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Stress, anxiety & brain injury

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Cognitive effects

Stress, anxiety & brain injury

Stress is part of everyday life and a natural reaction to change and adjustment with a major life change.


Stress also occurs in response to ongoing daily hassles such as traffic, noise or inconsiderate people. The body responds to stress with the 'flight or fight' response in the central and peripheral nervous system. This involves a series of chemical changes which prepare people for a stressful event.


Imagine the body's reaction to the sound of a loud siren late at night outside a person's home. During this stressful event the body becomes mobilised into action via the brain's messages. Changes may include increased heart rate and blood pressure, sweating, dilated pupils and extra sensitive senses such as hearing and vision.


While the 'flight or fight' response is vital for survival, if this occurs too often to the body as a result of chronic stress, there can be negative effects such as reduced protection from disease and infection, hypertension, heart, liver and kidney conditions and psychological disorders.


Stress is Much Worse with a Brain Injury

In the vast majority of cases people find it much harder to deal with stress after a traumatic brain injury or similar brain disorder. Coping with stress uses many different cognitive functions such as recognising the symptoms, identifying causes, formulating a coping strategy, maintaining control of emotions appropriately and remembering these techniques. A brain injury can dramatically affect each of these areas resulting in very little ability to cope with the normal stresses of everyday life. Family members can find this hard to realise and believe a person is simply whingeing, being overemotional or immature.


A brain injury has been likened to having a couple of lanes closed down on a six lane highway. While the traffic is light there is little disruption to the normal flow. But once the traffic reaches a critical point those closed down lanes suddenly result in traffic at a standstill backing up for kilometres. The same applies for a person with a brain disorder such as a traumatic brain injury - they can often handle a light load of stress, conversation, noise or workload, but at a critical point they can no longer cope and the stress sets in.


Understanding and Managing Stress

The first step a person can take to reduce stress is to become aware of the major sources of stress that exist in their life. The person may like to keep a stress awareness diary for a few weeks that lists the date, time, event, severity, symptoms, and coping strategies they used to ease the situation. The second step is to categorise different stressful situations as follows:




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


Four Skills for Managing

These are Awareness, Acceptance, Coping and Action skills. Some skills may be more useful in certain situations. Each skill may be explained better using a situation which people are often faced with after brain injury. To illustrate these skills, let us use the example of a person who is stressed because they have an appointment for a neuropsychological assessment.


Awareness skills

This is 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.


Acceptance skills

Acknowledging the stress and being realistic about how it affects a person's lifestyle e.g. what aspects are controllable/uncontrollable or important/unimportant.

Example: Recognise 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 the assessment.


Coping skills

Prepare to cope with the stressful situation by learning various strategies. Identify what changes a person can make to control the situation and reduce stress levels.

Example: Using Self-Talk to develop a constructive outlook towards the assessment.


Action skills

Actively making changes to counteract or reduce the level 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.


Some Coping Strategies for Managing Stressful Situations

Progressive muscle relaxation

A person learns to identify muscle groups and the difference between tension and relaxation in the muscles.


Focus upon 4 main muscle groups:

  • hands, forearms and biceps
  • head, face, throat and shoulders
  • chest, stomach and lower back
  • thighs, buttocks, calves and feet


Tense muscles for 5-7 seconds and relax for 10-15 seconds.
Time to master: 1-2 weeks, 2 x 15 minute sessions per day.


Slow breathing techniques

Proper breathing habits are essential for good mental and physical health. First, a person needs to focus upon their breathing pattern. They need to identify whether they breathe mainly through the chest or through their stomach. Short, shallow and rapid breaths from the upper chest should be avoided. The aim is to breathe deeply and slowly through the nose. A person should feel greater movement in the stomach than the chest as they inhale and exhale. Practice breathing exercises everyday.


Learn to apply slow breathing as needed e.g. when feeling stressed, angry or anxious.


A person uses imagination e.g. pleasant daydreams or memories to will him or herself into a relaxed state, by: 

  • Getting comfortable, scanning the body for tension and relaxing the muscles
  • Selecting a favourite peaceful place which is real or imagined
  • Focusing the imagination using all 5 senses
  • Using affirmations such as repeating 'I am letting go of tension'; or 'I am feeling peaceful'.


Practice using visualisation three times a day for a few minutes or longer. This is usually easiest for the person in the morning and at night in bed. Eventually, with practice a person can use visualisation in everyday situations when feeling uptight. The effectiveness of whatever strategies are used to manage stress will be improved if after each strategy is used, it is evaluated. This can be done by:

  • Noticing the physical, mental and behavioural signs of stress
  • Selecting a coping strategy for reducing stress
  • Evaluating whether or not the strategy worked by reassessing the level of severity
  • Maintaining the use of the strategy.


If there has been no change or an increase in stress levels, try using other strategies.



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