MAKING SENSE OF EMOTIONAL CHANGES FOLLOWING BRAIN...
Transcript of MAKING SENSE OF EMOTIONAL CHANGES FOLLOWING BRAIN...
MAKING SENSE OF
EMOTIONAL CHANGES
FOLLOWING BRAIN INJURY
Sarah E. Porter, PsyD, LPMadison Neuropsychological Services, LLC
Neuropsychologist, OwnerMadison WI
Let’s Talk About Emotions
How did you manage emotions BEFORE your injury?
What changes have you/your caregivers experienced in
emotional expression and reactivity FOLLOWING the
injury?
What coping strategies have been successful to deal
with these changes?
Video Clip: Inside Out
The Amygdala: The Brain’s Emotional
Control Center
Part of the Limbic System
Supports a variety of
functioning:
Emotions, behavior, motivation,
long-term memory &
olfaction/smell
The Amygdala is located within the
Temporal Lobe
Associated with the experience
and regulation of emotions
Has a close relationship with the
hippocampus (associated with
memory formation/retrieval and
learning)
The Frontal Lobe AND Executive
Functioning
The Frontal Lobe:
Encompasses many cognitive
processes
Including Personality traits
It’s “What makes us, us”
Executive Functioning entails:
Initiation
Problem solving/critical thinking
Cognitive flexibility
Judgement
Impulse control
Social/sexual behaviors
Why Does Emotional Regulation
Change FOLLOWING Brain Injury?
The amount of regulation change depends upon the following factors:
If the injury was traumatic or acquired (e.g., stroke, viral, etc.).
Location of the insult or lesion
Severity of the injury
State of consciousness during/following injury
Prior brain-related injuries
Coping abilities PRIOR to injury (including use of alcohol or illegal
substances)
Adjustment factors (Loss of: job, independence, family/support system,
etc.)
Mental health history (prior to injury)
Common Emotional Changes
FOLLOWING Brain Injury INCREASED
Irritability
Anger
Aggression
Sadness/depression
Apathy/loss of volition
Anxiety/panic
DECREASED
Awareness/insight into functioning
Thinking before acting (leading to “flying off the handle”)
Mood stability (frequent emotional changes/reactions)
Management of Emotional Changes
Gaining increased awareness of emotional changes/reactions
May lack insight into self-perception of emotional changes “everything
is fine”
May often be first noticed by a friend or family member
Identifying triggers/precipitating events
Environmental: sounds, smells, crowds, bright lights
Physiological: headaches, vision changes, nausea, fatigue
Learning NEW ways to cope and manage emotions
What may have worked before IS NOT working now
Getting creative to find new ways to cope (e.g., used to run before injury; now
due to physical pain can barely walk)
Being OPEN to receiving help from others (family/friends; rehab team; therapist;
psychiatrist; support groups; peers)
Beyond Typical Emotional Changes: When
To Notify Your Doctor/Medical Team
Sometimes the severity/frequency of emotional changes following brain
injury warrants a formal clinical diagnosis
Only your medical/mental health team can make this determination
“My wife says since my TBI I have been acting crazy; so I must have PTSD”
Thoughts/actions of wanting to harm yourself or others
Impulsive/reckless acts that may LEAD to danger of self or others
Inappropriate emotional responses to a situation (in a manner that is a
gross disregard for social norms/practices)
Emotional Regulation Disorders Often
Diagnosed Following Brain Injury Major Depressive Disorders
Anxiety Disorders
Generalized Anxiety Disorder
Posttraumatic Stress Disorder
Panic Disorder
Mood Regulation Disorders
Intermittent Explosive Disorder
Alcohol/Chemical Dependencies
PseudoBulbar Affect (PBA) (in rare cases)
Outward expressions of sudden/frequent uncontrollable bouts of
laughter and/or sadness that does NOT match how you feel inside
Psychosis (in rare cases)
Interventions Emotional Changes Following
Brain Injury Medical/Mental Health Consult
Medication management (by general medical providers or psychiatrists)
Neuropsychological Assessment
Helps to identify CURRENT levels of cognitive and mental health functioning
Clarify diagnosis and inform treatment intervention
Mental Health Intervention
Individual or group psychotherapy: Cognitive-Behavioral Therapy (CBT)
Bio/neurofeedback
Exposure techniques for PTSD/trauma issues
Dialectal Behavior Therapy (DBT) and mindfulness practices
Alternative/Lifestyle Interventions
Yoga/mediation
Acupuncture
Exercise/healthy diet
Support groups
How Can Friends/Family Members
Help? Help to identify emotional/mood changes following Injury in SUPPORTIVE AND
NON-JUDGEMENTAL WAY
Point out triggers, behaviors, reactions that may NOT be aware to the individual
Ensure SAFETY for the individual
Explain WHY the behaviors are problematic
Notify appropriate persons if threats/actions of homicidal/suicidal ideation (e.g., mental health professionals; MD; police, etc.)
Assist in scheduling/transporting/attending of medical and mental health appointments
Risk management support
Help to minimize contact/interaction with potential triggers (e.g., crowded/loud places; scene of injury/accident)
Inform others (e.g., friends, family, acquaintances) of emotional/behavioral changes
Help the individual to get connected with the BIAW support groups and/or TBI survivor ID card
HELPFUL RESOURCES
Brain Injury Alliance of Wisconsin
http://www.biaw.org/
Brain Injury Association of America
http://www.biausa.org/
Brainline.org: Preventing, Treating, and Living with TBI
http://www.brainline.org/landing_pages/categories/depression.html
The Brain Injury Guide & Resources
http://braininjuryeducation.org/TBI-Basics/Behaviorial-and-Emotional-Impacts-of-
TBI/
REFERENCES
Johnston, B., & Stonnington, H.H., (Eds). 2009. Rehabilitation of
Neuropsychological Disorders: A Practical Guide for Rehabilitation
Professionals. Second Edition. Psychology Press, NY NY. Pp. 83-84.
Mason, D.J. (2004). The Mild Traumatic Brain Injury Workbook. Raincoat
Books, Oakland, CA. pp. 119-127.
Schwarzbold, et al. (2008). Psychiatric disorders and brain injury.
Neuropsychiatric Disease and Treatment: 4(4), 797-816
University of Missouri (2012). The Brain Injury Guide & Resources. Website:
http://braininjuryeducation.org/TBI-Basics/Behavioral-and-Emotional-
Impacts-of-TBI/
QUESTIONS?