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Concussion/Traumatic Brain Injury & CBT

What is Traumatic Brain Injury?

Traumatic Brain Injury (TBI) refers to insult to the brain that causes impairment. Common causes of TBI are the result of a blow to the head, stroke, brain tumor, infection, lack of oxygen (hypoxia), and/or toxic chemicals. TBI is a major cause of death and disability in the US and a significant public health concern as1.7 million people sustain a TBI in a given year.  Depending on the severity of the injury, symptoms may remit after a short period of time or may cause life- long disability. Injury to the brain impacts personality, cognition and behavior. Although the majority of TBIs are classified as concussions or mild TBIs, as many as 10% of those who have TBI experience complex symptoms that last from months to years. 

What are common symptoms following a TBI/Concussion?

Common symptoms after a TBI fall under several categories: physical, cognitive, emotional, and behavioral.  

·         Physical: chronic pain, migraines, sleep disturbance, changes in appetite and sexual functioning, impaired movement, sensation, and dizziness

·         Cognitive: confusion, difficulty with attention/concentration, problems with organization and planning, memory impairment, communication difficulties, trouble with reasoning, problem-solving, decision-making, and judgment

·         Emotional: psychiatric disorders (depression, anxiety, adjustment, post traumatic stress disorder), personality changes, irritability, apathy, emotion dysregulation, and rumination

·         Behavioral: verbal/physical outburst, impulse control, apathy, rigidity, lack of initiation, and engaging in risky behavior

Psychologists are specially trained to help individuals and families cope with many of these complex changes.

How can CBT help?

Extensive research has found Cognitive Behavioral Therapy (CBT) to be a highly efficacious treatment for:

Mood disorders 

Large numbers of people with a brain injury have clinically significant mood disorders following their injury.  Comorbid mood disturbances are a major contributing factor of impaired function and symptom exacerbation. 

·         Common presenting problems:

o   Depression

o   Anxiety

o   Post Traumatic Stress Disorder

o   Rumination

o   Emotion Dysregulation

o   Adjustment post injury  


·         Treatment strategies include:

o   Education to better understand the impact of injury

o   Self-monitoring

o   Behavioral experiments

o   Cognitive restructuring

o   Emotion regulation

o   Problem solving techniques

Behavioral changes

Following a brain injury, individuals often exhibit behavioral changes.  Damage to the frontal lobe, which is responsible for self-monitoring, initiating, adapting and other aspects of personality, can cause the individual secondary distress lead to an increased risk of physical harm.  CBT offers a framework for examining how actions impact feelings and thoughts and it provides techniques to delay impulsive actions, evaluate alternative behaviors and predict potential outcomes.

·         Common presenting problems:

o   Anger outbursts

o   Apathy

o   Impulsivity

o   Disinhibition

o   Lack of initiation

o   Hyperactivity

o   Impaired social skills


·         Treatment strategies include:

o   Anger management

o   Relaxation training

o   Behavioral activation

o   Compensatory strategies

o   Cognitive restructuring

o   Social skills training

Physical symptoms 

The psychological approach to reducing and/or better tolerating pain as well as reducing physical symptoms secondary to a TBI aim to increase self-management, facilitate positive behavioral change and address cognitive factors that contribute to its maintenance. 

·         Common presenting problems:

o   Chronic pain

o   Migraines

o   Sexual dysfunction

o   Sleep disturbance

o   Changes in eating


·         Treatment strategies include:

o   Mindfulness training

o   Identifying triggers

o   Medication adherence

o   Improving sleep hygiene

o   Stress management

o   Graded activation

o   Pain management

What do I need to do?

If you would like further information about cognitive-behavioral treatment for a concussion or traumatic brain injury, or if you would like to schedule an appointment, please call the American Institute for Cognitive Therapy at 212-308-2440. 

Dr. Heather Glubo heads up our treatment team.