Traumatic Brain Injury

What is Traumatic Brain Injury?

  • A 15 year-old cheerleader flies high into the air above her team. As she completes her beautiful maneuver, a team member is out of position for her catch. The ground is very hard as her head makes contact, causing her to lose consciousness for 10 seconds.
  • A 30 year-old realtor is rear-ended as he slows down for a red light. The jolt causes his head to snap forward and back. He thinks he is fine until he starts having severe headaches and feeling ‘fuzzy’ a few hours later.
  • A 23 year-old sergeant rides shotgun in a Humvee as his convoy drives along a ‘too quiet’ side street in Baghdad. The sudden IED blast pushes his brain back and forth inside his skull. His squad notices that he doesn’t remember things like he used to, but they are undermanned and need him to complete their missions.

Many people in the United States sustain a mild traumatic brain injury (mTBI) every year – around 1.4 million. How they receive their injury comes from many sources, but basically a mild traumatic brain injury is a bump, blow, or jolt to their head or a penetrating head injury that disrupts their normal brain function. Sometimes the person loses consciousness and sometimes they don’t. The result of this traumatic blow to the brain is a set of symptoms that affect these persons dramatically and who sometimes need medical attention and treatment.

What are these symptoms? Here are the main ones:

  • Headache
  • Memory complaints
  • Nausea
  • Vomiting
  • Irritability
  • Balance complaints
  • Difficulty concentrating
  • Vision disturbance
  • Sleep Disturbance

Depending on the severity of the symptoms, persons with an mTBI may need to go to medical specialists such as neurologists, speech, hearing and or vision specialists, and neuropsychologists for treatment. These specialists diagnose and treat as well as recommend changes in lifestyle that assist recovery from the injury. These changes might include rest, a cessation of the activity that caused the injury, and an adjustment in expectations for normal performance in work, school, and general daily activities.

Therapy for Traumatic Brain Injury

Adjusting to the life-altering event of a traumatic brain injury – whether it is mild, moderate, or severe – is a very emotional process. A TBI can sometimes alter your life 180 degrees, and even if it doesn’t change your life to that extreme, it changes how you think, solve problems, and remember. It changes your relationships with family members, friends, partners, and professional contacts. Part of the frustration with having a TBI is that no one gets what it means to have a TBI especially since a TBI person looks and mostly acts ‘normal.’ Sustaining a TBI is a big deal. Therapy can help with the emotional impact of a brain injury.

Therapy can help in three important ways: Helping the brain-injured person deal with depression, anxiety, and family relationships.


Many persons with a TBI will recover with little or few treatment interventions. Others will notice some symptoms lingering for a longer time.

The longer the symptoms last, the higher the tendency to feel depressed or anxious. In fact, research has shown that persons with TBI experience depression within a year of the injury. That makes sense since persons have to give up so much of what they are used to doing as a result of their injury. They have to adjust their view of themselves as well as their role with their family and social networks. All of these adjustments add up to a whole lot of feelings of loss and self-blame, which can be overwhelming and lead to an emotional shut-down.


Where does anxiety come in? Anyone with TBI symptoms starts to worry about when they will return to their previous level of functioning and will begin to second-guess their abilities and strengths which they had an abundance of before their injury. Their increasing anxiety often takes on a life of its own and begins to inform their decisions and choices. Anxiety also affects sound sleep.

Stressed-out Family Relationships

Persons with a TBI can’t manage their symptoms alone. They need help from family members to accomplish daily tasks as well as to support them to keep going. Brain injured persons often take their irritability out on their closest relationships, which is hard for these persons to not take personally. These caretakers – often a spouse or a parent – are under a lot of stress and need support and attention to help them deal with their brain-injured loved one. The brain-injured person and their caretaker may need to learn how to relate to each other in a completely new way; they need support as a couple and as individuals to help them carry on.

How I Treat Clients with TBI

1) Collaboration with other medical professionals. I always get signed releases from my clients to consult with the various treatment professionals in their lives. This collaboration helps my clients to know that hopefully their treatment professionals are heading in the same direction – having them feel better.
2) Thorough assessment of medical history, including previous injuries, illnesses, medically induced traumas, and current medical and dental care. I always obtain a family history that includes medical issues, quality of relationships, trauma and neglect as well as strengths and positive relationships.
3) It is very important to me to know what my client’s support system is for their daily and ongoing care. I often meet with the client’s social support system whether it is a spouse or committed partner, family, or other caregivers to help educate them on the TBI and/or to help work out relationship difficulties.
4) Treatment modalities can include concrete interventions such as setting up daily routines and self-care. I use EMDR and DBT skills training in emotional regulation, distress tolerance, and interpersonal effectiveness. Also see My Treatment Approach for more ideas.