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Cognitive-Behavioral Therapy After Traumatic Brain Injury: How It Helps with Recovery

woman trying cognitive-behavioral therapy after traumatic brain injury

Cognitive-Behavioral Therapy (CBT) offers an effective way to help people cope with the emotional and psychological tolls of brain injury.

There are several different CBT strategies that you can try, depending on what you want to improve. Today’s article will walk you through all the various cognitive therapies and how they treat the side effects of traumatic brain injury.

Cognitive-Behavioral Therapy After Traumatic Brain Injury

Most brain injuries, no matter how severe, will cause the person to experience emotional and behavioral changes. These changes can include:

  • Emotional lability (extreme mood swings)
  • Anxiety disorders
  • Depression
  • Angry outbursts
  • Orbitofrontal syndrome (acting impulsive and aggressive)
  • Flat affect (lack of emotions)

Some other issues TBI can cause are PTSD and lack of empathy and social skills.

Unfortunately, these issues can cause unnecessary suffering. Some, such as severe depression and anxiety, can even halt recovery. That’s why it is crucial to find treatment as soon as possible.

With the right coping methods, you can learn to manage the emotional effects of brain injury so that they no longer dictate your actions.

That’s where CBT comes in.

What is Cognitive-Behavioral Therapy?

Cognitive-behavioral therapy is the most scientifically verified psychotherapy treatment, with over 1,000 studies on 10,000 patients, all demonstrating its effectiveness. It’s been successively used on a wide variety of disorders, including traumatic brain injury.

CBT seeks to help people understand why they behave the way they do. It does this by training patients to become more aware of their mental state and emotional triggers.

Cognitive-behavioral therapy is based on three core principles:

  1. Beliefs create feelings
  2. Feelings dictate behavior
  3. Behavior reinforces beliefs

Therefore, to get to the root of the problem, most CBT treatments focus on uncovering unhealthy thinking patterns.

Cognitive-Behavioral Therapy Strategies

The goal of cognitive behavioral therapy is to retrain your brain to replace negative thoughts with positive ones. Therapists might use several strategies to accomplish this, which we will examine below.

Cognitive Restructuring Techniques

Man describing problem to therapist during cognitive behavioral therapy session

Cognitive restructuring teaches people to identify “automatic thoughts” and question them. These are the thoughts that occur throughout the day, without any conscious effort on our part. They provide commentary on our experience and are the lenses through which we interpret the world.

Most of the time we accept these thoughts as true, but when a person has a psychological illness or TBI, those automatic thoughts tend to be dysfunctional. Cognitive restructuring helps you eliminate negative thoughts and find better, more accurate beliefs.

For example, if you struggle with depression after your TBI, most likely there are some negative thoughts fueling your feelings. A CBT therapist might help you discover that you believe people won’t like you because you have a brain injury, which makes you more hostile to others, which leads to self-isolation and further depression.

The next step would then involve learning how to question those thoughts and break that pattern.

One exercise many therapists use is to have the patient write down as many of their negative thoughts as they can. After that, they will go through each thought and try to find a more positive interpretation together.

Over time, you will gain the ability to stop and question negative beliefs on your own, before they take root.

Successive Approximation

This CBT technique is perfectly suited for traumatic brain injury patients. Its goal is to help people learn how to complete tasks without getting overwhelmed.

The therapy works by starting the patient out with a simple task that is similar to the more difficult task that they struggle with. Once the person masters that task, the harder one feels less daunting.

Activity Scheduling (Behavioral Activation)

Woman writing in calendar

Activity scheduling helps people plan and initiate behaviors they should be doing more of, such as going for a walk or meditating. It also targets harmful behavior that only worsens symptoms, such as social isolation and inactivity.

This strategy is especially effective for people with traumatic brain injuries. Since TBIs often cause executive dysfunction, it can help to have an outside influence holding you accountable.

The more you practice scheduling activities with a therapist’s help, the easier it will become to do it independently.

Skills Training

Many of the emotional problems that TBI patients face stem from not having the appropriate skills to handle the situations they face.

Fortunately, CBT can help remedy this problem through skills training. Some common skills that cognitive-behavioral therapists might focus on include:

  • Social skills
  • Communication
  • Problem-solving
  • Assertiveness

Training sessions will usually involve role-playing where the person can practice their skills without fear of embarrassment.

Acceptance and Commitment Therapy (ACT)

peaceful man

Acceptance and Commitment therapy combines elements of Buddhist mindfulness meditation with behavioral therapy. Like cognitive restructuring, it tries to help people transform their unhealthy thoughts.

ACT uses five principles to help the patient overcome harmful beliefs and feelings.

  • Defusion. Instead of arguing with negative thoughts, which can make them seem valid, ACT therapists will tell their patients to simply not engage. This is especially helpful when these thoughts are deep-rooted.
  • Acceptance. Disengaging doesn’t mean ignoring completely. The next step is to allow the thoughts and feelings to come without fighting them. Recognize that these thoughts exist, but don’t give them any importance in your life.
  • Mindfulness. The next step is to learn how to stay grounded in the present, without trying to interpret anything or predict what will happen.
  • Clarity. With this step, the patient discovers what is most important to them. This helps the person clarify their goals and values and learn to recognize behavior that sabotages that goal.
  • Commitment. Finally, therapists will help the patient create and execute plans that will let them reach their goals. This is the most important step in ACT and requires serious participation in order to work effectively.

Although ACT is a newer therapy, it shows a lot of promise for people with traumatic brain injury.

Cognitive-Behavioral Therapy for TBI Patients  

If you struggle with depression or other mental health issues after brain injury, cognitive behavioral therapy can help improve your quality of life.

However, since CBT requires some self-awareness skills, it may not work for TBI patients with severe cognitive deficits. For those patients, other forms of behavioral therapy would be a better fit.

To figure out whether CBT is right for you, schedule a consultation with a cognitive therapist. He or she will assess you and help you find the strategies that will work best with your needs.

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Step 1: Download Free Rehab Exercises

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Step 2: Discover Award-Winning Neurorehab Tools

Step 3: See What Other Survivors Are Saying