Understanding the Psychological Effects of Brain Injury: What They Are & How to Pursue Recovery

Various cognitive and behavioral changes that impact one’s personality or emotions may occur following a brain injury. These changes can be referred to as the psychological effects of brain injury. Many of these psychological effects can interfere with recovery, making it more difficult for survivors to regain independence and return to their daily roles. 

For this reason, it’s important to learn which psychological effects may occur after brain injury and the most effective ways to address them. This article will outline many of the most common psychological effects of brain injury and discuss effective treatment options.

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• How can a brain injury impact psychology?
• Potential psychological changes
• Treatment options

How a Brain Injury May Impact Psychology

The brain is made up of many different areas and structures which are responsible for specific cognitive, emotional, and/or physical functions. When the brain sustains an injury, the affected areas may no longer be able to operate properly. This may cause functional changes, referred to as secondary effects.  Depending on the severity and location of injury, there are many different physical and psychological effects of brain injury that may occur.

While there are multiple areas of the brain that contribute to psychological functions, damage to the frontal lobe, in particular, often results in psychological changes. This is because the frontal lobe is primarily responsible for higher-level cognitive functions and plays a vital role in personality and emotional regulation. 

Some of the psychological effects of brain injury may not be immediately apparent, making it especially challenging to identify and distinguish whether certain psychological symptoms are related to one’s brain injury or a separate condition.  Because of this, it is important to obtain an adequate assessment from a neuropsychiatrist to identify potential physical and psychological effects of brain injury.

Psychological Effects of Brain Injury

Psychological effects of brain injury can include cognitive, behavioral, and emotional effects that can make recovery more challenging and/or cause a shift in personality. Fortunately, there are a number of excellent resources for survivors to use to help them overcome these new challenges.

Here are some of the most common psychological effects of brain injury:

Anger and Aggression

Aggressive behaviors, including anger and agitation, are a typical part of the acute recovery phase after brain injury. Outbursts of anger and aggression can sometimes persist past this initial recovery phase, and should be addressed for the safety of the survivor and those around them.

Emotional Lability

Emotional lability can be characterized by intense, inappropriate and rapidly changing emotional responses. These reactions may be out of context for the situation (e.g. laughing during a sad event) and may not represent how the individual is actually feeling.

Depression

Depression is another common psychological effect of brain injury, with survivors being two to five times more likely to develop depression than the general population. In addition to feeling sad or apathetic, those with depression are also likely to experience fatigue and indecisiveness, all of which may negatively affect their motivation to pursue recovery.

Anxiety

Anxiety, or excessive and persistent concern about daily situations, can also occur after a brain injury. For some, anxiety may develop due to the brain’s susceptibility to overstimulation following injury.

Alexithymia

Survivors experiencing a lack of empathy, also known as alexithymia, are unable to see and feel what another person is feeling. They may seem uninterested or egocentric, and may also have difficulty identifying, describing, and processing emotions.

Perseveration

Perseveration refers to repetitive or continuous behaviors that may present as the tendency to stay focused on one task, topic, or thought patterns. Survivors may be aware they are perseverating, but be unable to stop it.

Flat Affect

Flat affect, or a lack of emotional expressiveness, is a psychological effect of brain injury in which survivors are unable to express themselves through facial expressions or tone of voice. Some characteristic features of flat affect include monotone speaking, avoidance of eye contact, no changes in facial expression, and/or neutral body language. 

Paranoia

Though rare, paranoia may occur as a psychological effect of brain injury. Survivors experiencing paranoia may feel as though they are being watched or persecuted in some way, which may present as being suspicious of others, even loved ones. High or extreme levels of paranoia can indicate a more serious condition. 

Anosognosia

Lack of insight, medically known as anosognosia, can be characterized by an inability to identify, understand, and reflect on a situation or action. Survivors with anosognosia lack self-awareness, and are unable to perceive the reality of their own condition. This can interfere with recovery because survivors may not recognize their need for help, and therefore won’t feel motivated to pursue or participate in rehabilitation.

Executive Dysfunction

Executive functions are high-level cognitive skills, such as attention, organization, decision-making, self-awareness, and understanding of social cues. When a brain injury impacts these functions, individuals may experience executive dysfunction. Some common symptoms include attention problems, lack of motivation or initiation, and impaired memory.

Disinhibition

Disinhibition refers to the loss of one’s impulse control, which can result in survivors saying and doing things they typically would not. This psychological effect of brain injury can often cause poor decision-making, risky behavior, impulsivity, and disregard for social subtleties. This can raise safety concerns for survivors and those around them.

Adynamia

Lack of motivation, or adynamia, is another potential psychological effect of brain injury. While survivors with adynamia may outwardly appear as lazy or depressed, they often are simply unable to execute the cognitive processes necessary for motivation. Symptoms of adynamia may include low activity, limited performance of self-care tasks, sleeping late into the day, loss of interest, or social isolation.

Confabulation

Confabulation involves the creation of false memories without the intent to deceive. One common source of these false memories is when the brain tries to fill in the “gaps” in one’s memory.  Individuals experiencing confabulation are not aware that their memories are false, which can make the condition difficult to discuss and address.

While this list of potential psychological effects of brain injury is not all-inclusive, it does demonstrate the wide range of psychological changes that may occur. Every brain injury is unique. Some individuals may demonstrate multiple psychological effects, some may have purely physical effects, while still others may develop delayed psychological changes as they continue to recover.

Methods to Cope with the Psychological Effects of Brain Injury

Although there is no perfect treatment or coping mechanism for addressing the psychological effects of brain injury, there are many resources that can help survivors identify symptoms and find proper treatment. Depending on the effect and its severity, treatments may vary from therapies and medications to more intensive methods like deep brain stimulation.

Professionals that specialize in the psychological effects of brain injury include clinical psychologists, neuropsychologists, neurologists, neuropsychiatrists, speech and language pathologists, occupational therapists, psychotherapists, and social workers. Survivors should consider asking their doctor to refer them to one or more of these specialists, depending on which would be most appropriate for their needs.

Here are some of the most common strategies for addressing the psychological effects of brain injury:

Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy is a type of talk therapy that focuses on helping survivors learn to recognize and change problematic emotions, behaviors, and thinking. The goal of CBT is to develop more effective ways to cope with psychological effects of brain injury

Cognitive-behavioral therapy is often used by psychotherapists, but can also be employed by other professionals, such as speech therapists, occupational therapists and social workers. Research has demonstrated that CBT can be an effective treatment for a range of psychological effects of brain injury, including depression, anxiety, anosognosia, and paranoia.

Speech Therapy

Pursuing speech therapy can help survivors improve conditions such as executive dysfunction, alexithymia, confabulation, perseveration and other psychological effects that may impact cognition and/or social interactions. Speech and language pathologists can provide cognitive rehabilitation, which may include exercises and activities focused on improving attention, memory, and other cognitive functions.

They may also provide social skills training to help survivors communicate and interact more effectively. While this may involve practicing specific social skills, survivors may also be educated on compensatory techniques, such as meeting with smaller groups of people or using stress relief strategies before engaging with others in a non-familiar environment.

Management Techniques and Coping Strategies

Many survivors benefit from learning appropriate management techniques and coping strategies for the psychological effects of brain injury. This may include:

• Anger management strategies: to address aggressiveness and agitation
• Stress management techniques: effective for reducing anxiety, confabulation, perseveration, and emotional lability
• Coping strategies: to promote overall psychological wellness
• Mindfulness: practice of focusing on being present in the moment

General coping strategies may vary by person and circumstance. However, many find taking time for self-care, going for a walk, or listening to music can help improve their sense of wellbeing. Participating in a brain injury support group may also be an excellent way to learn management techniques and coping strategies from others in similar situations.

Pharmacological Interventions

Doctors may prescribe medications to assist with managing the psychological effects of brain injury. While non-pharmacological interventions are often preferred, medications can be used in conjunction with other therapies or as a stand-alone treatment if others are ineffective. The specific types of medications used vary depending on the individual’s needs.

New and Experimental Techniques

Researchers are consistently looking for new treatments to resolve the psychological effects of brain injury. One treatment that has shown great promise is brain stimulation. This treatment may be invasive or non-invasive, and involves using electrodes to stimulate specific areas of the brain to manage conditions such as depression and anxiety. Stem cell therapies are also being studied to help aid in recovery following brain injury.

The treatment options to address the psychological effects of brain injury are numerous. Discussing specific conditions and concerns with one’s medical team is the best way to determine which treatments may be most effective.

Overcoming Psychological Effects of Brain Injury

Survivors may experience a variety of psychological effects after brain injury, especially if the frontal lobe has been affected. The frontal lobe is one of the main areas of the brain that contributes to cognitive processes and personality. When this area of the brain has sustained an injury, it can cause multiple psychological effects such as emotional lability and anosognosia, or lack of insight. 

A number of treatments, such as cognitive-behavioral therapy, speech therapy, management techniques, and pharmacological interventions can help survivors address the psychological effects of brain injury. New treatments are also consistently being researched, with some showing great promise for advancing the field of brain injury recovery.

Working closely with one’s medical team is imperative for optimal improvements. By pursuing recovery, many survivors can overcome the psychological effects of brain injury and return to their daily activities.