Emotional Distress and Symptom Management following Injury and Disease

Our emotional well-being and quality of life depend on how well we can function in our world.   When our daily life is disrupted by a major injury like a brain injury, or disease, recovery can be a challenging road ahead, to say the least.

1. This article discusses the underlying sources of emotional distress that are experienced by people who suffered a brain injury or disease that negatively impacts brain functioning.
2. It provides information on how to address symptom management in a way that allows a person to actually return to their daily life as opposed to the often experienced downward spiral of the crash and burn that comes with pushing through activities or symptoms.

How to get better after a concussion:

The brain is responsible for everything including physical, cognitive (thinking), emotional, and social functioning, sleep regulation, balance, balancing the body’s water household, movement, and so on.  In short, the brain is the control center that allows us to function successfully in everyday life- to do the things that we want to or must do, successfully.

When the brain is impacted by injury or disease, the ensuing difficulties of not functioning in everyday life and work can be devastating on many levels,
bringing with it decreased quality of life and emotional distress.

Symptoms following brain injury including concussion, stroke, chemo brain, and other diseases that impact brain functioning often include:

1. Physical symptoms, which include invisible and invisible symptoms such as
   • Fatigue, headaches, sensory sensitivity, dizziness
   • Difficulties with movement
2. Cognitive symptoms (slowed thinking speed, memory difficulties, difficulties concentrating)
3. Emotional distress (low mood, stress)

As mentioned above, our emotional well-being and quality of life depend on how well we can function in our world.   When our daily functioning is negatively impacted due to having suffered a longer-term injury or being diagnosed with a disease, the emotional challenges can result from different underlying sources. Some emotional difficulties may relate to the injury and can relate to questions such as: ‘why did this happen to me’. Emotional difficulties also can result from the worries about the future following an injury, difficulties functioning in your daily life due to symptoms can create worries and depression, that may express themselves in questions such as: ‘Is this the new me?’ or ‘How am I going to do this task’. Other emotional difficulties may result from just ‘not feeling good’ due to symptoms, and the resulting challenges of being at work or spending time with friends and family. The latter is a non-exhaustive list of the underlying reasons for the emotional challenges that people experience following a concussion.

Importantly, it is the emotional difficulties that seem to rise to awareness, but it is the sources that drive these emotional difficulties that also must be addressed for recovery to become an ‘upward spiral’.

In short, all of the above, the physical and cognitive symptoms, and the associated emotional difficulties, not only negatively impact a person’s ability to function in everyday life.   It is oftentimes difficult for people to know what to do to get better – how to approach symptoms and what strategies to use while struggling to manage daily life.

Therefore, to decrease the emotional suffering following such injury or disease, we need to address the specific sources that drive the emotional suffering including symptom management (physical and cognitive difficulties). At the same time, understanding both, emotional challenges and what drives them, and how these interact, is an important part of learning on how to get better following concussion, which oftentimes is part of the therapeutic approach at Mind your Brain in addition to learning about symptom management, strategy use, and a gradual approach to activities and more. If you would like to learn more about Heike’s approach to concussion recovery, e-mail me at mindyourbrain1@gmail.com or schedule a free 15-20 minute phone or skype consult here.

Here are some points and suggestions for symptom management, especially fatigue management, following concussion or other conditions that impact brain function through gradual exposure to activity and symptoms while increasing functionality and emotional well–being.

The How-to’s of gradual exposure to activity and symptoms

Symptoms following brain injury including concussion, stroke, chemo-brain, and other diseases that impact brain functioning often include:

1. Physical symptoms (e.g.
   fatigue, headaches, sensory sensitivity, dizziness)
2. Cognitive symptoms
   (slowed thinking speed, memory difficulties, difficulties concentrating)

Our emotional well-being and quality of life of course depend on how well we can function in our world.   And under health conditions, we know that sometimes we can push through activities in order to complete the task, usually without much consequence. However, after a brain injury, such an approach can have negative consequences: people “crash” and it may take a few days to ‘recover’ from this ‘crash and burn’ approach. While regaining one’s energy, it likely feels like it will ‘never’ get better, or even that it gets worse despite best efforts. While this approach may sometimes be used under healthy conditions without too many negative consequences, it does not work well when dealing with fatigue following a brain injury (concussion, chemobrain, stroke). Now, the brain needs frequent breaks (more short breaks more often) to re-fuel because it cannot fulfill the usual energy requirements of a usual day of work or life. Keep in mind that a concussion is an injury; even though one cannot see it from the outside like a broken arm, the injured brain will require a balanced approach between activity and rest to allow for efficient healing and returning to full form effectively. Therefore, a gradual approach to return to activities is generally recommended.

It is usually more advantageous to do cognitively demanding tasks (e.g. doing taxes, organizing information) or physically demanding tasks (e.g. shopping, cleaning) for shorter periods of time and switch to other tasks to give the system (brain/ body) a break from doing exactly the same for too long (this includes such ideas such as a change in body position, switching up exercises in the gym). With regard to physical tasks, humans usually do this without too much consideration- for example, a body position becomes uncomfortable and we change position.

However, when it comes to cognitively demanding tasks (eg, reading, driving, participating in a conversation)- that is tasks that require effortful processing such as unfamiliar and/ or complex tasks requiring conscious attention, frequent changes in activity, and breaks, are needed as well and important!

Following a brain injury, it can be difficult to identify the need for a break. If you are have experienced a brain injury and struggle with the consequences, you could read on “How can I get better after a concussion“, or feel free to e-mail at mindyourbrain1@gmail.com with your questions, or just book a free 15-20 minute consult with me here to learn how to identify the need for a break proactively (and breaking the crash and burn cycle), thereby creating an upward spiral of recovery.

Explaining “concussion”

A concussion is a type of acquired brain injury. An acquired brain injury is any injury to the brain that occurs after birth. An acquired brain injury can result from physical trauma (brain injury due to external trauma: hit to the head) or it arises from an internal cause (stroke, brain surgery, brain infections).

Is a concussion the same as mild traumatic brain injury?

A concussion is a traumatic brain injury (TBI) because a concussion results from a blow to the head (hitting the head) that is strong enough so that the brain is shaken and/ or rotated within the skull. Not every bump to the head will result in a concussion!

However, the term ‘concussion’ should not be confused with the term ‘mild traumatic brain injury’. A concussion can occur at any level of severity of traumatic brain injury- thus a person with a mild, moderate, or severe traumatic brain injury most likely will have suffered a concussion. The term ‘mild traumatic brain injury’ (or moderate or severe TBI) is a diagnostic term – it is based on certain criteria: Glasgow Coma Scale, length of loss of consciousness, and length of post-traumatic amnesia.

A mild traumatic brain injury is diagnosed if loss of consciousness lies between 0 and 30 minutes. Thus, a mild traumatic brain injury can be diagnosed when the person did NOT suffer any loss of consciousness; but feelings of confusion or feeling dazed must be present and not result from substance intake.

What is a concussion? What does the word mean?

Well, the actual word concussion means ‘shaking’. Within the context of a brain injury, a concussion leads to a so-called ‘neurometabolic’ cascade. In other words, brain injury occurs at the cellular level. Only in more severe cases will there be evidence of actual structural changes that can be seen on brain imaging such as CT or MRI (e.g., contusions).

The word concussion is derived from Latin- to concuss means ‘shaking’. When used in the context of traumatic brain injury, this ‘shaking’ of the brain leads to a neurometabolic cascade (e.g. injury response at the brain cell level).

In clinical terms, concussion refers to a syndrome. A syndrome is a group of symptoms that consistently occur together and are associated with a concussion. Concussion symptoms include physical, emotional, and thinking symptoms. All of these symptoms in combination with factors that are internal and external to the injured person create the challenges that people face when attempting to recover from a concussion. Internal factors include things like age, educational level, pre-injury health status, and resilience. External factors include things like familial support, society’s level of support (e.g., are rehabilitation programs available), an employer’s/ colleague’s support when returning to work in a gradual fashion.

The most common and longer-lasting symptoms after a concussion are fatigue and headaches in addition to slowed thinking speed and associated emotional difficulties (eg., stress, anxiety). If you would like to know how to address symptoms after a concussion, you could read more on Emotional Distress and Symptom Management following Injury and Disease.

If you need to know how to get better after a concussion, you can continue reading How can I get better after a concussion or if you have more specific questions, you can e-mail Heike @ mindyourbrain1@gmail.com to set up a free 15- 20 minute phone or skype consult to ask questions or just schedule the consult here