It can also be linked to someone s frustration at not being able to express themselves or perform at the level they previously expected.

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1 The emotional and behavioural effects of Brian Injury can be the most difficult to understand and treat. Many of the people who sustain a brain injury are left with some form of emotional or behavioural change, which carers, family and society as a whole find embarrassing, difficult to understand and hard to accept. Agitation This is often a major problem in the early stages of brain injury when the individual is usually still in hospital. The agitated behaviour is normally unprovoked and is a result of neurological damage rather than a reaction to events or problems. Agitation may present as constant movement, pacing up and down, repetitive purposeless activity, getting up and down constantly or inability to focus attention. Explosive Anger and Irritability Dramatic mood swings; outbursts of anger and irritability are likely if the brain injury has caused damage to the parts of the brain involved in controlling emotional behaviour. It can also be linked to someone s frustration at not being able to express themselves or perform at the level they previously expected. Lack of Insight and Awareness Insight and awareness are the abilities to recognise our own strengths and weaknesses and to appreciate the effect our actions may have on others. Skills such as self-awareness, insight, sensitivity and empathy can be lost if damage occurs in the frontal lobe area of the brain. Denial is a mechanism that we use to protect ourselves from overwhelming or unpleasant realities. It is a natural process that we all adopt when coping with situations such as loss or bereavement. Vicky Richards, Co-ordinator / CNS, CBIT Emotional & Behavioural Effects of Brain Injury 1

2 In someone with an injury to the brain a combination of loss of insight and a natural tendency to avoid reality may make the person behave as if they were perfectly ok. Anxiety and Apprehension After brain injury, people often experience difficulties with employment, finances and uncertainty about their future prospects and health. Many brain-injured people will feel anxious and apprehensive; others may become obsessional in their thoughts and actions. Some develop specific fears and experience feelings of panic, palpitations and breathlessness. Depression The most common psychological reaction to brain injury is depression. Brain injury can bring about many losses loss of job, loss of roles, physical and cognitive limitations. The depression may intensify as the person struggles painfully and seemingly helplessly to regain lost skills and roles. It may be that depression does not surface until some time after the brain injury, when the hospital demes rehabilitation complete and the person returns home, only to be confronted with the realisation that life can never be the same again. For some, the depression may be severe and if the person experiences feelings of hopelessness and starts to neglect his or her appearance, these may be sings of depression that require active treatment. The persons General Practitioner should be able to provide effective treatment, although referral to a Psychiatrist or Neuropsychiatrist may be necessary. Impulsiveness and Lack of Inhibitions An individual with brain injuries may lose the ability to control either their actions or speech. They may act on impulse, say the first thing that comes into their head, and become excessively demanding. They may also lose the ability to discriminate about how and when to express feelings. This can result in mood swings or periods of sudden tearfulness. This can be exacerbated if they also have a lack of awareness. An improvement may be possible using a behaviour modification programme devised in conjunction with a Neuropsychologist. Vicky Richards, Co-ordinator / CNS, CBIT Emotional & Behavioural Effects of Brain Injury 2

3 Sexual Problems Sexual Problems experienced by a person who has suffered a brain injury can include increased/decreased sex drive, promiscuity or misinterpretation of other people s behaviour as sexual advances. These problems are caused by damage to a small nerve centre in the middle of the brain, which affects the sex drive and the release testosterone. There are often difficult and embarrassing problems to admit to and talk about. However, it may be beneficial for you to speak to your General Practitioner and / or Specialist Nurse. Managing Your Anger and Irritability People often feel there is little they can do to control their anger. Anger and irritability often feel like they happen out of the blue and people feel like they just snap. Usually however, there are triggers that spark your anger, there are also warning signs from your body that you can learn to spot. If you learn to recognise the kind of situations where you may become angry, and if you learn the warning signs, you can manage your anger more effectively. By using some of the following techniques you can learn more about your anger and how to manage it better. These may take time to master, and you may need to enlist the help of family and friends. Learn to recognise the Triggers There is usually a pattern to your anger. It may tend to happen in particular situations, with particular people and with particular provocations, e.g. tiredness, noise, traffic, crowds, being ignored. It is important to identify the causes of your anger. Keep a diary and record a) each time you got angry, b) where you were, c) who was there, and d) what was going on at the time. You will notice that your anger is usually not random and not an uncontrollable force. Vicky Richards, Co-ordinator / CNS, CBIT Emotional & Behavioural Effects of Brain Injury 3

4 Identify What is Upsetting You Look at the records in your diary and ask yourself: What is it about the situation that I find annoying/irritating? What am I thinking when these situations occur? Make a list of the kinds of statements that go through your mind. Try to come up with alternative ways of looking at the situation, which makes you angry. Recognise the Physical Signs Pay attention to your body, notice if you have any signs such as clenched fists, gritting teeth, feeling hot or cold, feeling hot or cold feeling nauseous, sweating, or your pulse rate quickening. When you notice the warning signs, combat by practicing deep breathing exercises (breathing deeply and slowly). Anticipate and Prepare Once you become aware of the kinds of situations where you are more likely to become irritable and angry, you can prepare by: Practicing what you are going to say and how. Watching the physical signs and breathing deeply. Be aware of the thoughts running through your mind. Replace them unhelpful thoughts with helpful or useful questions: e.g. I m getting angry. How can I sort this so that everyone gets what they want? Take Time Out If you feel your anger is getting out of control, remove yourself from the situation and cool off; count to 10, sleep on it, distract yourself, exercise, or relax. Vicky Richards, Co-ordinator / CNS, CBIT Emotional & Behavioural Effects of Brain Injury 4

5 Ventilate and Explore Feelings Your feelings are important. Don t bottle up feelings until you explode? Talk to friends or family, or discuss issues with a professional if necessary. Vicky Richards, Co-ordinator / CNS, CBIT Emotional & Behavioural Effects of Brain Injury 5