Behavior Therapy and Cognitive Behavior Therapy are types of treatment that are based firmly on research findings. These approaches aid people in achieving specific changes or goals.
Changes or goals might involve:
A way of acting: like smoking less or being more outgoing;
A way of feeling: like helping a person to be less scared, less depressed, or less anxious;
A way of thinking: like learning to problem-solve or get rid of self-defeating thoughts;
A way of dealing with physical or medical problems: like lessening back pain or helping a person stick to a doctor’s suggestions.
Behavior Therapists and Cognitive Behavior Therapists usually focus more on the current situation and its solution, rather than the past.
They concentrate on a person’s views and beliefs about their life, not on personality traits.
Behavior Therapists and Cognitive Behavior Therapists treat individuals, parents, children, couples, and families.
Replacing ways of living that do not work well with ways of living that work, and giving people more control over their lives, are common goals of behavior and cognitive behavior therapy.
HOW TO GET HELP:
If you are looking for help, either for yourself or someone else, you may be tempted to call someone who advertises in a local publication or who comes up from a search of the Internet.
You may, or may not, find a competent therapist in this manner.
It is wise to check on the credentials of a psychotherapist.
It is expected that competent therapists hold advanced academic degrees.
They should be listed as members of professional organizations, such as the Association for Behavioral and Cognitive Therapies or the American Psychological Association.
Of course, they should be licensed to practice in your state.
You can find competent specialists who are affiliated with local universities or mental health facilities or who are listed on the websites of professional organizations.
You may, of course, visit our website (www.abct.org) and click on "Find a CBT Therapist"
The Association for Behavioral and Cognitive Therapies (ABCT) is an interdisciplinary organization committed to the advancement of a scientific approach to the understanding and amelioration of problems of the human condition.
These aims are achieved through the investigation and application of behavioral, cognitive, and other evidence-based principles to assessment, prevention, and treatment.
How can I help support an individual who has brain injury-related difficulties?
Family members and loved ones or supporters play a critical and often underappreciated
role in recovery after brain injury. Health-care professionals encourage
loved ones of the survivor to attend medical appointments to help relay
information, track the discussion, and to record instructions for the survivor,
with the survivor’s permission. Involve the survivor in decision-making when
possible. In terms of medical appointments, you can help the person with brain
injury track their appointments using an appointment binder, planner, master
calendar that everyone can see and contribute to tracking, or online calendar
that you can both access (and in the case of mild brain injury, you can serve as a
backup reminder system). You can also keep a binder of information obtained
from appointments as well as educational resources, all in one central location.
You can bring this binder to appointments to help you stay organized.
Especially in the case of moderate to severe brain injury, it will be important
to learn how to work with the rehabilitation team, which is frequently a new skill
for many. Learn the team members’ roles and the parts they play in the rehabilitation
of the survivor. You can write their names down in an appointment
binder, which can also be helpful for the survivor. You can keep a list of questions
for the survivor’s providers as well as the answers the providers give. It can
be difficult to trust the different team members, but the more questions you ask
the more likely it is you will be able to talk openly about your concerns. Also ask
what you can do at home or “after treatment hours” to help the treatments generalize.
Are there home exercises you can help the survivor to do to ensure the
brain and body will get the most benefit from the treatments?
If the survivor has a severe brain injury as determined by a doctor, ask the
doctor about whether it would be appropriate to have a guardian (in some states
this is known as a “conservator”) to delegate decision-making about health care
and finances on behalf of the person with TBI. Legal consultation should be
If you have a large family or support network and are interacting with a rehabilitation
team during your survivor’s treatment, it may be helpful to have one or
two immediate family members serve as a representative to family and friends.
Information passed from the medical staff can be directed to those individuals,
who then relay messages to others and funnel decisions to the medical staff. It
may also be helpful for the survivor to visit with 2 to 3 people at a time at most,
to avoid overstimulation.
What communication skills can be helpful in interacting with individuals after brain injury?
Consider talking in a distraction-free and non-brightly-lit place. A one-on-one
format may work better than "family meeting" format for communication.
Because the survivor’s speed of thinking may have been adversely affected by the
brain injury, speak slowly, as though you are throwing a bunch of commas (like
bullet points) into your sentences.
Avoid multipart questions. Pause to check
for understanding (survivor can summarize in his/her own key words). Use
"key words" that summarize the message. Remind the person that he or she
can write down information you are providing in a calendar/notebook during
the conversation. The survivor can learn that he or she will attend where
his or her eyes are orienting and can use this as a cue to stay "on track" and
maintain eye contact as time post-injury progresses. Remember that the
brain injury survivor has brain-based difficulties with memory and attention
and it is most likely that they are not intentionally tuning you out. Try to
assist the brain injury survivor to break complex tasks into a series of simpler
tasks. While walking with the person, point out landmarks: these may
may later serve as reminders of paths to places.
It may be helpful to rely on professionals to explain their rationale for
instructions to the survivor so that everyone knows where any restrictions in
activities came from. This conversation can be recorded or written with the
therapist's and survivor's permission. Written guidelines can also provide
cueing in the case of memory problems.
If you were or are significantly involved with the person with brain injury,
rehabilitation providers want to gather information from you and to involve
you in care. Communicate with providers and attend appointments to the
extent possible. This can help prevent miscommunication later.
Consider the impact of communications on the recovery and coping of the
person with brain injury. Some families have found it helpful to discuss concerns
individually with providers both separately and together from the person
with TBI. Consider whether all who want to be involved in the life of the
person with brain injury but who disagree can come together for a common
How do I prevent burnout as a caregiver?
Learn about how TBI will impact your loved one, because knowing what to
expect can lower your stress level. Knowing about TBI and the symptoms it
causes for your loved one can also help you understand when symptoms such
as irritability are due to TBI. The ABCT fact sheet on TBI for brain injury
survivors may be of help.
Ask for help (for example, asking a neighbor to run an errand for you). Do
not try to do everything all on your own; you will need a list of support people
willing to help you with tasks. You can draw on this list in a time of
stress. Be aware that sometimes respite care is available, where another
appropriately trained individual can come into the home and assist or provide
caregiving for you so that you can take a break. You can find more out
about this in the resources section below. You may be able to take time off
from work under the Family and Medical Leave Act.
Don't forget to focus on your own self-care, too. Have an outlet for your
stress. You need some time to yourself.
Remember that being strong or being a good caregiver doesn’t mean taking
responsibility for everything around you and completing everything on
Accept offers of help from others. Caregivers who get help (in the form of
counseling or talking with a trusted friend or religious or community leader)
are less likely to burn out.
Stay positive, taking one day at a time. Even if your loved one is unable to
show appreciation, you can choose to feel good about the job that you are
doing. Focus on what you can control. Set priorities. Make a list and start
with the most important; if you can, let some things go for now. Keep a journal
of the progress you have made and milestones. Even if you are unable to
restore your loved one to how they were before the injury, you can provide a
safe and loving environment for that person.
If your loved one is expected to have difficulties that may be lifelong, recognize
that you are probably going through a grieving process. It is completely
normal to feel denial, anger, depression, and guilt for not having been able
to protect your loved one. It is also completely normal to be unsure where to
begin. There is no wrong door to walk through in beginning to seek help. The
Internet can help open the door to what resources are available, but you have
to walk through it.
Some excellent self-help materials for caregivers are available. Caregiver
tips are available at brainline.org. Also check out the Mayo Clinic’s guide
entitled “Understanding Brain Injury: A Guide for the Family,” available at
and Karol’s Overcoming Grief and Loss after Brain Injury (2010; Oxford) is
an excellent resource. Another book some partners of survivors find helpful
is The Stranger in Our Marriage: A Partner’s Guide to Navigating
Traumatic Brain Injury, by Dr. Colleen Morgan (2010, Peppertree).
What treatment can my loved one receive for brain injury?
There are a variety of treatment and rehabilitation programs that may help
your loved one. This will strongly depend on how severe the doctors say the
injury is, and on what the survivor's day-to-day functioning is now. Typically,
complete cognitive and physical rest, including plenty of sleep, is initially recommended
for several days after the injury. After that, people with moderate
to severe injuries can participate in rehabilitation during the weeks immediately
following the injury, where they receive treatment from a variety of specialists
over a shorter period of time. This is usually the most intensive part
of treatment. After this program is completed, some people live in transitional
living programs, which are nonmedical residential programs that teach
skills for community living. Others participate in day treatment programs,
where rehabilitation is provided during the day so the person can return
home at night. Long-term care and supervised living programs are residential
facilities that provide care and rehabilitation to people with TBI who are
unable to live independently.
For people with mild brain injury who are more independent but whose
symptoms have not resolved, services can be provided through the outpatient
setting (a routine medical appointment). Speech pathologists and rehabilitation
psychologists or neuropsychologists can sometimes provide cognitive
rehabilitation, a form of treatment that focuses on helping people develop
strategies to compensate for changes in memory and thinking. Clinical psychologists
(especially rehabilitation psychologists or neuropsychologists) will
frequently work with people with brain injuries to help the survivor and their
support system understand and adjust to a new medical situation and
changes in abilities.
Neuropsychological assessment is a type of evaluation used for treatment
planning. This type of assessment is conducted by a neuropsychologist, who
has advanced training in the relationship between brain functioning and
behavior. Neuropsychologists frequently help individuals with brain injury,
their support system, and other health-care providers to understand the
severity of the injury, strengths and weaknesses, prognosis (that is, whether
one's functioning is expected to return to pre-injury levels or not), applications
of the results for daily functioning, and treatment planning for medical
care. The assessment provides direction for vocational and educational choices
or accommodations, the type and intensity of treatment needed, as well as
safety guidance for day to day living.
What are my other resources for getting support?
For those who are affected by brain injury, please remember that you are not
alone and that there are so many resources and strategies to understand and
compensate for brain injury. Neighbors and members of community or religious
organizations you belong to are often good sources of support. If you
can enumerate the needs of the survivor and support network, people can
offer to fill in the gaps.
You can also talk with the brain injury survivor's primary care doctor, a
social worker, or a local area agency about options for respite care, which
provides short-term relief to those who are caring for family members.
The Brain Injury Association of America (http://www.biausa.org) has
state chapters that can provide local referral resources for treatment facilities,
respite care, transportation, care coordination, support groups, educational
materials, and providers who can help. Also, frequently the regional
neuropsychological society has an online roster of neuropsychologists who
specialize in assessment and treatment.
If your loved one is a military veteran, you can call VA's caregiver support
line at 1-855-260-3274, or visit their webpage at http://caregiver.va.gov for
further information. A useful fact sheet entitled “Traumatic Brain Injury: A
Focus on Family and Caregivers” is available at http://www.polytrauma.va.gov/downloads/VA_TBI_Caregiver_Factsheet.pdf.
Caregivers play a critical
role in the recovery of individuals with moderate to severe TBI, and the VA
supports a family caregiver program which applies to caregivers of individuals
with TBI (http://www.caregiver.va.gov). This program can provide a
stipend, training for caregivers, support via telephone or in-person meetings,
in-home skilled nursing, respite care, and a variety of other services for those
determined eligible. The Department of Defense and Department of Veterans
Affairs use the Defense and Veterans Brain Injury Center (DVBIC) as their
clearinghouse for patient and family educational materials about TBI. DVBIC
can help people connect with case management, which can help individuals
get resources they need for day-to-day living. Their web address is
Education about brain injury can be empowering and can help reduce the
stress that comes with the unknown. Ask as many questions of your survivor’s
doctors as possible, so you can know what to expect. Read as much as
you can on your own, but make sure what you read is appropriately tailored
to the severity of your loved one’s injury. Your doctor can help steer you
toward whether it would be more appropriate to read about mild brain injury
or severe brain injury. Some good readings for family members include
and the Mayo Clinic Guide (“Understanding Brain Injury: A Guide for
Caregivers,” available at www.mayo.edu/pmts/mc1200-mc1299/mc1298-01.pdf).
Particularly if your loved one sustained a severe brain injury and is expected
to have lifelong changes in functioning related to his or her brain injury, it
is possible that your loved one may be entitled to social security disability
benefits (SSDI or SSI). You can contact the Social Security Administration to
find out more about these programs and whether your loved one will qualify
for these benefits. Contact the Social Security Administration at www.ssa.gov
or (800) 772-1213.
For more information or to find a therapist:
Please feel free to photocopy or reproduce this fact sheet, noting that this fact sheet was writen and produced by ABCT. You may also link directly to our site and/or to the
from which you took this fact sheet