MAKING SENSE OF EMOTIONAL CHANGES FOLLOWING BRAIN INJURY

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1 MAKING SENSE OF EMOTIONAL CHANGES FOLLOWING BRAIN INJURY Sarah E. Porter, PsyD, LP Madison Neuropsychological Services, LLC Neuropsychologist, Owner Madison WI

2 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

3 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)

4 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

5 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)

6 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)

7 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)

8 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)

9 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)

10 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

11 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

12 HELPFUL RESOURCES Brain Injury Alliance of Wisconsin Brain Injury Association of America Brainline.org: Preventing, Treating, and Living with TBI The Brain Injury Guide & Resources TBI/

13 REFERENCES Johnston, B., & Stonnington, H.H., (Eds) Rehabilitation of Neuropsychological Disorders: A Practical Guide for Rehabilitation Professionals. Second Edition. Psychology Press, NY NY. Pp Mason, D.J. (2004). The Mild Traumatic Brain Injury Workbook. Raincoat Books, Oakland, CA. pp Schwarzbold, et al. (2008). Psychiatric disorders and brain injury. Neuropsychiatric Disease and Treatment: 4(4), University of Missouri (2012). The Brain Injury Guide & Resources. Website: Impacts-of-TBI/

14 QUESTIONS?