Section XIX: Mild Traumatic Brain Injury

Adapting to a Brain Injury

Goals of the Exercise

1. Identify common symptoms of mild traumatic brain injury.

2. Reduce behavioral symptoms of mild traumatic brain injury.

3. Decrease memory, attention, and concentration deficits through adaptive strategies.

4. Reduce the level of daily distress caused by mild traumatic brain injury.

Additional Problems for which this Exercise may be Useful

Suggestions for Processing this Exercise with Veterans/Service Members

The “Adapting to a Brain Injury” exercise allows the veterans/service members to identify common symptoms resulting from mild traumatic brain injury (MTBI), and then to find ways to compensate for those symptoms for however long they last. This is important, given that many of the symptoms of MTBI are vague and overlap with many psychiatric conditions. In addition to assisting the clinician with treatment recom-mendations, it can also alleviate much of the veteran's/service member's anxiety and confusion about the diagnosis. This exercise also provides assistance to the veteran/ service member in coping with two of the more common and concerning symptoms of MTBI, memory and attention/concentration problems. Follow-up for this exercise could include reporting back to the therapist/therapy group on actions related to this assignment and their outcomes, as well as bibliotherapy using books suggested in Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner and/or videotherapy using films on the topic of “Chronic Illness and Disabilities” recommended in Rent Two Films and Let's Talk in the Morning, 2nd ed., by John W. Hesley and Jan G. Hesley, also published by John Wiley & Sons.

EXERCISE XIX.A Adapting to a Brain Injury

Mild traumatic brain injury (MTBI), or what is sometimes called a concussion, is a relatively common occurrence in the general population with slightly higher rates in military personnel. This exercise will help you identify some of the more common symptoms of MTBI. It will also teach you a few strategies on how to lessen the impact of two of the more common symptoms of MTBI, memory and attention/concentration problems. It is important to keep in mind that for most people the symptoms of MTBI generally disappear three to six months after the injury, with very few people having symptoms one year after the injury.

1. Please circle any of these different symptoms of mild traumatic brain injury that you are currently experiencing.

•Fatigue •Headaches •Blurred vision •Memory loss •Poor attention and concentration
•Sleep problems •Dizziness •Lack of coordination •Irritability •Easily angered •Anxiety
•Sadness •Seizures •Nausea •Changes in smells •Slowed thinking •Getting lost or confused
•Sensitivity to light and sounds •Loss of initiative •Work and/or relationship problems

2. Using the format below, develop a set of daily to-do lists, one for each day of the week, to help you remember the important things you need to get done on that day.

Day of the week: _____
Activity/Task #1 Time to be completed Outcome
_____ _____ _____
Activity/Task #2 Time to be completed Outcome
_____ _____ _____
Activity/Task #3 Time to be completed Outcome
_____ _____ _____
Activity/Task #4 Time to be completed Outcome
_____ _____ _____
Activity/Task #5 Time to be completed Outcome
_____ _____ _____

3. Please list three activities that have become difficult for you since your injury due to lapses in attention and concentration. Once you've done that, break the desired time you wish to spend engaging in these activities into 15-minute segments. For example, if you need to spend an hour reading a book or manual for an upcoming exam, break the reading assignment into four 15-minute segments, and check off each 15-minute segment once you finish it. In between, try switching to different activities or just taking a few minutes to relax; you may need to set a time to return to that activity or another one. It helps to have an inexpensive sports-type wristwatch with an alarm you can set.

#1:

Activity _____

Amount of time to spend in activity

_____ minutes _____ hours

15-minute segments

_____ (15 minutes) _____ (15 minutes) _____ (15 minutes) _____ (15 minutes)

_____ (15 minutes) _____ (15 minutes) _____ (15 minutes) _____ (15 minutes)

#2:

Activity _____

Amount of time to spend in activity

_____ minutes _____ hours

15-minute segments

_____ (15 minutes) _____ (15 minutes) _____ (15 minutes) _____ (15 minutes)

_____ (15 minutes) _____ (15 minutes) _____ (15 minutes) _____ (15 minutes)

#3:

Activity _____

Amount of time to spend in activity

_____ minutes _____ hours

15-minute segments

_____ (15 minutes) _____ (15 minutes) _____ (15 minutes) _____ (15 minutes)

_____ (15 minutes) _____ (15 minutes) _____ (15 minutes) _____ (15 minutes)

Be sure to bring this handout back to each session with your therapist and discuss with him or her about which parts of this exercise have worked the best for you and which parts haven't worked, and also about any other coping methods you've started using to adapt to your injury.

Helping My Family and Friends Help Me

Goals of the Exercise

1. Decrease memory, attention, and concentration deficits through adaptive strategies.

2. Reduce the level of daily distress caused by mild traumatic brain injury.

3. Reduce behavioral symptoms of mild traumatic brain injury.

4. Attend and participate in a family session.

Additional Problems for which this Exercise may be Useful

Suggestions for Processing this Exercise with Veterans/Service Members

The “Helping My Family and Friends Help Me” exercise seeks to enlist the aid of the family and friends of a veteran/service member who has suffered a mild traumatic brain injury (MTBI) in routines designed to help him/her with activities of daily living and any recuperative/therapeutic activities in progress. The first step is brainstorming with the veteran/service member to think of ways that people close to him/her could provide this kind of help. Then plan a family/group counseling session with them to explain the effects of the MTBI and how they can help. Finally, ask them for that help. Alternately, depending on the insight of the veteran/service member about the approach most likely to be effective, this type of conversation can take place with each of the people involved one at a time—either one-on-one with the veteran/service member or jointly with the therapist. Follow-up for this exercise could include reporting back to the therapist/ therapy group on actions related to this assignment and their outcomes, as well as bibliotherapy using books suggested in Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner and/or videotherapy using films on the topic of “Chronic Illness and Disabilities” recommended in Rent Two Films and Let's Talk in the Morning, 2nd ed., by John W. Hesley and Jan G. Hesley, also published by John Wiley & Sons.

EXERCISE XIX.B Helping My Family and Friends Help Me

A mild traumatic brain injury (MTBI), also called a concussion, can cause some problems in general functioning in any of our lives. However, we don't have to try to solve these problems alone. This exercise will guide you in finding ways that other people in your life can help you adapt, and then planning how you can ask them for that help.

It is important to keep in mind that for most people the symptoms of MTBI generally disappear three to six months after the injury with very few people having symptoms one year later. So part of the information to present to family members and friends is that you are unlikely to need whatever assistance you're asking them to give you for very long.

You may be uncomfortable with this idea because you're determined to handle this yourself, or because it's hard for you to ask people for things in general. It's good to have the drive to take charge of your life situation—it will help you along the way—but there's nothing wrong with letting other people give you a hand, either. Think of it this way: If you could help them in a similar way and they needed that help for a while, would you want them to let you know, and would you want to help them out? The answer is probably yes, and they probably feel the same way about you. Think of it as another way to put the Golden Rule into action and treat others in the same way you want them to treat you.

1. If you've already gone through the exercise titled “Adapting to a Brain Injury,” you've identified symptoms of your MTBI that you've been experiencing. If you haven't done that exercise, you can make a list now as the first step in this exercise. Please circle any of the following symptoms you're experiencing, and check off the areas where they affect your life:

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2. Now that you've captured that information, please think of the people around you who could help you—maybe by calling you and reminding you of something or giving you some encouragement—in each of the activities or parts of your lives in which you're affected, and how they could help you with the problems affecting you in that part of your life.

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3. Step three is to carry out this plan and keep talking with your therapist about how it's working. Keep this up for however long it takes for these symptoms to improve to the point where you no longer need these people's assistance.

Be sure to bring this handout back to each session with your therapist and discuss with him or her about how it's working out and any areas you want to change or improve.