Just this week I reported on the question above in a presentation at the 10th Annual National Summit on Sports Concussion in Los Angeles, California. In my recent post, I noted that a survey done through NPR and a survey firm found that one quarter of persons reported having had a concussion. As you may remember, a concussion, also known as a mild traumatic brain injury (TBI), is caused by a bump, blow, or jolt either to the head or the body that causes the brain to move rapidly inside the skull. Loss of consciousness is not necessary for a concussion to occur. Not all blows or jolts to the head result in a TBI. A concussion changes how the brain normally functions. Concussions can have serious and long-term health effects.. A concussion is considered a brain injury. The most frequent causes of non-sport related concussions include falls, being struck by blunt objects, and automobile accidents.
Most of the time, we hear about the physical and cognitive aspects of concussion, such as headaches, loss of memory and poor attention/concentration. However, psychiatric complaints are common in concussion. For example, rates of some common mental health complaints in concussion include depression (25-50%), anxiety (10-77%), sleep problems (30-70%), agitation and aggression (~30%), and suicide (~3x Incidence of people without consussion). Depression and anxiety, the most common symptoms, often are not recognized as consequences of a concussion. Yet, they occur with a frequency to make it advisable to assess for and manage as needed.
Feelings of anxiety are common in postconcussive syndrome (PCS). They are associated with a loss of self esteem along with fears of permanent brain damage and may enhance the original symptoms including physical and cognitive symptoms. Research reports indicate that patients with symptoms at 3 months post-injury were likely to experience high levels of stress and anxiety.
Depression can occur directly or indirectly from the neurobiological results of the brain injury. It also can occur as a psychological reaction to deficits and problems associated with the brain injury. Finally, it can co-occur with an anxiety disorder. There are many research studies concluding that over years of follow-up individuals with a concussion have a 3x risk for developing a diagnosable depressive disorder. The risk becomes even more concerning when we see that the risk for suicide, based on longitudinal studies in numerous countries to include Canada, Denmark, and Sweden all conclude that there is a 3x increase in suicides in the decade following concussion, with the risk increasing if you have more than one concussion.
There is good news. There are many direct forms of treatment for the emotional symptoms from concussion. These include education, support, and guidance; sleep hygiene; relaxation procedures; psychotherapy; medications. Other treatments for concussion which may assist generally include accommodations, vestibular therapy, physical therapy, cognitive rehabilitation, and vision therapy.
Support and educate benefit patients in that the patient receives information on what symptoms to expect and how to cope with them. Research studies have shown that the sooner such information is received the better given that concussion is associated with high levels of anxiety. Participation in a social support group results in improved mood and reduced anger, confusion, frustration, anxiety, depression, and isolation.
Sleep problems are common in concussion. Therefore, getting onto a regular sleep cycle is crucial to recovery. Recommendations include:
Only go to bed when tired
Don’t lie in bed more than 20 minutes
Relax each night before bed
Wake up at the same time every morning
Avoid taking naps
Avoid caffeine after lunch
Relaxation procedures help reduce anxiety in concussion. I have discussed these procedures in other posts to include breathing, progressive muscle relaxation (PMR), calming visualization, and meditation. I like to use PMR as it includes a combination of breathing, relaxing visualization, and progressive tension/reduction of various muscle groups. Some individuals have been using mindfulness procedures to achieve calming states which reduce overactivation in some brain areas.
Cognitive behavior therapy (CBT) approaches have been shown in research to reduce depression and anxiety in concussed persons. As I have discussed in other posts, CBT is based on the premise that much of our unpleasant feelings such as depression and anxiety are driven by our thoughts. In concussed persons with depression, overly general thoughts can include "I'm not the same as I was; I'll never get better; My life will never be right again" among many others. All such thoughts will contribute to depression/anxiety and a worsening of other concussion symptoms both physical and cognitive. CBT can assist in helping the concussed person correct their cognitive biases and misattributions about the effects of the concussion, contributing to an improvement in emotional state.
So, if you or a loved one or friend has suffered a concussion, please be mindful of the emotional outcomes which often are not recognized. There is much help available. As always, your mindset when you suffer such an event has much to do with how well and how soon you recover. May all your thoughts be helpful ones. Best wishes on your journey.
Dr. Paul Longobardi
For information on these and related topics, please see my website at www.successandmindset.com.