NOTE: Examples are based on some facts but are primarily fictional to protect people’s privacy. The names are fictional as well [1].

See sources 
 

 

Mindfulness and mental health

Sometimes life does not turn out as we expected. Coping with all the changes that accompany living with the effects of brain injury can be overwhelming. If you find yourself, or someone you love, dealing with depression or anxiety, you are not alone. Nearly half of all people with brain injuries experience depression and anxiety at some point in their recovery journey [1].

Studies have shown that mindfulness meditation can help decrease depression symptoms and improve anxiety among people with brain injuries [2, 3].

When we are in pain – whether it is physical or emotional – our instinct might be to avoid or deny it’s happening. This is often done out of fear.  “The root of all fear is the fear of our strong emotions,” says Kaira Jewel Lingo, a long-time student of Thich Nhat Hahn, the Buddhist monk who initially brought mindfulness to the West. “If we lose the fear of any emotion, then we lose the added layers of suffering. All emotions are workable.” [4]

One way of working with emotions is through mindfulness practices. Informal mindfulness involves paying attention to the activity you’re doing and engaging all your senses to fully observe your experience in each moment.
For example: slowly eating a meal, paying full attention to each bite. This includes looking, smelling, tasting, even hearing the crunch of food – with no distractions like television or a smartphone.

Often the experience is more enjoyable because you can really take in the small moments that are often missed. Another example is eating a meal without talking. With less stimuli and when your attention is not being divided, the experience is more restful.

How does mindfulness meditation work?

Mindfulness meditation is the practice of learning to sit with our experiences – including thoughts, emotions, and bodily sensations – to observe what we are feeling as it is happening. This is done with kindness, not through self-judgement or storytelling.

Although mindfulness meditation has its roots in Buddhism reaching back 2,500 years, Jon Kabat-Zinn, founder of the Mindfulness-Based Stress Reduction program [5] developed non-religious mindfulness meditation programs available in clinical settings to help patients.
 
Mindfulness practices can be particularly helpful after brain injury by learning to focus on the present moment by attending to one thing at a time. “For someone who has had a brain injury, it can come as a big relief to learn ways to cope with frustration, poor concentration, and memory issues. It is easier for the brain when we pay attention to one thing at a time to increase focus and concentration which is helpful for making and recalling memories,” says Melissa Felteau, who after struggling with her own brain injury recovery, adapted Mindfulness Based Cognitive Therapy for traumatic brain injury (MBCT-TBI) [6] and was a co-investigator on a number of research studies.  

“Practicing mindfulness meditation can also help with improving low mood and feelings of anxiety, that can lead to mood swings and angry outbursts. All of us feel badly when our emotions get the better of us,” said Felteau. Learning how to sit with difficult emotions and diffuse the level of reactivity can go a long way in befriending the mind. “I am not talking about denying or covering up real issues or pretending everything is fine when it is not. Rather, it is about turning towards the experience and learning to build capacity to develop a different relationship with difficult emotions,” said Felteau. “Learning to extend kindness and compassion to oneself in the face of hardship can be a transformative game changer to improving overall quality of life.” 

Benefits of mindfulness meditation 

The benefits of mindfulness meditation include:  

  • Slowing down to observe the moment and appreciate the feelings and sensations that are present 
  • Allowing an openness to embrace what is here, building resiliency for difficult moments  
  • Learning how to receive see your thoughts and self with kindness, compassion, and non-judgment 
  • Helping to step away from repetitive negative thinking 
  • Addressing apathy and helping to cope with feelings of loss of self and isolation
  • Recognizing warning signs of depression and actively taking steps to prevent decline [7]. 

The mind is always active – but you can still meditate

If you are thinking, “I can not meditate!  My mind is always active!”, you’re half right.  Minds are continually active: full of thoughts, feelings, observations, judgments, planning, daydreaming, analyzing, and a whole lot more. According to Felteau, “One myth worth busting is that learning to meditate will not “empty” the mind – you will still have a steady stream of thoughts, emotions, sensations – but you can learn how to have a different relationship to them to settle the mind, so it is not so anxious, sad, reactive, or all over the place.”

The practice of mindfulness meditation teaches us to sit with moment-to-moment awareness, returning from mind wandering time after time, while detaching from memories or worrying about the future.

It is easy to be hard on oneself when comparing to what was possible pre-injury. With mindfulness, you come back to just the moment. You let go of thoughts where comparisons are made. You try not to waste energy worrying about something in the future that may or may not happen. Instead, you try to develop the perspective that all thoughts and feelings are viewed as passing events in the mind [8].

Soon you will learn that all things – good, bad, or neutral – are flexible. Thoughts arise and pass away just like each breath. That’s why the first object of attention in meditation is the breath.  You will notice the same arising and passing away of emotions, sounds, and bodily sensations too.

Mindfulness meditation teaches that being with each moment is different, so you learn each moment brings another new experience, another fresh opportunity to begin anew.  “Practicing this form of acceptance and self-compassion invites us to soften our negative reactions and encourages tolerance for imperfection and failure much needed after a TBI,” [6]. 

The ‘Sitting Like a Mountain’ exercise

Practicing patience when thoughts come up, allowing them to pass like clouds moving across the sky, helps the mind to quiet naturally.

Using the image of sitting like a mountain is a classic meditation. Sitting solid, stable, and dignified as all forms of weather pass by including countless clouds, beating hot sun, rain showers, threatening thunderclouds, flashes of lightening, and snowstorms. These forms of weather all come and go but the mountain just sits, enduring it all – trusting in the knowledge that all weather phenomena arise and pass away. Just like life, all things come and go.

Two wings of a bird

Another traditional teaching sees mindfulness like two wings of a bird, with one wing being wisdom and the other wing being compassion. Without both wings, the bird cannot fly. The wisdom that comes with awareness of thought patterns is important to bring understanding, kindness, and compassion to the experience of meditation. Self-compassion is like the love and care one would extend to a small child but turning that nurturing on yourself. These moments of generosity and self-care are the heart and foundation of mindfulness.

Ways to practice

There are several ways to practice mindful meditation. The key is consistency in your practice, and not being afraid to change if something isn’t working for you.

Examples include:

  • Finding a compassionate teacher in person or online to help answer questions and guide you 
  • Schedule a time every day, often at the same time so it becomes a habit to meditate 
  • Start with 3 minutes of breath practices like the 4 by 6 breath or the 3-7-8 breath to settle the mind
  • When you can, do 3 minutes of mindfulness meditation without interruption. Next time try for 5 minutes. Then 10 minutes. Set a timer so your mind is not distracted by the clock. Work up to 20 minutes daily 
  • If you’re having trouble sleeping, try doing a slow check-in with the different parts of your body while in bed to drift off to sleep 
  • Use a free app like UCLA Mindful, or Healthy Minds Program from the University of Wisconsin Madison – both based on evidence-based research of MBSR/MBCT
  • Start small and begin again if you lose your daily momentum

Practicing mindfulness may help you to cope with the changes and challenges that brain injury brings. Learning mindfulness is like learning to use a new muscle. The more you “flex the muscle” the more you strengthen the neural connections in the brain.

Learning to intentionally view difficulties and discomfort as passing events in the mind [9] like weather passing a solid, stable, and dignified mountain can bring stability. Offering yourself openness, kindness, compassion, and acceptance in a way that befriends the mind and builds a sense of wholeness can be helpful and offer a sense of hope.

See sources
 

How to get started journaling

According to Dr. Elizabeth Gilbert, the Head of Research at PsychologyCompass, “decades of research” back up the benefits of journaling when it comes to reducing anxiety, easing depression, working through trauma, and setting goals. “If there are stressful things happening in your life, journaling trains you to stop, react, and make sense of it all,” Gilbert says. “Even just make a narrative about it. Tell it in a story in a way that makes sense.”

In life, overthinking an activity or task can lead to not doing it. This can be the case when you are thinking about starting a journal. It’s important to remember there are no rules in journaling – only suggestions based on what you’d like journaling to be for you. This means there is no wrong way to journal.

Many people are under the impression that journaling means having to write daily or often; then, they feel guilty when they don’t achieve this rhythm. The practise of keeping a journal is meant to be guilt-free. Journaling is journaling, no matter how often you want to do it – even if it’s once a year.

It’s also important to know that journaling isn’t just for when you’re feeling sad, depressed, or troubled; journaling is a way for you to express yourself and your feelings any time in your life journey. For example, you can use an entry in your journal to share what you’re happy about and express gratitude.

Getting started is as easy as picking up a pen (or opening an app, a voice recorder, or sitting down in front of your computer) and jotting down or speaking whatever thoughts happen to be in your mind at the moment.

There are therapeutic benefits to journaling, no matter how often you do it. The key is to get started!

Suggestions to help you begin

Here are some suggestions you can use if you’re interested in starting your own journaling process.

Select a journaling method
There are several ways to keep a journal. These include:

  • Writing by hand in a notebook or journal,
  • Typing on a computer or tablet
  • Using an online journaling app for writing or voice recording. Use your phone or tablet to search for an app that is right for you. Please remember that some apps have free or freemium features and others require payment
  • Using a tape recorder
Try to avoid expectations
Don’t set journaling goals that may end up being unrealistic. It’s important to give yourself time to understand journaling and find the right rhythm for you.

You also shouldn’t expect yourself to write in full sentences or even in a straight line. Use bullet points, make random notes all over the page, draw or doodle, and forget correct spelling and punctuation. None of those things are as important as the act of journaling.

Choose a time to journal
When you’re first beginning, it’s a good idea to journal first thing in the morning or  before you go to sleep. Things can come up during other times in the day that may keep you from journaling.

Even if you schedule a regular time to journal, stay flexible and forgiving. Life happens, and schedules and circumstances change. What matters is to journal when you have the time and when you need it.

Set a time frame that’s not overwhelming
Begin each journaling session with the goal of writing/talking for five minutes. It’s surprising how much you can write/speak in that amount of time. And if you want to continue past those first five minutes, you can. This helps ensure journaling never feels overwhelming.
What to journal
This is one of the biggest concerns for some beginners. Some ideas to get you started include:

  • Thoughts that have been on your mind recently
  • What you’ve been feeling lately – physically, emotionally, or mentally
  • How you would like to feel – physically, emotionally, or mentally
  • Things you can do to think and feel the way you want
  • What it is that you need right now
  • A decision you need to make
  • Something you’d like to change and something you’d like to stay the same
  • Your opinion on the weather, a favourite TV show, a movie you watched, a book you read, something you just experienced, current events, or a person you met or already know
  • Good things and frustrating things that happened today
  • Things for which you are grateful

You can also use more formal journaling prompts. They are excellent when you’re stuck for a topic but still want to journal.  We have a few journaling prompts you can use to help get you started. You can also find more journaling prompts on the internet or in books.

Journaling can be anything from a fun hobby to a form of meaningful therapy. But make sure you don’t get stuck in negativity or wallow continuously in problems or self-blame. It’s important to use journaling to release pent-up emotions and to rant, but eventually, you need to move forward, find solutions, and include the positives — and journaling will help you with that too.

Lastly, remember to be patient. Experiment with different types of journaling until you find what works for you.

Journaling after brain injury: The therapeutic benefits

For centuries, people have found journaling beneficial and cathartic. But only recently have the emotional, mental, and physical health benefits of journaling been proven through research studies.

This section will introduce journaling and how it may be helpful to those that have experienced brain injury.

Section includes:

What is journaling?

Journaling is the act of freely expressing yourself in your own private notebook, audio recordings, or videos.
Your journal is a safe space where you can be 100% yourself; you can discover and make sense of yourself and your experiences. You can also use your journal as a tool to help with growth and personal strength.

To journal is to write about your life – it is telling your story. Life-based writing is one of the most reliable and effective ways to heal, change, and grow.

-Kathleen Adams, author of Journal to the Self and Founder/Directory of The Center for Journal Therapy

You don’t need to be a ‘writer,’ have perfect penmanship or punctuation, or know how to spell. If you have thoughts, you can journal. You simply need to be who you are in the moment.

There are no rules when it comes to journaling. It is suggested that you date (day, month, year) every entry—and depending on what you want to achieve, there can be important guidelines—but your journal is your personal creation. You are in control.

With its many forms (hand-written, voice-recorded, typed in computers, websites, apps, and visual art), journaling is accessible to everyone. Journaling has become more popular, in part due to extensive research being done on the benefits of the practice. A vast amount of information exists to help guide you in your journaling purposes or goals.

Ultimately, journaling is an exploration of self: a reflection of you, your life experiences, and the era in which you live. It’s a life tool that may contribute to your health, happiness, and give you more compassion towards yourself.

Journaling after trauma: Research on the therapeutic benefits

For several decades, an increasing number of studies have proven that when a person writes about emotional and traumatic experiences, they may experience significant physical, mental health and behavioural improvements as a result.

One of the first researchers to empirically prove the scientific benefits of journaling (expressive writing) is Dr. James Pennebaker, Ph.D., an American social psychologist and lead researcher on Expressive Writing at the University of Texas. He has authored many studies and publications, including the book, Writing to Heal: A Guided Journal for Recovering from Trauma and Emotional Upheaval [1]. He conducted his original work on expressive writing and trauma in 1986 [2].

More research findings here
In Pennebaker’s original research [2], he assigned healthy undergraduate students to one of four groups: three groups wrote about personally traumatic life events for 15 minutes for four nights in a row while the fourth group wrote about unimportant topics. The researchers tracked the participants’ visits to the university health center over the next six months. They found that writing about traumatic events was associated with fewer visits to the health center.

The study showed people’s health and productivity improved when they wrote about traumatic experiences or uncertainty—particularly if they constructed causal accounts or plans. Pennebaker found that translating our experiences into our own written language makes the experience more understandable. Pennebaker says, “Emotional upheavals touch every part of our lives. These things affect all aspects of who we are — our financial situation, our relationships with others, our views of ourselves and writing helps us focus and organize the experience.”

Since the initial experiment, the concept has been utilized in many studies of physical health and biological outcomes after journaling. Analyses of these studies confirmed the original finding: expressive writing is generally associated with better health.

A more recent study (presented in a conference paper and submitted for publication, Pennebaker, Keith Petrie, Ph.D., and others) at the University of Auckland in New Zealand found a similar pattern among HIV/AIDS patients. Patients who wrote about life experiences measured higher immune functioning than the control group. This suggested that journaling reduced their stress by releasing their illness-related anxiety. “By writing, you put some structure and organization to those anxious feelings,” he explains. “It helps you to get past them.”

Behavioural changes have also been researched as a result of journaling. Students who write about emotional topics have shown improvements in grades. Senior professionals laid off from jobs get new jobs more quickly. University staff members who write about emotional topics are subsequently less absent from their jobs. The article, Emotional and Physical Health Benefits of Expressive Writing [3] offers the following about outcomes of expressive writing:

Immediate and longer-term effects of expressive writing

The immediate impact of expressive writing is usually a short-term increase in distress, negative mood and physical symptoms… However, at longer-term follow-up, many studies have continued to find evidence of health benefits in terms of objectively assessed outcomes, self-reported physical health outcomes, and self-reported emotional health outcomes.

Long-term effects of expressive writing [4]

Health outcomes
  • Fewer stress-related visits to the doctor
  • Improved immune system functioning
  • Reduced blood pressure
  • Improved lung function
  • Improved liver function
  • Fewer days in the hospital
  • Improved mood/affect
  • A feeling of greater psychological well-being
  • Reduced depressive symptoms before examinations
  • Fewer post-traumatic intrusion and avoidance symptoms
Social and behavioural outcomes
  • Reduced absenteeism from work
  • Quicker re-employment after job loss
  • Improved working memory
  • Improved sporting performance
  • Higher students’ grade point average
  • Altered social and linguistic behaviour

Why does writing work?

Perhaps the main reasons for the benefits of journaling are simple: the value of using the written word to express oneself and the act and relief that comes from disclosure that is as honest as possible.
Another explanation is that the act of converting emotions and images into words changes the way you think and organize thoughts.

Journaling after brain injury – Telling your story

“We make our lives bigger or smaller, more expansive or more limited according to the interpretation of life that is our story.”~ Christina Baldwin, Storycatcher: Making Sense of Our Lives Through the Power and Practice of Story

One of the best ways to know and understand the events of our lives and their impact on us is by using a centuries-old, uniquely human and innate skill that we all have: storytelling.
In Forming a Story: The Health Benefits of Narrative by James W. Pennebaker and Janel D. Seagal [5], the authors state,

…constructing stories is a natural human process that helps individuals to understand their experiences and themselves. This process allows one to organize and remember events in a coherent fashion while integrating thoughts and feelings. In essence, this gives individuals a sense of predictability and control over their lives. Once an experience has structure and meaning, it would follow that the emotional effects of that experience are more manageable.

Following a brain injury, whether mild, traumatic, or non-traumatic, your life and world change. There is a great deal to make sense of. Pennebaker and Segal tell us that journaling in the form of storytelling can help: “Constructing stories facilitates a sense of resolution, which results in less rumination and eventually allows disturbing experiences to subside gradually from conscious thought.”

Barbara Stahura, a Certified Journal Facilitator, is the primary author of After Brain Injury: Telling Your Story [6], the first journaling book for people with brain injury. In this book, she offers the following.

As a person with brain injury, you have been hurt and traumatized by something most people haven’t experienced and can’t understand. (No matter how you suffered your brain injury or what type it is) you now must deal with a number of challenges you never expected or imagined. One major challenge you face is making sense of a life disrupted and perhaps altered forever. Another is being accepted as a person who still has value and whose life still holds meaning and purpose. Yet another us revealing a new self to people, perhaps even your loved ones, who don’t realize or understand the change the injury caused you (changes you may not understand, either). Since every brain injury is as unique as who experienced it, you will face individual hurdles. However, no matter how many challenges your brain injury create for you, one thing is certain: You have a new story to tell.

In the book, Expressive Writing, Counseling and Healthcare [7], author Barbara Stahura writes, “For many people with brain injury, the old story is gone or greatly changed.” Journaling can be a tool that helps a person find their new normal post-injury and explore the next chapter.

In Brainlash, Maximize Your Recovery from Mild Brain Injury, author Gail L. Denton, Ph.D. [8], who suffered a brain injury in 1991, writes, “My journal… was my way to reach inside and pull out my Self so that I could look at her and begin to figure out the new her! This woman was experiencing and expressing thoughts and emotions that the old me did not easily recognize as being ME. I wanted to know what was going on. I wanted some understanding, if not control. Journaling was my way to make sense of my predicament.”

Journaling can become a therapeutic and helpful tool for recovery and daily living.

See sources

Managing financial stress

Money worries can be a large source of stress and anxiety. According to the Government of Canada, a survey in 2018 reported that “48% of Canadians say they’ve lost sleep because of financial worries”. Financial stress has increased even more due to the COVID-19 pandemic. Individuals have experienced reduced or lost incomes, with many peoples’ financial future remaining uncertain. This stress can greatly impact mental health and overall wellbeing.

The impact of financial stress

Finances are a common trigger for stress. Much like other forms of stress, individuals can suffer from insomnia, anxiety, depression, and increased anger and frustration. It can impact relationships with spouses, friends, work colleagues, and families. If any form of stress gets bad enough, physical and mental health can get worse. This could affect work performance, which could lead to more financial stress.

How to manage financial stress

Often stress will not go away unless the source is found and addressed. The same is true of financial stress. This is a challenge, but there are some ways you can manage your finances and manage your finance-related stress.

Ask for help
Finances can be complicated, and many people need help with them. You can ask a caregiver, friend, or family member to help you either with stress or with your finances.

If you want to better understand your finances and how they work, The Canadian Bankers Association offers free support and community programs. These programs provide education on safe online financial practices and fraud. Many banks also offer free financial advice, as well as services, to strengthen your financial skills.

Additionally, you can access the financial literacy programs through the Government of Canada, which provides you with access to workshops and videos.

Review your finances and complete a budget
The first step is to review and understand your financial situation and your financial obligations. The best way to do this is to make a budget. Your budget should include:

  • Any income you generate
  • Assets you hold
  • Debts
  • Financial commitments (such as rent, groceries, and other recurring bills

This will give you a clear picture of your financial status, and give you an effective tool for identifying financial problems.

Identify financial problems/stressors and develop a plan
By understanding your financial situation and making a budget that addresses the financial stressors, you may alleviate some stress and anxiety.

For example, if debt is the source of your financial stress, review your options for debt consolidation (combining two or more debts into one single debt) or repayments to reduce or eliminate it.

If spending is a source of financial stress for you, use your budget to set a spending limit based on your needs (groceries, electricity) versus wants. You can track your spending over the course of a few weeks to keep track of how much you save and what items may trigger impulse spending. If you know you are an emotional spender, you can look for additional ways to cope with those emotions.

If you have not been able to determine your triggers, ask for help from a loved one, a friend, or a family member. If you are not familiar with how to address financial stressors, you can talk to a financial professional.

Learn more about managing financials
Once you have a budget and have started addressing your financial stressors, you will need to manage them going forward.

Usually fear and anxiety come from the unknown. Once you have a better understanding of how to manage your money, much of that anxiety and stress will disappear. There are many free financial courses and programs available that can help you understand how to manage your finances.

Look for ways to reduce your spending
Once you have your budget in place and know how much money you spend each month, you can look for ways to reduce costs.

For example, if you order a lot of take out dinners, you can save money by eating out less. Or if you order a coffee per day from a coffee shop, you’ll save more if you make yourself a coffee at home.

Look for sources of financial assistance
Depending on your circumstances, you may qualify for some sort of financial aid.
Do not take any unnecessary financial risks
If you are suffering from financial stress, it is important not to take any unnecessary risks. Risky investments, compulsive spending or gambling can lead to more stress.

Understanding your financial situation and sticking with your budget is the best method to reduce your financial stress and anxiety.

Engage in self-care to manage stress
While some people do use spending as a self-care tool, there are several areas of self-care. Self-care activities should help you focus on yourself, your well-being, and overall reduce your stress.

Intimate partner violence & brain injury

Intimate partner violence (IPV) is physical, emotional, and verbal abuse by a significant other or intimate partner. IPV is a global public health issue, and it can happen to anyone.

According to the World Health Organization, one in three women will experience intimate partner violence in her lifetime. Most may also suffer one or more brain injuries as a result, since IPV often involves blows to the face, head, and neck.  Brain injury in IPV can also happen from a loss of oxygen to the brain caused by strangulation. Often times, these injuries result from repetitive episodes of IPV occurring over many months or years.

While there’s traditionally been a strong focus on sports-related concussion, brain injuries caused by intimate partner violence receive much less attention.

Statistics about intimate partner violence

  • In Canada, every two and a half days, a woman or girl is killed violently, usually by a male partner or family member [1], and each night, more than 6,000 women and children find refuge from gender-based violence in shelters [2]
  • 35-80% of women affected by IPV experience symptoms of traumatic brain injury [3]
  • Up to 92% of IPV incidents involve hits to the head and face, and strangulation [4]
  • Strangulation is one of the most dangerous forms of IPV, increasing the risk of death in following assaults [5]
  • Some victims can die weeks after being strangled because of the underlying brain damage, even if there is no visible injury [6]

Statistical information about intimate partner violence (IPV) as collected and reported by the Government of Canada.

An invisible and underreported issue

Intimate partner violence (IPV) tends to happen behind closed doors, and there may not be signs obvious to people outside the household. Brain injury is often just as invisible, causing lifelong symptoms and challenges, but with no outward signs of disability. Clinicians may also not ask about intimate partner violence in their practice.

IPV is also extremely underreported. This happens for a variety of reasons, including:

  • Shame and stigma associated with IPV;
  • Fear of not being believed;
  • Desire to keep the family together, and;
  • A lack of recognition as to what constitutes abuse, causing victims to think it’s normal

Many women who have experienced a brain injury from IPV aren’t even aware that the challenges they face are related to a brain injury, which makes it much harder to receive a diagnosis or timely treatment. Also, research in Canada and elsewhere has shown that front line service providers lack knowledge and training/awareness about brain injury [7]. It’s a difficult, terrifying situation. Support from friends, family, and local resources can make all the difference, although in some cases, women may lack family support..

Effects of intimate partner violence (IPV) and brain injury

Intimate partner violence (IPV) and brain injury can each cause significant, long-term challenges, but when someone experiences both, the effects may intensify, and become more complex.

IPV is linked to lasting psychological trauma. Emotional disturbances such as complex post-traumatic stress disorder (PTSD), anxiety, and depression are common.

Brain injury survivors can suffer some of the same issues, along with a range of cognitive, physical and behavioural changes.

Effects of brain injury can include:

  • Difficulty communicating
  • Memory problems
  • Reduced judgement and problem-solving skills
  • Shortened attention span and inability to concentrate
  • Inability to initiate tasks or activities
  • Headaches
  • Fatigue

This is a small example of the kinds of effects people with brain injury can experience. And it can further be compounded by the cause of the brain injury (or injuries). In a study of female veterans, results found that women with persistent IPV-related TBI symptoms were nearly 6 times more likely to have probable PTSD compared those with no IPV-related TBI history [8].

Both brain injury and IPV can have an impact on activities of daily living (ADLs), parenting, and court appointments/proceedings. This can be discouraging and scary, particularly for women who are single parents or engaged in custody negotiations. The more survivors; family members and friends; health care workers; and other service providers (such as lawyers and social workers) understand the effects of brain injury, the more appropriate support can be provided.

Unfortunately, survivors of IPV and care providers commonly mistake brain injury symptoms for the emotional distress brought on by the abuse [9]. That’s why research and educational resources on brain injury and IPV are so important.

Increased risk of intimate partner violence (IPV) towards people with disabilities

Overall, women and men with disabilities have a higher risk of abuse, including from intimate partners.

According to Statistics Canada, “Canadians with a disability were more likely to be victimized in their own home, as close to 30% of violent incidents against a person with a disability occurred in their private residence.” [10]

The study dives deeper, indicating that 23% of women with a disability “experienced emotional, financial, physical or sexual violence or abuse committed by a current or former partner” in a 5-year period. This is 2 times higher than the rates of those without a disability. Women with disabilities were also more likely to experience physical violence leading to injury [11].

For individuals who have a disability (brain injury or otherwise), the increased risk of physical violence can lead to further or new injury. This could lead to an even higher risk of violence – and the cycle goes on.

This is yet another indicator that supports for women with brain injury and experiencing IPV are essential.

Assessment by a physician

If you, or someone you know, have been hit on the head, face, or neck, or have been choked or strangled, it is important to access medical care as soon as possible, and request that health care providers look for indications of brain injury. If you are not able to see a medical professional, speak to a social worker, support worker at a shelter or a brain injury support worker.

The earlier a brain injury is diagnosed, the earlier a treatment plan can be put in place. When you do meet with a doctor, it’s important to tell them if you have ever been struck on the head or neck.

Signs of a recent or more serious injury include:

  • Loss of consciousness
  • Neck pain
  • Seizure
  • Vision changes
  • Weakness or feelings of tingling or burning in the arms or legs [12]

Additional signs of brain injury may include, but are not limited to:

  • Balance problems
  • Headaches
  • Emotional lability
  • Fatigue
  • Memory issues
  • Sleep disturbances
  • Trouble speaking

Treatment of brain injury

Treatment for brain injury and its effects can be challenging not only because it is often misdiagnosed, but individuals who are in temporary shelters or transitional housing may not be able to access the supports and services they need for effective rehabilitation. Rehabilitation is a long-term process that involves regular appointments with various therapists and checkups with physicians.

It’s important for the person’s health and wellbeing that they access appropriate supports and services available to help them with their brain injury recovery. A good place to start is at your local brain injury association.

Support for survivors

Resources

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