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Perseveration After Brain Injury: How to Stop Repetitive Thoughts and Behaviors

Woman getting help from psychologist for perseveration after brain injury

Perseveration after brain injury causes repetitive and continuous behaviors, words, or thoughts. It occurs due to changes in memory, attention, and cognitive flexibility.

Today’s article will explain the causes and types of perseveration after TBI. We’ll also discuss how family members can help their loved ones manage their symptoms.

Let’s begin.

Definition and Causes of Perseveration

Perseveration is a thought disorder that causes prolonged repetition of a word, phrase, or gesture after they have ceased being appropriate. It also involves the inability to shift goals or tasks when required.

Perseveration after brain injury is caused by damage to the frontal cortex, which helps control a person’s self-awareness and inhibition. Without those skills, a person who perseverates finds it hard to inhibit one set of actions and switch to another.

In other words, perseveration is a failure of cognitive flexibility. Cognitive flexibility allows people to move between different tasks smoothly, change their ways of thinking, and apply concepts from one context to solve problems in another.

Without cognitive flexibility, TBI patients can get stuck on certain thought patterns or activities. They are usually unaware of their perseveration and cannot control it, but it can cause problems in their personal or professional lives.

Types of Perseveration

The three most common types of perseveration after brain injury are:

  • Stuck-in-set: The uncontrolled or extended maintenance of a thought, activity, or topic in conversation, despite the situation changing.
  • Recurrent perseveration: The unintentional and unfocused repetition of a behavior. For example, a person with recurrent perseveration might write the same word or letter multiple times for no apparent reason.
  • Continuous perseveration: The uncontrollable repetition of an impression or feeling. An example of this is someone who continues to dwell on their anger longer than seems appropriate.

All people experience perseveration to one degree or another. For example, when a song gets stuck in your head, you are actually perseverating. But after a brain injury, perseveration becomes much more severe, and many people cannot stop even when they want to.

Examples of Perseveration After Brain Injury

man staring at laptop late at night because he has perseveration after brain injury

©iStock/dusanpetkovic

Perseveration can manifest in different ways, and no two people will experience the exact same symptoms.

For example, a person with perseveration might continue shaking another person’s hand for longer than is socially acceptable. Others might continue to clean an object longer than necessary.

Most of the time, however, perseveration occurs during conversations or social interactions, when the person cannot switch between ideas or responses. They might also repeat the same words and phrases.

Other examples include behaviors such as:

  • Repeatedly switching T.V. channels
  • Putting food in their mouth without stopping to chew or swallow
  • Writing the same word or phrase over and over
  • Putting on and taking off an item of clothing

Sometimes, however, perseveration is not accompanied by physical actions. Rather, the person will obsess over a thought until they can no longer function normally.

It’s important to realize that perseveration after brain injury is not a behavioral problem, but a cognitive one. Therefore, trying to convince the person to “snap out” of their actions may make the situation worse.

Treating and Managing Perseveration

Because there are so many varying degrees of perseveration, treatment will require careful evaluation by a neuropsychologist. You can also consult with an occupational therapist, who can help you develop some helpful coping strategies.

Some of the best interventions for perseveration include:

One of the most helpful cognitive therapy tactics for perseveration is a technique known as thought stopping. This refers to the use of a visual cue or action that can prevent perseveration from taking hold. For example, some people snap a rubber band on their wrist when they start to perseverate.   

Helping Someone Who is Perseverating

boyfriend comforting girlfriend who is perseverating

It can be difficult to watch a loved one perseverate. Fortunately, there are some helpful strategies you can apply to stop perseveration. Some examples include:

  • Recognize. Teach the person how to recognize when they are perseverating and how to ask for help. You can also create a “stuck signal” which you can use to let the person know they are stuck.
  • Simplify. Give simple, clear instructions on what the person needs to do. For example, if they can’t stop brushing their teeth, tell them to put the brush in your hand, relax their fingers, etc.
  • Offer praise. If they manage to stop perseverating, reinforce this behavior with positive comments.
  • Set a time for perseveration. If the person tends to obsess over a certain topic, schedule a time with them when they can talk or think about it freely. But emphasize that when the time is up, they must stop. Set an alarm so they know when their time limit ends.

These are just a few examples of tactics you can use to reduce perseveration after brain injury. But since every case is unique, you should consult with a psychologist for more personalized advice.

Understanding Perseveration After Brain Injury

Perseveration is a common side effect of brain injury. It causes patients to engage in repetitive and compulsive thoughts and behaviors.

This problem can be harmful to a person’s relationships and even their health, depending on the type of perseveration they engage in.

Fortunately, with the right support, patients can learn to recognize and reduce their perseverative behavior after brain injury.  

©iStock/KatarzynaBialasiewicz

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