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
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.
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.
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.
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.
Actively making changes to counteract or reduce the level of
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
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
- Selecting a favourite peaceful place which is real or
- 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
- 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.