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Industry: Email Alert RSS FeedEmotional changes following brain injury: psychological and neurological components of depression, denial and anxiety
Journal of Rehabilitation, April-June, 1991 by Carol Armstrong
Summary
Depression, denial and anxiety have all been examined with neurological, reactive, and adaptive explanations. Rather than take a reductionistic approach, it's been recommended to knit these explanations together to understand how emotional response to brain injury is truly dynamic. Interpersonal communication and relationships are very sensitive to disruption in the patient's emotional balance and coping ability. Thus, this area deserves the closest examination when trying to understand the brain-behavior of emotional and personality change. Patients often are less capable of evaluating themselves, anticipating problems, initiating resolutions, or surmounting their own feelings. Changes are often found in sensitivity, arousal, and the ability to inhibit or stimulate emotion so that it matches a situation or the consequences of behavior.
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Family reactions to emotionally changed patients are also dynamic, but are likely to result in grief, depression, and often, somatic illness in family members. However, their emotional changes may be misinterpreted and untreated.
Rehabilitation and behavioral management, though lacking empirical evidence of its global efficacy, have been found to address important psychological needs of patients. They provide structure, timely and appropriate reinforcement, motivation, and explanations of patients' functioning.
Depression, denial, and anxiety in persons with acquired brain injury have varied faces and may appear as anger, apathy, agitation, or impulsivity. There is often a separation between experience and expression due to the frequency of frontal and temporal lobe injuries. Patients are often not able to integrate perceptions with thoughts, thoughts with emotions, and emotions with words or affect. The three faces of emotional change in brain injured persons are due to neurological damage, ego injury and defensiveness, and adaptive response.
The neurological bases for a flat depression are thus far associated with dorsolateral and left frontal injuries. An agitated depression with components of inappropriate anger, anxiety, and disinhibition are associated with right hemisphere injuries. The ego reactive bases of depression include ego injury, loss of sense of self, and fears and anxieties related to lack of control. Adaptive bases of the more familiar left hemisphere depression are acknowledgement of the worst, or the breaking down of denial. This is necessary to permit the adaptive and constructive ego to emerge so that a sense of self-persistence of one's beliefs and values, as well as personality, can redevelop.
The neurological bases for denial have been known longer than those for depression. Specific syndromes are associated with areas of the right hemisphere. Right frontal injury results in the inability to understand underlying or metaphorical meanings, inappropriate affective reactions, and disinhibition of anxiety which may lead to impulsivity. Right temporal injury often affects the ability to understand intention and emotional signals in speech. Integration of emotion, memory, and sensory experiences are also the function of the temporal lobes. Right parietal injury results in slower reaction times, and altered ability to attend to sensory information and events bilaterally, though with greater affect on the left body side. Right occipital injury results in loss of the visual field on the left, but also the ability to make sense of some visual stimuli perceived, such as facial affect or facial characteristics. Denial in most patients also includes an unwillingness to give up control, social place, identity, and value in the eyes of the self and others. Fears of uncontrollable loss and unpredictability may combine chaotically with disinhibited anxiety and disintegration of affect. However, denial has adaptive bases as well, primarily, the prevention of a catastrophic reaction. The more awareness a pawtient has, the more likely depression will affect motivation and self-belief. Paradoxically, denial helps to maintain emotional stability and motivation.
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