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While stress is part of everyday life and a natural reaction when major change occurs, its impact can be much greater following brain injury.

Stress occurs in response to daily challenges; everything from traffic and noise to relationship problems or money worries. The ‘fight or flight’ response is driven by the sympathetic nervous system, triggering a series of chemical changes which prepare our bodies for a stressful event. For example, if you think you hear someone breaking into your house late at night, it’s likely your body will be mobilised into action – increased heart rate and blood pressure, sweating, dilated pupils and your senses greatly heightened.

While this response is useful in dangerous situations, if our ‘fight or flight’ response is triggered too often as a result of chronic stress, there can be negative effects, including reduced protection from disease and infection, hypertension, heart, liver and kidney conditions and psychological disorders.

Stress is much worse with a brain injury

Most people find it much harder to deal with stress after a traumatic brain injury or similar brain disorder. Coping with stress requires many different cognitive functions;

recognising the symptoms, identifying causes, formulating a coping strategy, maintaining control of emotions appropriately and then remembering these techniques.

A brain injury can dramatically affect each of these areas, resulting in a much-lowered ability to cope with

everyday stresses. For family members, this can be hard to understand and seem like whingeing, being over emotional or even being immature.

Understanding and managing stress

The first step to reducing stress is to become aware of the major sources that exist in your life. It can be useful to keep a stress awareness diary for a few weeks, listing the date, time, event, severity, symptoms and coping strategies used to ease the situation. The second step is to categorise different stressful situations as follows:

  • controllable – uncontrollable
  • important – unimportant

This can help a person stand back from their situation in order to view it more clearly and objectively.

There are also four key skills involved in managing stress: awareness, acceptance, coping and action. To better understand their roles, we can use the example of a person who is stressed because they have an appointment for a neuropsychological assessment.


Getting a clearer understanding of the situation and how it affects the person.

Example: finding out what a neuropsychological assessment involves and the purpose of the assessment.


Acknowledging the stress and well being realistic about how it affects a person’s lifestyle, with regard to those aspects that are controllable/uncontrollable or important/unimportant.

Example: recognising that the assessment needs to be conducted and that it will probably be quite tiring and demanding. The person may not be able to control when and how long the assessment is, but they can manage their thoughts and reactions to it.


Preparing to cope with stressful situations by learning various coping strategies. Identify what changes you might be able to make to control the situation and reduce stress levels.

Example: using self-talk to develop a constructive outlook towards the assessment.


Action skills are about actively making changes to counteract or reduce of stress.

Example: following through with the anxiety management plan and monitoring stress levels. After the assessment the person can find a relaxing and enjoyable activity to wind down.

There are some other coping strategies for managing stressful situations which include:

progressive muscle relaxation – tensing up and then relaxing particular muscles, in sequence, for a number of seconds at a time

slow breathing – by breathing slower and more deeply from your stomach, you send a signal to your nervous system to calm down

visualisation – using mental imagery – either of how you would like the situation to play out, or of a relaxing environment such as being in nature – to achieve a more relaxed state of mind.