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?