When the brain is injured, a person’s emotional processing and responses can change. When this is paired with the intense feelings that come with adjusting to major life changes associated with brain injury, navigating emotions can be difficult. This is true for both you and your loved one.
The way the person with a brain injury experiences and shares emotions will be changing. They may even experience emotions that are out of character. This happens to a lot of people. For example, a person who was mostly calm and cheerful before an injury may feel more aggression or anger after the injury. It may be that their emotional processing never returns to what it was before the injury. As with all parts of brain injury recovery, it takes time to learn how emotions are affected and what can be done to manage them.
As a caregiver, your emotional and mental well-being is equally important. Coping with the emotional effects of brain injury in someone you’re close with can be incredibly hard. A person with a brain injury may be emotionally abusive towards you. They may have emotional outbursts in inappropriate settings. They may display behaviours that are unusual, worrisome, or frustrating. Many caregivers experience the same issues and emotions you are experiencing. It’s important to develop your own support network through friends, local brain injury associations, and health professionals.
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There are some emotions that are more common than others after a brain injury.
Changes in emotions
It is common for someone with a brain injury to get frustrated, angry or irritated more often or more quickly. They may even become aggressive. This can lead to yelling, cursing, and physical outbursts. This is distressing for everyone involved.
These episodes of anger or an increase in irritability can be caused by:
- Confusion
- Depression
- Fatigue
- Frustration with a task that is harder than it used to be
- Frustration with this new reality
- Misunderstanding another person’s intentions
- People telling them what to do or pointing out mistakes
- Too much stimulation (e.g., light, noise, and movement)
You can help in these situations by:
- Engaging in calming activities together or have the person with a brain injury do something on their own – listening to music or reading are some examples
- Learning how to react when your loved one is experiencing an episode of anger or irritability. It’s important to remember that it’s not personal and they are not intentionally trying to be hurtful. Remain calm and practice patience. You can use active ignoring and redirection to something calming to cope with their emotional outburst.
- Making a set of rules for communicating, including what’s not acceptable (like yelling, cursing, hurting others, etc.)
- Not arguing or speaking to the person when they are experiencing an anger episode.
- Practice deep breathing and meditation with them. This can help teach them strategies for redirecting and coping with their anger in the moment.
- Removing the person from the situation to a quiet, calm place
- Talking through the outburst and what could have caused it after the person has calmed down.
- Work with a doctor who is familiar with acquired brain injury and emotions on some self-calming methods and communication strategies. Cognitive behaviour therapy can provide support and tools to help people with brain injury manage anger/aggression and help both of you understand these reactions.
Anxiety is a common emotion related to mental health. It stems from feelings of worry and fear, and can have significant impacts on someone’s behaviours and emotions.
Depression is directly related to mental health and the emotions after a brain injury. Adjusting to a new self is difficult and can result in elevated stress and feelings of sadness, loneliness, despair and anger. When these feelings last for weeks or longer, a person may be diagnosed with depression and require professional treatment.
A lack of emotional control means a person speaks or does something before thinking it through, reacting solely based on emotions. They don’t consider the outcome/consequences of what they say or do. They may also do risky or dangerous things. Emotional control and behavioural (impulse) control are closely linked because they are both managed by the same brain systems.
If your loved one experiences trouble with emotional control and impulsivity, there are some ways you can support them.
- When it’s time to make a decision, provide a verbal reminder to stop and take their time.
- Set up a system where the person runs their decision by you
- Practice making decisions together
Mood swings – also called emotional lability – are when a person goes from one emotion to another quickly, often for short periods of time. It can also mean they experience emotional outbursts – for example, laughing or crying excessively even if they don’t feel happy or sad.
Mood swings are common when the parts of the brain that control emotion are injured. Sometimes there is an obvious reason why emotions suddenly change. At other times there is no specific event that causes a change in mood: it appears random. This can be confusing.
In general, these mood swings are outside a person’s control. It’s important not to take them personally or be impatient with your loved one.
Ways you can help them manage mood swings include:
- Deep breathing
- Redirecting them away from the cause of the emotional change
- Leading your loved one in a calming activity
Doctors will advise whether mood stabilizing medications would be beneficial. If your loved one does start taking medication, remember that it may not work right away.
Over time, many people find that their mood swings happen less and less as their emotions balance out and they employ appropriate coping methods.
Personality changes can come from both emotional and behavioural changes and may become exaggerated or more intense after a brain injury. For example, a quiet person may become even quieter; an assertive, active person may become aggressive and even more outspoken. The opposite can happen too, where a normally quiet person becomes very outgoing or outspoken.
These changes can happen with all brain injuries. While some people find that their emotions and personality changes fade as they recover, some changes may be permanent.
It can be difficult to adjust to these personality changes. The best way to cope with them is to practice patience and remain calm during any emotional outbursts. This is just as challenging for the person with a brain injury, and you will have to work together to navigate these changes.
How do I help my loved one cope with their new reality?
It’s normal to feel upset, angry, and sad about the brain injury. It’s also easy to get swept up in grief over what has changed. Your loved one will be feeling grief for themselves, but you will be too—your life has also changed. It’s important to let yourself feel your grief, but not dwell on it too long. Instead, do your best to focus on the positives, including progress, things you have to look forward to, and things that make you both happy.
It’s going to take a long time, and some days will be better than others. If you are having difficulties, make sure to share them with your family, caregivers, and the doctors.
Identifying and managing emotional effects of brain injury
There are ways for you and your loved one to work together to manage the emotional effects of brain injury.
Working with a cognitive behavioural therapist, psychologist, or psychiatrist
One of the most effective ways to manage the emotional effects of brain injury is to work with a healthcare professional with a specialty in mental health, behaviour and emotions.
Cognitive behavioural therapists address cognitive and behavioural challenges, which can be related to emotions. They develop a personalized program that will benefit your loved one, addressing their specific areas of need. This includes coping with emotional challenges. Cognitive behavioural therapy is goal-oriented and can involve you if you are the main caregiver. These plans can adapt over time as new goals are set, but in general cognitive behavioural therapy is meant to be a short-term treatment that teaches the person with a brain injury the skills they need to cope with cognitive, emotional, and behavioural changes. There is a fee for this service. While cognitive behavioural therapy may be covered under some insurance plans, this can be an out-of-pocket expense.
Psychiatrists and psychologists specialize in talk therapy and mental health, which can have a huge impact on emotions. The main difference between them is that psychiatrists have medical degrees rather than primarily academic degrees and can prescribe medication. Working with either a psychiatrist or a psychologist can help your loved one unburden themselves, access feedback, and understand the relationship between their mental state and their emotions.
Join them in deep breathing
If you or your loved one are feeling overwhelmed, pausing and taking deep breaths is a good tool to help with focus and calming. Deep breathing sounds relatively simple but there’s a lot more to it than just “in and out.” There are additional steps you can take to bring more mindfulness to the exercise and further help your loved one move away from their anger.
Take breaks
When we’re tired, we tend to get more emotional. After a brain injury, many people experience fatigue. Make sure your loved one is taking breaks and getting some alone time.
Remove stressors
Are there things causing stress for your loved one? If so, try to find ways to remove them. Depending on what the stressors are, you’ll need to come up with different ways to handle it. One example: if they gets stressed because they can’t remember how to complete a task, a checklist can help manage that stress.
Visit support groups
Many communities have local brain injury associations or support groups with activities and resources for people with brain injury and caregivers. Participating in support groups is a great way to build up your community; it also provides a place where you both can feel safe and welcome, which will have a huge impact on mental health. Support groups are also a great place to hear about other experiences and learn new tips/strategies that have helped others in recovery.
Create a routine
You have both experienced a lot of changes. Creating a schedule for each day or each activity can take a lot of stress away for the person with a brain injury, minimizing their emotional reactions. When they know exactly what’s happening and what to expect, they can mentally and emotionally prepare.
Exercise
Exercise can have a positive effect on both the body and the mind. Even if it’s just a few arm circles, a walk, or leg stretches. Please note: You should only do exercises that have been doctor-recommended.
Spend time outside (if possible)
Fresh air is a great way to boost positive feelings for both you and your loved one. Even if they are only outside for a few minutes at a time, this change of venue and activity can be incredibly stimulating.
Medication
In some cases, it might make sense to take medication to help with depression or anxiety. Please note: only the doctor can recommend and prescribe medication.
Disclaimer: There is no shortage of web-based online medical diagnostic tools, self-help or support groups, or sites that make unsubstantiated claims around diagnosis, treatment and recovery. Please note these sources may not be evidence-based, regulated or moderated properly and it is encouraged individuals seek advice and recommendations regarding diagnosis, treatment and symptom management from a regulated healthcare professional such as a physician or nurse practitioner. Individuals should be cautioned about sites that make any of the following statements or claims that:
- The product or service promises a quick fix
- Sound too good to be true
- Are dramatic or sweeping and are not supported by reputable medical and scientific organizations.
- Use of terminology such as “research is currently underway” or “preliminary research results” which indicate there is no current research.
- The results or recommendations of product or treatment are based on a single or small number of case studies and has not been peer-reviewed by external experts
- Use of testimonials from celebrities or previous clients/patients that are anecdotal and not evidence-based
Always proceed with caution and with the advice of your medical team.
Information provided in part by My Health Alberta and sourced in part from Model Systems Knowledge Translation Center (MSKTC)
