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Confabulation After Brain Injury: Dealing With False Memories Following TBI

girl with confabulation after brain injury

Confabulation after a brain injury causes a person to create false memories. However, the patient does not realize their memories are inaccurate, which can lead to confusion.

You’re about to learn more about confabulation, including how to help your loved one cope with false memories. Let’s dive in.

What is Confabulation?

Confabulation refers to the creation of false or inaccurate memories without the intent to deceive. In other words, the person does not realize that their memory is false. For this reason, some psychologists refer to confabulation as “honest lying.”

People who confabulate typically do so because of gaps in their memory – therefore their brain tries to “fill in” these gaps with confabulations.

These false memories can take a number of different forms. The most common types of false memories include:

  • Inserting memories from one event into another time or place
  • Exaggerations of actual events
  • Recalling an older event but believing it took place recently
  • Filling in memory gaps with fabricated details 
  • Creating a new memory from an event that never occurred

For example, a TBI patient may say they remember eating oatmeal for breakfast, when in fact they did not eat at all that morning.

Causes of Confabulation After Brain Injury

confabulation false memories brain injury

The exact cause of confabulation is unclear, but damage to the basal forebrain does increase risk of confabulation.

It’s also possible that frontal lobe damage can make confabulation worse. For example, if the person lacks self-awareness, they are less likely to question the accuracy of their memories.

Confabulation also occurs in people without brain injury. In fact, most of us probably have created false memories at some point in our life. That’s because it’s one of the ways that the brain copes with normal memory gaps.  

But after brain injury, especially after the person emerges from a coma, the problem can become more widespread and persistent. Because the brain has more memory gaps than usual, the confabulations get more detailed. Some patients will invent entire conversations and events that never occurred at all.

Types of Confabulation

Confabulation can manifest in different ways. The two most common are verbal and behavioral confabulations.

  • Verbal confabulations. These occur when the person makes a statement about false memories. For example, when they tell you about their trip to the grocery store even though they never left the house.
  • Behavioral confabulations. These refer to behavioral changes the person makes in response to their false memory. Baking a cake for a person whose birthday was three months ago is an example of behavioral confabulations.

Doctors also categorize confabulation according to when they occur. For example:

  • Provoked confabulations occur when the person creates a false story in response to a question. Usually, it is a subconscious attempt to hide their memory loss. This type is the most common.
  • Spontaneous confabulations happen when the patient tells a fabricated story without any provocation.  

Confabulations don’t always sound unrealistic. In fact, most of the time the events the person talks about seem completely plausible. As a result, it can often be difficult for others to distinguish fact from fiction.

Managing Confabulation After Brain Injury

man with tbi attending therapy for confabulation

Confabulation is one of the most difficult secondary effects of brain injury to treat. This is partly because it is hard for a person to admit that their memory is wrong, and usually these individuals do not even realize that they are confabulating.

For the person suffering from confabulation, their false memories feel as real as their other memories. Therefore, finding out their memories are wrong can seem like a threat to their very identity.

That’s why psychologists suggest that family members and friends avoid confronting the person directly about their false memories. Most of the time, it does not do any good, and usually just ends up agitating them.

Still, confabulation can have a negative impact on daily function, as the person requires almost constant supervision. Therefore, it is crucial to find some ways to manage its effects.

Best Techniques to Reduce Confabulation

Since confabulation is often a response to memory loss, strengthening the patient’s memory skills may help reduce incidents of confabulation. Speech therapists and neuropsychologists can teach the person different exercises that will help improve their memory.

There is also evidence that confabulation increases under emotional stress. This means that helping the patient reduce their stress after brain injury may improve their symptoms. Mindfulness techniques are a great way to lower stress and have even been shown to improve memory.

Finally, improving the person’s self-awareness can enable them to question their false memories on their own. Cognitive-behavioral therapy can help them accomplish this goal.

You should inform the therapist about the patient’s confabulation before they begin treatment though. That way they can tailor their treatment to the person’s condition.

CBT and other psychotherapies can also help the person develop ways to cope productively with unpleasant facts, such as the idea that their memories are unreliable. This makes it one of the best therapies for confabulation after brain injury.

False Memories After Brain Injury

Confabulation can be a troubling result of TBI for loved ones to encounter, especially if you do not know what is happening. At first glance, it can seem like the person is lying, but that is not necessarily the case.

For someone with confabulation, their false memories are so vivid and detailed that they feel real. Therefore, it’s important to be patient and avoid getting into an argument with them. They may be wrong, but it is unlikely that you will convince them.

Rather, the best approach is to encourage them to improve their memory skills through speech and cognitive therapy. The better their memory can perform, the less their brain will need to compensate with false memories.

photo credits: iStock/Prostock-Studio/Pheelings MediaSeventyFour

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