CBT for Brain Injury

Written By CBTDenver

Unfortunately, many people experience brain injuries. Common causes of brain injury include falling and hitting your head or an accident, such as a car accident. It has been estimated that over two million people experience a traumatic brain injury (TBI) each year in the US. Like any type of injury, there is a range of severity following TBI from mild to severe. After a TBI, people can experience mood and behavior changes, such as feeling more angry, anxious, or depressed or acting more impulsively or aggressively.

What is CBT?

CBT is a type of therapy that focuses on the relationship between thoughts, feelings, and behaviors. Please see What is CBT? on the CBT Denver website for an overview of CBT. After a brain injury, a person may experience changes in their thinking or more rigid thinking. CBT can assist in identifying and challenging unhelpful or inaccurate thoughts that can arise, or intensify, after TBI. CBT also focuses on behavioral activation and engaging in activities that are meaningful and important, which can boost mood and decrease isolation or avoidance that may increase after TBI. CBT teaches practical coping skills for managing emotions, improving effective communication, and problem-solving which can be areas of concern for people with TBI.

This article provides an overview of CBT for brain injury.

Brain Injury and Mental Health

Following a brain injury, a person can experience

  • Depression

  • Anxiety

  • Flat affect or displaying little emotion

  • Mood swings

  • Impulsivity

  • Limited ability to think about another person’s experience/limited empathy

  • Difficulty in social situations

In some cases, a person may have experienced mental health symptoms before a brain injury, and the injury exacerbates symptoms, or mental health symptoms may arise for the first time after an injury.

Benefits of CBT for Brain Injury

  • Improved mood and emotional regulation: For example, reframing unhelpful thoughts that are associated with anxiety, anger, and depression, helps to decrease the intensity of emotions.

  • Enhanced coping skills: Exploring challenges associated with living with a TBI, and practicing coping skills to address challenges

  • Increased functioning: Coping skills and mood regulation can allow people with TBI to function more effectively and increase their sense of independence. Also, CBT can help a person more fully engage in other treatments, such as physical rehabilitation, which can help support functioning.

  • Empowerment: CBT can empower people to take an active role in their lives and recovery from TBI, fostering hope and a sense of optimism

For example, a person thinks they cannot complete their physical therapy exercises and feels frustrated and angry when doing exercises, and then they stop doing their exercises, which may increase their frustration as they may feel more incapable. CBT can help this person identify that they may be thinking in an all-or-nothing manner, telling themselves that they cannot do their exercises if they experience any difficulty. By challenging and reframing the thought – “I can’t do everything in the same way I used to, and I can still do exercises in a modified way” -  they feel less frustrated, are more engaged in treatment, and ultimately feel more capable and have improved functioning.

CBT Techniques Following Brain Injury

  • Cognitive reappraisal: Reappraising/reframing an unhelpful thought as described above

  • Behavioral activation: For example, scheduling enjoyable activities as part of a person’s weekly routine

  • Successive approximation: Breaking larger goals into smaller pieces to enhance motivation and confidence and working toward larger goals by focusing on gradual, smaller goals

Please keep in mind that CBT following brain injury may have limited effectiveness if a person is experiencing severe cognitive impairment.

To learn more about CBT for brain injury, please contact us at CBT Denver.

CBTDenver
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