Stress, Anxiety and Brain Injuries
By Nicole Ritonja, Registered Psychotherapist (Qualifying)
Clinic Director
Brain injuries and concussions are one of the most common injuries worldwide. With increasing recent media attention, the awareness for these injuries has been growing exponentially. Often one of the most frequently reported symptoms following a head injury is difficulties with anxiety, depression, and stress. This post will highlight why anxiety, stress, and depression are common symptoms in individuals following a head injury and why it is important to manage these.
What happens when you have a brain injury or a concussion?
In order to understand this, we have to look at how the nervous system reacts to a head injury. After a head injury, your body can go into a state that is commonly referred to as “fight-or-flight” mode. When you enter into this state, your body releases the stress chemicals adrenalin and cortisol. These stress chemicals have the purpose of communicating to the brain that you are in danger and that action is required. Eventually, once you are safe again (i.e. after complete rest) this fight or flight mode is meant to “turn-off”, and thus the body is supposed to stop producing stress hormones. However, in people who develop long-standing symptoms, these stress chemicals often do not stop being produced and this “fight or flight” mode continues. This causes an issue for your body because these hormones are only meant to be activated for small periods of time in order to produce a physical response. When you continuously operate in “fight or flight” mode as a result of a brain injury, the brain is being told that it is still not safe. This means that your brain still views the injury as needing attention and continues to amplify the pain and symptoms. The continuous stress chemicals being released cause your nervous system to become highly sensitized, which also produces inflammation in the body. Your brain’s normal function is affected when inflammation and sensitivity are present and cause the symptoms of the injury to persist even if the brain tissue is actually healed.
The brain best healing process following a concussion, is when it is in a relaxed state. Rest essentially allows the brain to heal as it allows this inflammation to settle. Inflammation hinders the ability of the brain to repair its neural connections. The longer the brain is inflamed, the less likely it will be able to heal these neural connections.
It is well supported in the research that anxiety and stress also causes inflammation in the brain. When a person consistently is stressed out, this stress only causes the inflammation in the brain to persists or increase, thus usually making symptoms even worse. This means that a person is less likely to recover from their post-concussion symptoms if they are experiencing a great deal of stress and anxiety.
What can cause anxiety and stress?
There are many reasons why people experience increased anxiety and stress following a brain injury. When your body is releasing stress hormones, it causes you to be ‘on-edge’ because your brain is perceiving that there is a potential threat to your safety. This means that your brain is constantly looking for a threat and thus remains stressed. The mind begins to worry and perceive danger in events that would normally be unreasonable or unlikely to perceive as dangerous previously. Because a brain injury is such a traumatic injury to the body, the body is likely to continue to release these stress hormones until it feels like the body is “safe”. However, if a person’s cognitive thought processes continue this cycle of anxiety, the body may not think it is “safe” when it actually is. Until these stress hormones are turned off, the brain will not be able to properly recover from the brain injury.
If there is inflammation or if the neural pathways that controls emotions and behaviour have been affected during the injury process, this can also lead to emotional dysregulation, causing anxiety and stress, allowing for increased irritability, mood swings, decreased ability to control anger etc. Although a person may have had good control over their stress and anxiety pre-accident, the event may trigger excess responses and may be more difficult to manage post-injury.
As well, symptoms of brain injuries can be very debilitating. Cognitive symptoms can include cognitive fatigue, feelings of being overwhelmed, decreased concentration, memory problems, and sensory issues. Physical symptoms can include headaches, nausea, noise and/or light sensitivity, dizziness and much more. It is no surprise that dealing with a combination of these symptoms can cause anxiety and stress, especially when the brain is already in an overly taxed state. Completing simple tasks can now prove aggravating, overwhelming, and exhausting as it takes increased cognition to complete these tasks with these symptoms. It can cause a person to feel very stressed out and may increase anxiety about the potential of further similar tasks.
The prevalence of anxiety and these other brain injury symptoms is also likely to lead to depression. A person may become more isolated and inactive as going into the community may overwhelm them with stress and fear because it aggravates their symptoms. This can cause a person to feel hopeless, angry, and/or sad because they are living in a state with persistent debilitating symptoms and anxiety. Also, brain injuries are often considered a “hidden injury” because the effects and trauma of the injury aren’t as visible to people as those of a visible wound. People often feel as though society does not truly understand the extent of their disability because it is so hard to physically see.
What can you do to help your brain heal?
Full rest for the first 48 hours after concussion! No tv, phones, laptops, very few conversations, etc.
After the first 48 hours try and incorporate very gentle exercise into your day. Doctors recommend gentle yoga and gentle walks
Eat a protein heavy diet. Take Omega-3 supplements as well as a multi-vitamin if you are not already.
Make sure you get a full 8 hours of sleep! Use melatonin if you are having difficulty falling asleep. The brain heals when you sleep so a proper sleep pattern is very important! Sleep is an essential component to helping the brain heal. Sleep allows the brain to be in an optimal state to promote healing and recovery. Poor sleep also increases the production of stress hormones in the body as if the body is fatigued the brain needs these hormones to help keep the brain more alert and aware.
Get back to doing some of your regular activities as soon as possible. Continuing complete rest after the first 48 hours actually doesn’t help the brain heal because it does not allow the brain to return to its normal activities. Listen to your body and do things slowly. If your symptoms flair up significantly then take a break. It is ok to allow your symptoms to rise a little if they go back down easily after the task or activity you are doing.
Meditate! As the brain only heals when you are in a relaxed state, this is a great way to promote relaxation and recovery. There are a lot of guided meditation apps and YouTube videos.
Psychotherapy (including cognitive behavioural therapy) and neurofeedback are also great ways to teach emotional regulation skills to manage anxiety, depression, and stress symptoms
Craniosacral therapy can help to increase mobility in the cranial system as head injuries can often impact and restrict this mobility.
Neurosensorimotor physiotherapy can also help to assess for areas of dysfunction in the sensory systems that often are impacted after a head injury. Dysfunction in the sensory systems also keeps the brain in a “flight and fight” state if not addressed.
Overall, controlling stress and anxiety is extremely important when trying to encourage the brain to properly heal from a concussion or brain injury. Practicing proper self-care and self-compassion is truly critical for giving yourself the ability to cope with the difficulties of this injury.