Psychology Is Essential In Treating Concussion.

I've had my fair share of knocks to the noggin. Almost a year ago my skateboard and I / my face encountered the berm of a pump track at pace, giving myself one of the worst concussions to date. 

The symptoms lingered for 2-3 months - I couldn’t drive, work long hours, I was nauseous a lot of the time with stabbing headaches throughout the day. I was extremely anxious, teary, dizzy, vacant and moody. Somedays I found myself in a panic wondering if I was going to feel like that forever… seriously questioning if I had quite literally deep fried my brain.

I received incredible treatment from the concussion physio, which was essential to my recovery, but only to a point.

Physically, I was doing all of the right stuff, but mentally, I was lacking.

Through my research as part of my thesis literature review, I came across mindfulness and acceptance based interventions (ACT & MAC), further discovering how these approaches not only aid performance and mental health, but also concussion rehabilitation.

As I delved deeper, and I came to understand that my relationship with my concussion symptoms was hindering my recovery.

A headache would come on and I would tense up, try to control it, attach to my ‘I’m concussed story’ and associate pain with going backwards and ‘doing it wrong’. Not only did I become more anxious, insecure, and generally upset, but my physical symptoms became worse and longer-lasting.

So I asked the question - what is actually going on in my head and what do these symptoms mean?

I learnt that headaches (to an extent) were a sign of my brain healing. Not frying.

Like rehabbing a knee, it’s going to get sore sometimes, that’s how you strengthen it. The same applies with the brain (same-same but different).

So having a sore head wasn’t always a bad thing; been uncomfortable was actually okay. 

But how do I become okay with this inevitable discomfort on the way towards feeling ‘better’?

I added mental skills to my treatment plan.

I practiced a willingness to experience any and all internal experiences without attaching to whatever came up. This was game changing. A headache that would last for hours would last for minutes. Feelings of worry would remain feelings of worry rather than leading to anxiety and the shit storm that went hand-in-hand with that level of suffering.

I came to understand the difference between what was, and what my mind was telling me 'was'.

Consequently, I wasn't overly identifying with, or acting upon unhelpful thoughts.

I started to act from what mattered and what would serve me in that moment, rather than been driven by my emotions.

I was able to make choices each day to not ‘pathologise’ or fear my symptoms, but to be kind, patient, accepting, and to confront (within my means) rather than avoid triggering situations.

Essentially, I found (through committed practice) comfort in discomfort to heal my brain, and I started to fully recover.

But then there was the question of how are other people healing from concussions? Are they taught evidence-based mental skills to help them deal with the difficult thoughts and emotions that go hand in hand with a concussion? The answer is, probably not.

When treatment is so focused on physical components of recovery, there is little room for a person’s psychology. 

Yet it’s the BRAIN - our feelings, thoughts and associated behaviours matter.

The psychology of concussion rehabilitation matters. 

It matters so much so that I almost changed the topic of my thesis from researching ‘stressed’ high performance athletes, to researching concussed high performance athletes in order to see how acceptance-based approaches helped speed up their recovery. 

For various reasons, I stuck to my initial proposal but there have been some interesting studies to surface.

First, researchers are discovering the importance of concussion psycho-education; that is, teaching patients the underlying mechanisms of their concussion while helping them to understand more about their experience.

For example, a clinical randomised control trial found that the most effective treatment for mild traumatic brain injury (mTBI) was psychoeducation, which worked to reduce  long-term post-traumatic symptoms whereby helping patients understand their situation made for less negative perceptions of their mTBI and improved recovery (Caplain et al., 2019). 

Second, there is evidence to suggest that psychological interventions are a very necessary part of concussion treatment (Bedard et al., 2003; Bay et al., 2018; Krzeczkowski et al., 2017; Azulay et al., 2013)

…and there are more clinical trials underway.

If you’re in that place right now,  struggling with lingering symptoms of a concussion, please reach out.

Lingering symptoms that manifest into psychological suffering can seriously suck, but there is a way forward.

So while if your patience is wearing thin, reach out and find out how developing the appropriate mental skillset and therapy can assist you during your healing process.

References

Azulay, J., Smart, C. M., Mott, T., & Cicerone, K. D. (2013). A pilot study examining the effect of mindfulness-based stress reduction on symptoms of chronic mild traumatic brain injury/postconcussive syndrome. The Journal of head trauma rehabilitation, 28(4), 323-331.

Bay, E., & Chan, R. R. (2018). Mindfulness-based versus health promotion group therapy after traumatic brain injury. Journal of psychosocial nursing and mental health services, 57(1), 26-33.

Bedard, M., Felteau, M., Mazmanian, D., Fedyk, K., Klein, R., Richardson, J., ... & Minthorn-Biggs, M. B. (2003). Pilot evaluation of a mindfulness-based intervention to improve quality of life among individuals who sustained traumatic brain injuries. Disability and Rehabilitation, 25(13), 722-731.

Caplain, S., Chenuc, G., Blancho, S., Marque, S., & Aghakhani, N. (2019). Efficacy of psychoeducation and cognitive rehabilitation after mild traumatic brain injury for preventing post-concussional syndrome in individuals with high risk of poor prognosis: a randomized clinical trial. Frontiers in neurology, 10.

Krzeczkowski, J. E., Robb, S. A., & Good, D. E. (2017). Trait mindfulness is associated with lower post-injury psychological symptoms following a mild head injury. Mindfulness, 8(6), 1594-1602.