Content provided in partnership with

Health Care Industry

Emotional changes following brain injury: psychological and neurological components of depression, denial and anxiety

Journal of Rehabilitation, April-June, 1991 by Carol Armstrong

<< Page 1 Continued from page 6. Previous | Next

A number of factors determine how effective behavior modification methods will be. For example, patients with anoxia, due to varying etiologies which often accompany head injury (e.g., cardiac arrest and respiratory distress or arrest, or ischaemia from the breakage of small blood vessels in the brain) or those with longstanding psychiatric problems, may not respond well (Gloag, 1985).

Most Popular Articles in Health: Fuel your workout: exercisers who eat before they work out have more energy ...; Soothe a dry, itchy scalp: 5 easy expert solutions; Cocktails and calories: Beer, wine and liquor calories can really add up. ...; The sour truth about apple cider vinegar - evaluation of therapeutic use; The, six best supplements you've never heard of: these secret weapons can ...; More »

In general, behavioral methods work better if: (1) they are provided soon after the problem emerges rather than later, before problems have worsened; (2) they can prevent rejection of the behaviorally disturbed from rehabilitation settings; and (3) they can be used in the patient's and family's natural environment. Delayed or absent treatment of behavioral problems is one of the most common problems learned from working with outpatient families and a family support group. An unfortunate example of the results of no behavioral therapy where it was warranted is the case of a patient who became extremely combative and destructive after a severe head injury and exhibited bizarre and dangerous behavior. Eventually he regained the ability to process the environment, and was able to talk and ambulate. He returned home but had difficulty modulating his frustration and expressing his thoughts and feelings. His need for attention and affection was great, and he sometimes competed with his sister for their parents' attention, even though the patient and his sister were both in their late 20s. Sometimes he would grab or push her, because he knew of no other way to express his feelings when he was anxious. This family needed a psychologist to work with the family as a whole, to teach each member how to set limits with him consistently. However, the had no source of payment for this service. Families need support from insurance companies and other payors of services for outpatient psychological therapy for patients' behavioral problems as well as family therapy to set up a systematic behavioral approach. Patients and families will also benefit if we stop taking behavior modification for granted. Behavior modification has multiple purposes and uses: it can not only be used to reduce problematic behavior, but can be used to support patients' involvement in rehabilitation therapies. In other words, it's a strategy for "peacetime" as well as "war".

Examples of behavioral management approaches which can be used with denial and depression can be found in a training manual for rehabilitation specialists (Armstrong, Patterson, Peterson, & Long, 1985). Issues of the patient's awareness are interrelated with adaptive responses, resulting in a broader understanding of behavior, as well as recommendations for treatment strategies.

Family Reactions

Family reactions to traumatic brain injury are likely to follow a developmental course, beginning with a response to acute stress which is reactive and crisis-oriented. This means the family can mobilize resources to meet the new challenges. This acute response will be followed by the varied patterns of response to prolonged stress, characterized by a continuum of adaptive to maladaptive responses. An inevitable cost to continuing performance of "normal" roles despite a continuing high stressor, is depression. Depression following head injury is epidemic in families perhaps due to prolonged states of fear and stress, and an underlying sense of frustration and helplessness which cannot be expressed or revealed. Families involved in supportive services have all pointed to the trauma caused by the constant changes in acute-care trauma treatment. In any case, depression has been found in relatives regardless of the severity of the injury or the duration of the patient's hospitalization. Oddy, Humphrey, and Uttley (1978) studied the emotional reactions of families, and found that the severity of the mood disturbance in relatives was found to correlate with the confusion (forgetfulness, disorientation), and verbal expansiveness (talking too long, too loud, too illogically) of the patient.

Health Care Industry

Emotional changes following brain injury: psychological and neurological components of depression, denial and anxiety

Journal of Rehabilitation, April-June, 1991 by Carol Armstrong

Find Research Guides for:

Find Featured Titles for: Reference

Most Popular Articles in Health

Most Popular Publications in Health