Stress is a common factor of life, affecting almost everyone at some point in their lives. For traumatic brain injury survivors, however, stress can look and feel very differently.

What is Stress? 

Stress is defined as “a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances” (Oxford Languages). Stress can be any change that results in physical, emotional, or psychological strain and is the body’s response to anything that requires attention or action (Scott, 2020). Stress helps the body adjust to new situations, keeping us alert, positive, motivated, and prepared to circumvent danger (Cleveland Clinic, 2021). 

During a stressful situation, the autonomic nervous system, the system within our body that controls our heart rate, breathing, vision change, and more, invokes a “fight-or-flight” response, which helps the body utilize its built-in stress response and face stressful situations (Cleveland Clinic, 2021). The brain, in concert with the body’s systems, orchestrates the response to stress, the goal being to reduce uncertainty and ensure existence. This adaptive response to stress is called ‘allostasis.’ A brain injury increases the likelihood of chronic allostatic overload, or chronic stress, in some patients, making them more prone to a variety of stress-related physical ailments, including chronic pain and posttraumatic stress syndrome,” explains Gary Goldberg, BASc, MD, doctor of Physical Medical and Rehabilitation at the Medical College of Virginia (ISO Press, 2020). The fight or flight response is imperative for survival. Still, if it happens too often, there can be adverse outcomes such as reduced protection from disease and infection, tooth and gum infections, ulcers, hair loss, heart, liver, and kidney conditions, and psychological disorders (Scott, 2020; Brain Injury Association of Queensland, Australia, 2014). 

Consequences of Stress

Chronic stress can cause negative symptoms such as:

  • Aches and pains
  • Chest pain 
  • Trembling
  • Grinding teeth
  • Racing heart
  • Diarrhea
  • Exhaustion or trouble sleeping
  • Headaches, dizziness, or shaking
  • High blood pressure 
  • Muscle tension, especially in the neck and shoulder, or jaw clenching
  • Stomach or digestive problems
  • Sexual dysfunction
  • Weak immune system (Scott, 2020; Cleveland Clinic, 2021).

Stress can lead to adverse mental and emotional conditions such as anxiety, irritability, depression, panic attacks, and sadness. To cope with chronic stress, people may adopt:

  • Drinking too much or too often
  • Gambling addictions
  • Overeating or developing an eating disorder
  • Compulsive decision making
  • Smoking
  • Using drugs (Cleveland Clinic, 2021).

Stress and Brain Injury

After a brain injury, the ability to cope with stress can become extremely limited (Brain Injury Association of Queensland, Australia, 2014). Dealing with stress requires multiple cognitive functions such as recognizing the symptoms, identifying causes, developing strategies for coping, maintaining control of emotions, and remembering these techniques when needed (Brain Injury Association of Queensland, Australia, 2014). An impact to the brain can hinder the ability to sustain and utilize these strategies, ultimately leading to decreased capability to cope, negatively affecting interpersonal relationships. People without brain injuries may think that the person with a brain injury is overemotional, uncontrollable, or immature (Brain Injury Association of Queensland, Australia, 2014). In reality, people with brain injuries can often handle stress (conversation, noise, workload, etc.) when light, but after reaching a threshold, the ability to cope becomes non-existent, and the person becomes stressed (Brain Injury Association of Queensland, Australia, 2014).

A study conducted by Amanda McIntyre, Ph.D., RN at St. Joseph’s Health Care in London, Ontario, Canada, found that acquired brain injury survivors with increased anxiety sensitivity and experiential avoidance of coping mechanisms experienced a more depressed mood and reduced quality of life compared to individuals who reported substantially less anxiety sensitivity and experiential avoidance (ISO Press, 2020). This finding illustrates the importance of developing and utilizing positive coping strategies for brain injury survivors.

Ways to Understand and Manage Stressors:

    1. Identify the Major Sources of Stress and Track Stress: Knowing what stresses you can profoundly affect how you respond to that stress. Many experts suggest keeping a stress awareness diary where you list the date, time, event, severity, symptoms, and coping strategy used during the stressful event (Brain Injury Association of Queensland, Australia, 2014). This, however, can be daunting if you are using notebooks to track your stress. Power of Patients has the answer: track your stress triggers and symptoms using our Dashboard. The Power of Patients Dashboard allows brain injury survivors and caregivers to track symptoms daily, with the ability to rate the severity and add descriptions of the event and coping strategy used. This allows patients to understand what is happening to them and advocate for care for themselves.
    2. Categorize Stressors: Once stressors have been identified, label them as either “Controllable or Uncontrollable” and “Important or Unimportant.” This allows a person to remove themselves from the situation and see the bigger picture / more objectively (Brain Injury Association of Queensland, Australia, 2014). 
    3. Utilize Muscle Relaxation Techniques: Muscle relaxation methods force the person to identify the muscle groups and learn the difference between tension and relaxation in the muscles (Brain Injury Association of Queensland, Australia, 2014). The four main muscle groups are 1. Hands, forearms, and biceps, 2. Head, face, throat, and shoulders, 3. Chest, stomach, and lower back, and 4. Thighs, buttocks, calves, and feet. Tense the muscles in the chosen muscle group for 5-7 seconds, then relax for 10-15 seconds. This exercise can be done for 15 minutes a day. (Brain Injury Association of Queensland, Australia, 2014).
    4. Slow Breathing Techniques: Properly breathing can lower the feelings of stress. A person should breathe deeply through the nose, feeling movement in the stomach area than in the chest. This should be done every day to learn how to apply slow breathing to calm them down when stressed, angry, or anxious (Brain Injury Association of Queensland, Australia, 2014). 
    5. Utilize Pleasant Visualizations: Visualizations happen when a person uses variations of the imagination, e.g., pleasant daydreams or memories, to make themselves feel more relaxed (Brain Injury Association of Queensland, Australia, 2014). This can happen by 1. Getting comfortable and checking your body for tension, 2. Imagining a real or imagined peaceful place, 3. Focusing on all of the senses, and 4. Using reassuring affirmations. These can be done in everyday, stressful situations (Brain Injury Association of Queensland, Australia, 2014).
    6. Have Conversations: Talk with trusted family and friends or other brain injury survivors about how they cope: Talking with people who also have a brain injury and deal with stress may provide insight into new ways a person can handle stress. It can also provide a sense of community and outlet for the individual (West and Kreutzer, 2008).
    7. Take Care of the Physical Body: Utilize meditation, yoga, tai chi, and others that physically use the body and work to relax it. Eat nutritious foods, exercise, and focus on getting enough sleep. This allows the body to physically handle stress better (Cleveland Clinic, 2021).

This is not an exhaustive list – there are many other ways to deal with stress. See Brainline’s articles: Part 1 and Part 2.

Dr. Goldberg states, “What is required is an optimal integration of insights obtained through conventional functional neuroscience–for example, with respect to neuropsychopharmacology and the operation of functional brain networks–and insights obtained through a relational, whole-person perspective that recognizes and fully honors and engages the subjective being, personality, and social context of the person whose existential struggles we as healthcare professionals are obligated and entrusted to help mitigate” (ISO Press, 2020). It is essential for brain injury survivors to talk to practitioners about the stressors in their lives and ask for practical ways to manage them. Therapies such as cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) may help address symptoms of stress (Scott, 2020). It is imperative to seek care when overwhelmed, using addicting substances to cope, or thinking about harming oneself (Cleveland Clinic, 2021). 

How Power of Patients Can Help

Power of Patients understands that brain injury survivors not only deal with symptoms following their brain injuries but stressors within their homes, communities, and societies that compound these symptoms and worsen their physical and mental states. We endeavor to support and advocate for brain injury survivors and their caregivers. Sign up for our free symptom and trigger-tracking Dashboard at powerofpatients.com to get started on identifying your stress triggers and taking back control of your life today!

 

References:

Brain Injury Association of Queensland, Australia. (2014, October). Stress & Brain Injury. Retrieved April 5, 2021, from https://bianj.org/wp-content/uploads/2014/10/stressandbraininjury.pdf

Cleveland Clinic. (2021, January 28). Stress. Retrieved April 05, 2021, from https://my.clevelandclinic.org/health/articles/11874-stress

ISO Press. (2020, August 18). Stress Overload and Pain Common Among Patients with Traumatic Brain Injury. Retrieved April 05, 2021, from https://www.newswise.com/articles/stress-overload-and-pain-common-among-patients-with-traumatic-brain-injury

Scott, E., MS. (2020, August 03). What is Stress? Retrieved April 05, 2021, from https://www.verywellmind.com/stress-and-health-3145086

West, D., & Kreutzer, J. (2008, July 17). Managing Stress Effectively After TBI, Part I. Retrieved April 05, 2021, from https://www.brainline.org/article/managing-stress-effectively-after-tbi-part-i

 

Other Resources:

https://schurigcenter.org/information-resources/coping-with-stress/

https://www.brainline.org/article/coping-post-tbi-anxiety-stress

https://msktc.org/tbi/factsheets/emotional-problems-after-traumatic-brain-injury

https://www.headway.org.uk/about-brain-injury/individuals/brain-injury-and-me/10-top-tips-for-coping-with-stress-after-brain-injury/

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