TBI and PTSD: Navigating the Perfect Storm | BrainLine
Nov 7, Often though, the connection is not made between the TBI and the symptoms. A common diagnostic error is to confuse the symptoms of TBI with. Jun 8, mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD). . attempted to differentiate symptom patterns between PTSD and mTBI have not had Relationship of screen-based symptoms for mild traumatic. It is possible that MTBI enhances risk for PTSD the association between TBI and PTSD is complex, Although this study found an inverse relationship between the length of post-traumatic.
Read More As a result of the wars in Iraq and Afghanistan, there is a tendency to think of traumatic brain injuries being suffered by soldiers exposed to blasts in Iraq and Afghanistan. There is no question that, due to the nature of these two wars and the role played by roadside bombs and suicide bombers, our soldiers are suffering TBIs in numbers equalled by many other wars. However, it is also true that civilians at home in the United States also suffer from TBIs caused by a diverse number of accidents.
What is Traumatic Brain Injury? Traumatic brain injury TBI is precisely what it says it is. As a result of a trauma, the brain is injured. This injury can be caused either by something penetrating the skull and harming the brain or from any type of blunt force trauma that causes the skull to hit something hard, causing the brain to hit up against the skull. TBI can be mild, moderate or severe in nature. The odd thing is that those people suffering moderate to severe types of injuries have a better chance of full recovery than those with mild injuries.
But the rate of PTSD after brain injury is much higher in veterans than civilians due to their multiple and prolonged exposure to combat.
Unwanted and repeated memories of the life-threatening event Flashbacks where the event is relived and person temporarily loses touch with reality Avoidance of people, places, sights, or sounds that are reminders Feelings of detachment from people, even family, and emotional numbness Shame about what happened and was done Survivor guilt with loss of friends or comrades Hypervigilance or constant alertness for threats.
Individuals with PTSD are at increased risk for depression, physical injuries, substance abuse, and sleep problems, which in turn can affect thoughts and actions. These risk factors also occur with brain injury. PTSD is a mental disorder, but the associated stress can cause physical damage.
TBI is a neurological disorder caused by trauma to the brain. It can cause a wide range of impairments and changes in physical abilities, thinking and learning, vision, hearing, smell, taste, social skills, behaviors, and communication. The brain is so complex, the possible effects of a traumatic injury are extensive and different for each person. Changes in cognition such as memory and concentration, depression, anxiety, insomnia, and fatigue are common with both diagnoses.
A period of amnesia for what went on just before retrograde amnesia or after anterograde amnesia the injury occurred is common. The length of time minutes, hours, days, or weeks of amnesia is an indicator of the severity of the brain injury. For example, the person may have no memory of what happened just before or after the car crash or IED explosion.
In contrast, the person with PTSD is plagued and often haunted by unwanted and continuing intrusive thoughts and memories of what happened.
The memories keep coming at any time of day or night in such excruciating detail that the person relives the trauma over and over again. Sleep disorders are very common after brain injury. Whether it is trouble falling asleep, staying asleep, or waking early, normal sleep patterns are disrupted, making it hard to get the restorative rest of sleep so badly needed.
The mental state of hypervigilance interferes with slowing the body and mind down for sleep. Waking up with night sweats so drenching that sheets and clothing are soaked. Flashbacks so powerful that bed partners have been struck or strangled while sleep battles waged. Many survivors of TBI recall the early support and visits of friends, relatives, and coworkers who gradually visited or called less often over time.
Loss of friends and coworkers leads to social isolation, one of the most common long-term consequences of TBI. The isolation with PTSD is different as it is self-imposed. For many it is simply too hard to interact with people. The feeling of exposure outside the safe confines of the house is simply too great. The person may avoid leaving the house as a way of containing stimuli and limiting exposure to possible triggers of memories. The person may unexpectedly burst into tears or laughter for no apparent reason.
This response may exacerbate the PTSD reaction, as well as promote continued hypervigilence to sensations and subsecpent maladaptive appraisals that these reactions arc indicative of permanent brain injury. This pattern was reflected in the aftermath of the Gulf War, when there were widespread concern of chemical weapons, which apparently contributed to medically unexplained symptoms that were linked to concerns about somatic sensations purportedly linked to chemical agents.
There are potential similarities between Gulf War Syndrome and the manner in which MTBI is currently being understood; both comprise general sensations that are commonly reported in stress responses, and both mistakenly attributed to common stress reactions.
This can be problematic because it can reduce people's optimism or expectancy for recovery. Implications for treatment This review has several implications for how symptoms following TBI are addressed in treatment.
In terms of treating the symptoms of PCS, current evidence suggests that simple neuropsychological education is modestly useful in reducing symptoms of PCS. That is, by reducing the arousal-inducing symptoms of PTSD, it is possible that many of the symptoms associated with PCS will be alleviated.
Similarly, by minimizing catastrophic appraisals that exaggerate the severity or adversity of PCS sensations it is probable that anxiety about these reactions would be eased.
For example, patients who are overly concerned about the adverse outcomes of dizziness or sensitivity to light can be taught to normalize these reactions in ways that minimize distress about these sensations.
Post-Traumatic Stress Disorder: Relationship to Traumatic Brain Injury and Approach to Treatment.
Cognitively reframing the perception of these reactions is akin to established treatments for panic disorder or health anxiety, in which patients are taught to tolerate somatic experiences in ways that discourage inferences involving an adverse outcome.
Although this approach has been proven to be very effective in treating panic disorder and health anxiety, it has yet to be tested with PCS. In terms of treating symptoms of PTSD, prevailing cognitive models posit that recovery from a traumatic experience involves integrating the trauma memory into one's autobiographical memory base in a way that allows a coherent narrative of the experience in which the person can contextualize the experience and consequently currently feel safe.
Fragmented memories of the traumatic experience can also occur in the context of TBI because of the impaired consciousness secondary to the injury. As noted above, TBI patients can reconstruct aspects of the traumatic experience that were not adequately encoded during the period of impaired consciousness. This scenario raises the possibility that treating PTSD after TBI will require adaptive reconstruction of this narrative in a way that facilitates adaptation rather than retraumatization.
For example, a patient who reconstructs their memory of a car accident in which they were excessively responsible for someone's death will have marked depressive responses relative to a patient who reconstructs the memory in a way that accepts a more reasonable level of responsibility.
Alternately, a patient can be encouraged to tolerate a level of uncertainty insofar as there is permanent amnesia of some aspect of the event; inability to tolerate uncertainty is linked to enhanced anxiety and worry. The extent to which a person with TBI needs to reconstruct the trauma narrative to recover from PTSD has yet to be empirically determined.
In the context of therapy, presenting memories or reminders of the trauma to the patient in the safety of therapy typically leads to symptom reduction.
Exposure can either be imaginai, which involves focusing on one's memories of the traumatic event, or in vivo, in which approaches and remains with reminders that usually trigger anxiety about the event.
Post-Traumatic Stress Disorder: Relationship to Traumatic Brain Injury and Approach to Treatment
On the premise that fear conditioning and extinction still occurs in the context of TBI, it would seem that that exposure-based therapy is the indicated intervention for PTSD following TBI. It may not be as useful to patients with more severe TBI because they are largely amnesic of their trauma. As noted above, some severe TBI patients can have nightmares or intrusive memories on the basis of reconstructions of their trauma; in these cases, imaginable exposure to those mental representations that are causing anxiety.
A survivor of a motor vehicle accident who sustained a severe TBI may experience marked fear when watching film footage of traffic; in such a case, the patient could complete exposure by repeatedly watching traffic footage. Through these techniques it would be hoped that extinction learning can be achieved, even though the patient may never retrieve direct memories of the traumatic event.
Increasing evidence indicates that many previously termed PCS responses are a function of psychological responses, and it hampers a patient's recovery if they mistakenly perceive these reactions as indicators of a brain injury that may be permanent. The likelihood that the presumed secpelae of MTBI are actually attributed to psychological responses to the traumatic experience is becoming more apparent.
Accurate identification of the true nature and cause of the symptoms experienced after TBI is important because if stress-related disturbances are mistakenly attributed to neurological factors, patients may be deprived of effective treatments that can, in most cases, alleviate the symptoms. As we learn more about the interaction of TBI and PTSD, it seems that we will be discovering much about how the brain responds to traumatic experiences, both in cases when there has and has not been a TBI.
Understanding this interaction between neurological insult and psychological response has the potential to shed light on the key mechanisms underpinning trauma response generally, and how it is impacted by different levels of brain injury. American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury.
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