Emotions can be heightened after TBI, surprising both the survivor and their family. Often there is no specific event that causes the feeling, or the emotion the survivor experiences feels out of proportion to what has happened! This can be confusing to everyone involved, but strategies can help.
Set a Healthy Baseline
Emotions are often stored in our body, so our first strategy is preventing buildup of big emotions. Getting adequate sleep, which might be a different amount that before your injury, is your first line of defense. Eating small amounts through the day can regulate blood sugar, which can help regulate emotional responses. Drinking plenty of water can improve your baseline mood as well!
Emotions often get stored in our body, so finding ways that you can exercise with your post TBI body can help with emotions. Having a daily movement and stretch routine can be vital for good emotional health.
Developing a relaxation practice can help. Some people find meditation helpful, and others prefer to integrate mindfulness into their movement. Our resources page has many options for you to explore.
Track your Emotions
Keep a log of the intense emotions you experience. Note the time of day, how much you slept the night before, how recently you have eaten, and the situation that sparked the emotion. Tracking may help you discover patterns that you can work to change. For example, if the emotions are more intense when you haven’t gotten enough sleep, perhaps revisiting your sleep routine will be helpful, however if you find that you have intense emotions after significant stimulation, perhaps sunglasses and earplugs will help.
Notice the Emotion Coming On
Once you start to feel the emotion, it can be helpful to remove yourself from the situation. When we are experiencing an intense emotion, the logical part of our brain is deactivated, and the irrational part of our brain is activated, which can lead to some behaviors that don’t help us in the long run. Go to a quiet place, take a walk, listen to music, or take a rest break - whichever seems to be the most calming for you.
After the Emotion
Whether the distressing emotion is tears, anger, anxiety, or excessive joy, after an emotional outburst people sometimes feel embarrassed by their reaction. This is an important time for self compassion. When we speak with kindness and understanding to ourselves, we create the learning mindset needed to make progress on these challenges. We can remind ourselves that our brains are different now, and we are working hard to develop new strategies to manage that changes in our life.
Surround yourself with understanding. Find a team of therapists who understand brain injury and can help you develop the skills needed to manage these new and intense emotions. At Progressive Rehabilitation Associates, we specialize in helping individuals who have experienced brain injury overcome these challenges and build a meaningful life. Find local community of people who have experienced something similar to what you have gone through. We are lucky here in the northwest to have a dedicated community of individuals who are thriving with brain injury at Brain Injury Connections Northwest. We love collaborating with BIC-NW, so keep an eye out for our upcoming presentations at their support group meetings.
A Special Note to Family and Friends
This is a challenging time for you. Not only is your loved one trying to understand and manage their new emotions, you are experiencing them in a whole new way. If possible, remind yourself that these changes are not personal. Take time for yourself, and find others who are also caring for loved ones with brain injury. Set safety boundaries during calm times: no yelling, no threatening, no physical violence, and work with your loved one on small cues you can offer if you see their emotions start to heighten. Remind yourself that healing takes time, and this is a journey.
Chris has been known to add a creative and energizing treatment style to each client’s rehab process for over 10 years. Never one to get stuck in a rut, Chris understands the need for a dynamic and personalized approach to finding function and wellness after an injury. “Each person that walks through these doors, whether for pain or brain injury, has a different story, a different set of experiences, and a unique injury. The nature of this interdisciplinary team approach allows for the development of a fine-tuned program for each individual.” Chris’ experiences as an adventure director, an educator, and general outside-the-box thinker often fuel an exciting approach to many people's rehab process.
Want to learn more about Chris and the creative work he does at PRA? Visit the Comprehensive Brain Injury Program (Brain Injury Rehab Center) and Comprehensive Pain Program page!
After a brain injury, it is normal to experience fatigue. Your brain is healing, rewiring and adapting. People often experience three types of fatigue: physical, mental, emotional, and interpersonal. Physical fatigue after brain injury is becoming more tired by physical activity than before your brain injury. Mental fatigue shows up as feeling unable to concentrate or focus. Angry outbursts and intense instances of crying are examples of emotional fatigue. Interpersonal fatigue is experienced by challenges tracking conversations or affect. Sometimes these all blend together - walking in the grocery store can impact someone physically, mentally, emotionally, and interpersonally.
Why is it important to manage energy levels? Because fatigue can affect your physical performance, create thinking foggy, increase symptoms of depression and anxiety, make memory challenging, and impair communication.
Here are five tips for managing energy after a brain injury.
Count your "Brain Bucks"
When you wake up, consider your energy level. How did you sleep? How are you feeling? Perhaps rate your energy in "Brain Bucks" on a scale of 0-100. Jot that number in your planner. As you go through your day, check in with yourself. How many brain bucks do you think you have left? Does your plan for the day need to change? If you find yourself in a deficit, it's hard to climb back out, so manage your brain bucks for each day as best you can. You'll notice you are running low on brain bucks if your symptoms increase or you find yourself with an unusual quirky need that feels unfamiliar.
Create a Visible Routine
The less new stimulus the brain has to pay attention to, the less it has to work. Create a routine to follow each day so your brain can use it's energy for working on recovery. Write your routine in large print and post it around your home for a visual reminder. For some people, this routine also includes limiting choices. After all, Einstein has several variations of the same grey suit, so he wouldn't have to use brain power to decide what to wear each morning.
"Do a little, rest a little."
We call this pacing, and you'll hear this reminder from all of our clinicians, no matter what discipline. Taking time to rest gives the brain an opportunity to recoup the energy it is exerting, allowing you to do more over the course of the day than if you overexert yourself and need a longer rest period.
Improve your sleep
Many people find their sleep impacted by brain injury, which then decreases energy. Work with your doctor, your pt, your it, and your counselor on improving sleep. Each discipline holds a piece of the puzzle to getting a refreshing night of rest!
Embrace your Journey
Every brain injury recovery is different. Self compassion is key to your recovery. Remind yourself when you are struggling that your brain is healing, and your brain has its own timeline. Embrace all the feelings that come up as you recover, and find ways you feel supported in your recovery. For some people, this is through TBI Support Groups, for others it's educating supportive friends and family, and for others, it's using social media to share your story and connect with others on the same path.
Progressive Rehabilitation Associates provides multidisciplinary Brain Injury Rehabilitation, as well as support for the community at large. Check out our Instagram and Facebook as well as our resources page for support in your brain injury recovery.
We are thrilled to introduce the new Medical Director of our Brain Injury Rehabilitation Program, Dr. Natalie Boodin. It is instantly obvious that Natalie is a perfect complement to our dynamic and experienced comprehensive team. She prefers to be casual and comfortable with clients, and strives to listen more than she talks; when clients meet her for the first time, she refuses to wear a white coat and introduces herself by saying “call me Natalie.”
Her attitude is approachable, but her education and experience are extensive. Dr. Natalie Boodin grew up outside of Detroit Michigan, and achieved the deans list at University of Michigan for her undergraduate education, completing her BS in Biopsychology and Cognitive Science. She then received her MD from Ohio State University, while receiving recognition for being an Outstanding Student in Physical Medicine and Rehabilitation. Schwab Rehabilitation Institute, a stand alone rehab unit in Illinois, was where she completed her residence. Se reflects “there was a significant amount of trauma in Chicago.” Serving individual recovering from brain injury became a passion. She also has training in medical acupuncture, which she has found effective for treating headache/migraine related to brain injury. She moved to Portland, Oregon in 2008, and has worked at PeaceHealth and Providence, as well as smaller independent practices.
She often sees individuals struggling to recover from a Traumatic Brain Injury as “the walking wounded”. “This is an invisible injury. So many people don’t understand TBI, and there are such varied and individualized symptoms and outcomes.” She is excited to lead a team of experts in treating TBI, because, “we can’t physically see what is going on inside the brain, so treatment needs to be creative. There are so many ways to treat brain injury, and each person needs an individualized treatment plan.”
If you are attending a first visit with Natalie, you will find her approachable and down to earth. She’s also an excellent listener and very validating. She shares “by the time people get to me, they have been blown off by many medical providers who don’t know why they aren’t getting better.” Her patients will be reassured that she knows everyone heals differently. You’ll find that she wants to really understand both your history and the impact this injury is having on your life. She wants to understand your unique symptoms. She’ll complete the physical exam, and discuss the plan with you.
She’s delighted to be the medical director at Progressive Rehabilitation because treating brain injury is by it’s very nature collaborative. She views herself as just one piece of the treatment puzzle, or “the glue that holds the team together, making sure everything is working well for the patient.” She notes that multidisciplinary treatment is ideal, because communication is easier for the team and the clients when everything is in one place.
In addition to her exceptional clinical skills, Natalie has a lively personal life. She is married and has eight year old twins. Her partner is a musician, and together they operate a guitar store, venue, and bar in Portland. In addition her two children are studying music, with her son taking piano lessons and her daughter taking guitar lessons. Her favorite part about living in Portland I the outdoors. “I love getting out and going hiking.” She also loves animals and has one dog and will be adding another furry friend to the family soon.
At Progressive Rehabilitation Associates, we are committed to individualized treatment for people with Traumatic Brain Injury, and we know that Natalie’s warm demeanor and extensive experience will serve our clients exceptionally well. Please join us in welcoming her to our team.
By Nimuë (Angie I. Cruz, MAE, LMHC, MHP, R-DMT)
Sara was diagnosed with Fibromyalgia six years ago. She had told the doctor right off the bat that she didn’t want to go on pain meds. Her family history included addiction, so she didn’t want to “temp fate” by going on heavy pain meds, so she decided to do everything within her power to learn how to live with chronic pain without medication management. Sara read everything she could on “Fibro” and made diligent efforts to eat healthy, do gentle exercise (mostly swimming and yoga) and basically bought stock in “Icy Hot” and other over-the-counter liniments. However, she still didn’t feel as good as she wanted to. “Is this as good as it gets?” She dishearteningly asked herself. And yet, she continued to seek the answers she sought.
One day, Sara had her niece Alice over who loved to paint. “Grab those watercolors and the paper, I’m going to get the oil pastels and draw over here.” She excitedly giggled to her niece. Suddenly Sara was flooded with memories of doing art when she was young and felt inspired to remember to “play” again. While Sara and Alice did their art, something unexpectedly moved Sara. She noticed she was starting to draw a “pain monster”. Her monster had red spikey horns throughout its body, with a ball and chain attached to it. The eyes looked sad and misunderstood, and tears streamed down its scaly face. “Ohh, your pain monster looks so sad! Why is he sad?” Alice inquired. Sara intuitively said, “It’s sad because on the outside it looks mean and threatening, but on the inside it’s hurting and sad because it feels so misunderstood.” Sara bravely answered. “Hmm, sounds like your pain monster needs compassion” Alice squealed with joy. “Hmm, I think you’re right, Alice!” Sara responded. Suddenly Sara had an inner “knowingness” that she herself needed this hug and felt sad that she judged her own pain so harshly.
Later that night, after Alice had gone home, Sara sat with the drawing of her pain monster “Harold” she had created. She closed her eyes and went into a meditative state to address Harold and let him know that she “saw” him and felt immense love for him (which in reality Sara knew that she was coming to terms with her own body). By externalizing her pain, addressing it, and listening to it, she came home to herself to learn how to be gentler and more appreciative of her body and all it did for her, despite her chronic pain. She started to address herself in a more understanding manner, and practiced listening to her body’s needs, on a daily basis without judging herself as harshly as she did before. While her pain did not necessarily shift, her relationship with herself did. Which in turn, led her to ways to be more patient with herself. While this is a fictional story with fictional characters, many clients have reported this type of response to me when working with them through the creative arts.
Can doing art help you reduce your pain levels? Absolutely! As an Expressive Arts Therapist and Licensed Mental Health Counselor (LMHC) I enjoy teaching my clients how to develop “tools” for their “toolbox” to reduce their pain, anxiety and depressive symptoms naturally, by engaging in activities that may help distract them from their pain and actually close the “pain gates” in order to experience pleasure. How does this work? Well psychologists posit that the perception of pain and pleasure run along the same neural pathways, that is why when we are feeling something pleasurable our pain is dulled, and vice versa. If a person enjoys doing art, it can act as a pleasant distraction from our pain, increase our ability to feel pleasure, and help us process what we are feeling leading us on our journey to healing! Neat, huh? Here are five tips to help you reduce your chronic pain, while having fun experiencing the creative arts.
So there you have it. Now you have some extra “tools” to play with. Now go out there and sing, dance, paint and sculpt! I can’t think of a more enjoyable to way to lower one’s pain while increasing one’s general feeling of wellness! Happy Healing! Note to the reader: Sara is a fictional client representing a blend of clients we see at PRA.
As a counselor, Kris treasures the moments she spends with people rebuilding a meaningful life after a significant injury or heartbreaking event. Specializing in Pain and Traumatic Brain Injury Rehabilitation, Kris supports people as they learn to accept their new life while finding ways to live whole heatedly and authentically. Kris utilizes a variety of modalities to facilitate this process, including mindfulness, expressive art, writing, movement, as well as Cognitive Behavior Therapy and Acceptance Commitment Therapy. Kris applies these modalities with individuals, couples, and with groups. When she is not at Progressive Rehabilitation Associates, you'll find Kris deep in the woods riding her off road motorcycle far from civilization.
One of Kris’s passions is using movement to facilitate healing for clients in our Comprehensive Multidisciplinary Pain Program. While Cognitive Behavioral Therapy helps people reframe problematic thoughts and challenge core beliefs about pain, movement helps clients access non-verbal emotions associated with their injury that are contributing to fear of movement and impeding full recovery. Using trauma-informed movement (https://www.traumasensitiveyoga.com/), clients experience the physiological symptoms of activating their sympathetic nervous system. The natural response to movement is increased heartrate and shortness of breath, which mimic a stress response, however when this stress response is engaged in the context of the therapeutic relationship and grounded in coping skills, the associated fear of movement that diminishes. In this practice, clients learn how to set boundaries and listen to their body, and with this newfound influence over their physiological state, their fear related pain often diminishes.