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 Do I Find Out How Severe My Brain Injury Is?
Your recovery will strongly depend on whether your injury is “mild, moderate,
or severe.” Doctors determine this based on how long you were unconscious or
unresponsive at the time of the injury. They also look at whether you were
unable or only partly able to form new memories immediately before, during, or
after the injury. Doctors call this posttraumatic amnesia. This amnesia differs
from everyday memory problems like forgetting to call a friend. Doctors also
look at whether you were disoriented and confused at the time of injury, and
how long this lasted. Stress can also cause people to be confused, disoriented, or
have trouble remembering what is happening. In some cases, it can be difficult
to sort out what changes in thinking, emotions, or behaviors are due to stress
versus brain injury itself. In these cases doctors will still continue to help you
with the symptoms or problems, even if we don’t know where they are coming
What Will My Recovery Look Like?
Brain injuries are like fingerprints, and each one is different. Recovery, too, is
different for each person and depends on the type of injury and how severe it is.
Your medical provider will let you know when it is safe to return to activities.
After mild brain injury there may be some symptoms immediately or soon after
the injury; however, most people fully recover within days to weeks. Some people
with milder injuries will return to work or school soon after the injury, and
involvement in these activities can be very important in the rehabilitation
process. Accommodations are changes to the work or school day, such as having
extra time to complete tasks, or testing your knowledge in a different way.
Accommodations are designed to remove limitations caused by brain injury, and
make it so that you can work around the brain injury. Accommodations level the
playing field so that you are not unfairly limited because of your injury in being
able to do the work you are asked to do. Talk with your doctor about whether
accommodations would make sense in your situation. There is usually a formal
process to obtain accommodations, which may involve legal consultation.
While almost everyone recovers from a single concussion or mild brain injury
within days, the time it takes to heal also depends on the number of brain
injuries one has experienced in a lifetime, and other conditions that may exist.
For symptoms that stick around after a mild brain injury, it can be beneficial to
have a “neuropsychological assessment” to better understand what contributes
to symptoms and to get some recommendations on how to deal with the symptoms.
In general, military personnel and veterans seem to have symptoms that last
longer than civilians. Many veterans have more than one medical problem, such
as chronic pain, medical conditions, posttraumatic stress, trouble sleeping,
depression, or substance use. These problems may make it harder to get better
from symptoms that were initially caused by any one problem, such as traumatic
brain injury (TBI).
Military and veterans who experience a milder brain
injury should remember that with proper treatment, improvement is likely.
People with more severe injuries will often continue to participate in treatment,
including recreational activities with supports, following their injury.
Recreational activities can be particularly important for retraining the ability
to work well with others, improving your mood, managing your emotions,
and for practicing memory and attention strategies. In general, after your
doctor says it is safe to do so, activities such as spending time with others,
attending outings or treatments, and participating in chores when safe to do
so can all help recovery. You can time these activities so that they happen at
a time of day when you are least fatigued. It is important to ask your doctor
about any safety concerns for resuming activities.
What If I Feel Like I'm Getting Worse?
Return to your health-care provider if you notice worsening in symptoms.
True worsening of symptoms directly due to brain injury is rarely due
to a worsening of the injury itself. Instead, worsening in symptoms is usually
because of poor sleep, physical pain, more stress, or worse mood, and does
not mean that further injury is occurring. To be on the safe side, check with
your doctor to make sure there is not an underlying medical condition that
could require care.
If you are receiving treatments for brain injury and it doesn’t feel like you
are doing well, it is very important to be up front with your doctors about
your feelings, including what helps you during your treatments as well as
your goals, so that they can have a chance to change the treatment, if possible,
to accommodate your preferences. They may also be able to clear up any
misunderstandings that arise.
You may also feel like symptoms are getting worse (for example, you are
getting more tired) as you get involved in more challenging tasks like work
and school. This is very normal and the symptoms often improve gradually
over time as you adjust to the new situation. Just remember that people usually
get better after a TBI, and not worse.
People have noticed (or I've noticed) some changes in my thinking (like my ability to remember new things), and my emotions, behaviors, and how I interact with others following my brain injury. What are some of the changes that people can have, what causes these changes, and what can I do about them?
Some common cognitive changes (changes in thinking) seen after brain
injury include trouble with learning and memory, trouble concentrating,
slowed thinking, speech and language changes, trouble multitasking, trouble
filtering out information that doesn't seem relevant, and trouble making
decisions. Recovery can take longer if a person has had multiple mild brain
injuries over a brief period of time. For a person who has had a severe injury,
some changes may be lifelong.
Emotional and behavior changes seen after brain injury can include trouble
"filtering" or restraining emotions or thoughts one would normally avoid
articulating, feeling less patient, mood swings or depression, irritability, crying
more, wanting to isolate, having trouble with healthy decision-making,
feeling as if people are getting on one's nerves more easily, trouble in relationships
with others, and not taking care of oneself (including grooming and
hygiene). Some people have difficulty getting started on or completing activities
(this can look like lack of motivation, not maintaining interest in activities
you’ve enjoyed, or not sticking with goals) due to brain injury. It is
important to remember that these changes can also be caused by other
things, like stress.
Your doctor may be able to tell you whether the changes in thinking (such
as memory), emotions, and behaviors that you are noticing are directly due
to damage to brain tissue, or due to other causes. The stress that goes with
life changes after brain injury can cause cognitive, emotional, and behavioral
changes, and you may find that people get on your nerves more easily.
Changes to sleep patterns or physical pain after injury can also cause people
to have concentration and memory problems. Some people find that after
brain injury they need to develop new coping skills and ways of dealing with
frustration. A therapist who specializes in cognitive behavioral therapy (CBT)
can help you get “unstuck” and change negative thinking and communication
What Are Some Common Concerns That Other People Have in Coping With Changes After Brain Injury?
Some people worry that they will not be able to get the help that they need,
that life does not hold much hope, or that things will get worse. Stay positive.
No one said this recovery process would be easy, but most brain injury survivors
will tell you that staying positive can only help deal with tougher days.
You will be able to deal with things more easily with more practice. It is
important to remember that tomorrow your ability to achieve your goals may
be better than today as your brain heals and as you learn new coping strategies.
Also, remember that brain changes from TBI can actually lead to
decreases in motivation. Realize that your brain is doing this but that you
don’t have to be defined by it. There are many people out there who have
experienced a brain injury, and who have gone on to have success related to
their job, school, or personal lives after brain injury. The way you talk and
think about your recovery affects the way you feel about it, so it’s important
to keep moving forward.
It may be tough to cope with the responses of others to your injury, or
changes in relationships, like loss of intimacy. People can feel as though they
have let their family or partner down, or you might find yourself using negative-
thinking traps, such as "labeling," where you tell yourself that you are
now "lazy" or "unintelligent" since the injury when in fact this is NOT the
case. Sometimes brain injury survivors use "all-or-nothing thinking" after a
brain injury. This happens when people believe that if they can't do everything
the same as they did before the injury then the outcome will be terrible.
This “all-or-nothing” thinking trap also happens when people believe that
they cannot return to having a productive life unless they can do as well as
before the injury. People are often able to do something just as meaningful
after the injury. Many people with brain injury have instead tried to engage
in more healthy thinking ("I would prefer to work, but I can have other
sources of meaning or be productive in other ways”).
Sometimes people get stuck in making unfair comparisons to other individuals
with brain injuries if they do not improve as fast as others. It is helpful
to remember that brain injuries are like fingerprints and no two are the
same; the only fair comparison is between "you" and "you."
What Are Some Helpful Thoughts and Coping Strategies ThatCan Keep Me Moving Forward in My Recovery?
It is important to focus on all you have accomplished in your recovery since
the injury (look forward, not backward). Many survivors have found that
focusing on self-care, such as getting enough sleep and getting involved in
pleasant activities, can be very helpful in moving forward. Try to challenge
"should" statements, such as "I am supposed to be employed right now" or "I
ought to remember everything." If you have always been an independent
person, it can be very difficult to challenge unhelpful thoughts such as "I
should not need help" or "I am a failure if I can't be self-sufficient." A therapist
can help you do this. Therapists will help people to come up with alternative,
balanced statements, such as, "I would prefer to work, but I can have
other sources of meaning or be productive in other ways" or "People with
medical conditions sometimes do need assistance." This might be a time to
reevaluate your value and self-worth based on the type of person you are and
other ways you participate in the lives of others. "Big-picture thinking" can be
helpful (for example, saying to yourself, "I am not good at details now
because of the brain injury. Instead, I will help people focus on the big picture
and on relationships").
What Types Of Treatments Are Recommended After Brain Injury?
Rehabilitation is a set of treatments that focus on the medical, physical, cognitive
(such as memory and attention problems), and emotional and social
changes that can occur after TBI. Rehabilitation helps teach people how to
compensate for problems, set realistic goals for recovery that people can successfully
meet, and teaches people to be safe in their environments.
Participating in a rehabilitation program is something you can be proud of
because it involves a lot of work and patience.
Everybody responds in their own way to rehabilitation. Some people after
severe TBI have extended stays in the hospital and others get rehabilitation
through routine medical appointments. People who experience more severe
injuries may benefit from rehabilitation that involves an overnight stay in a
hospital for several weeks to months. Many brain injury rehabilitation programs
involve spending the night at a hospital for days to weeks and getting
help from multiple types of doctors there.
Around the country there are many programs that provide rehabilitation
for individuals with TBI. One such program for military members is the
National Intrepid Center of Excellence for traumatic brain injury and psychological
health in Bethesda, MD, which is tailored toward the needs of service
members. The VA also has similar programs for veterans through the
Polytrauma system of care (http://www.polytrauma.va.gov). This system is
for people with TBI, many of whom also have other injuries. A list of brain
injury rehabilitation programs in your state can likely be obtained from the
Brain Injury Association of America (http://www.biausa.org).
People with milder injuries may receive rehabilitation treatment by coming
to the clinic just like a routine medical appointment. Also, those who are
well enough to travel to an outpatient clinic for therapy or whose family
members will provide all the help and supervision needed at home are able to
have visits provided through an outpatient clinic.
Cognitive rehabilitation is a treatment used to help individuals compensate
for memory, attention, and other thinking problems. One major focus of cognitive
rehabilitation is helping you organize your physical environment and
your day to increase productivity and attention. It is often provided by a
speech pathologist or a neuropsychologist.
What Can I Do to Improve My Memory and Attention Problems?
Develop personal mottos or key words that cue you to stay on track or complete
tasks. These mottos help trigger your memory about what you need to
do. Some examples that have been used are, “do it, write it, or forget it,” “be
here now,” “stop, relax, refocus,” and “KPW” (“keys, phone, and wallet,”
which you can use when leaving the house). Follow a routine as much as you
can. Take breaks as needed and pace yourself. Use key words to summarize
information so you can later recall it from memory using just the key words.
Also, relaxation strategies promote the brain’s readiness to learn and remember.
Relaxation strategies are very beneficial to people diagnosed with TBI
because stress can literally cause changes in brain functioning, particularly
memory and attention functioning. Ruminating and worrying about symptoms
can make them appear worse. Try some brief relaxation techniques
before starting a task, including slow, deep breathing. Many people say that
managing stress has improved memory and concentration!
What Communication Skills Can I Try to Improve My Relationships With Others?
Some brain injury survivors will find that they need to slow down speech to
get words out. Others need to “take a step back” mentally to create some distance
before discussing personal things. You can manage your discussion of
your injury while looking for cues to continue talking (the other person continues
their eye contact with you) or stop (the other person looks away from
you). Some people will ask permission to summarize what they have heard, to
ensure they didn’t miss anything. Other survivors find that focusing on keeping
a friendly expression or remaining at an arm's length away is helpful.
The fatigue you may be experiencing after brain injury can increase when
you’re around a lot of other people. Know this so that you can slow yourself
down or take a break from the action. Start out with briefer activities, and
pace yourself to prevent fatigue. You may need to use assertive communication,
such as “I’m going to need some breaks” or “I’m probably going to need
to leave early” to prevent fatigue. The use of “I” before each of these statements
and communicating the messages up front can help prevent others’
hurt feelings if you need to stop the activity.
A counselor can help you master some communication skills or help you
adjust to brain injury as a couple or family.
What Are Some Other Recovery Tips After Brain Injury?
1. Remember that you are not alone. There are many people just like you,
recovering from a TBI. Don’t isolate yourself, a tendency that can come
after a brain injury, and make sure the people you do spend time with treat
you with dignity and respect. If you’re part of a group therapy setting, you
can find others to share your recovery with who understand what you are
going through. If you would like to start group therapy or meet one on one
with a supportive professional but can’t find these resources, start with
your primary care doctor or a mental health professional, both of whom
will likely know what resources are available in the hospital or local community
for people who have experienced brain injuries. Support groups do
help. It can be difficult to know what services to ask for or to find doctors
who specialize in helping people with brain injury. Be persistent. There are
many doctors out there who are waiting to help.
2. Remember that things will get easier once you have developed a routine.
3. Keep your family and loved ones involved in your recovery process if it is
possible. They are probably doing the best they can but may be new to
brain injury and may be adjusting to changes as well. At the same time,
people in your support system may get a sense of life purpose and
increased self-esteem from being with you and from providing a safe and
4. Mental and physical rest immediately within the days following brain
injury can help your brain heal faster. You should receive plenty of sleep
during this time period. While getting plenty of sleep is always a good
idea, you can consider talking with your doctor about increasing your
activity level and socializing more with others, for the sake of your mood
and your recovery. Ask your doctor about whether this makes sense.
5. All too often people feel overwhelmed by their memory problems, but one
useful coping strategy has been to isolate and identify each memory
problem, make a list on paper, and attack one problem at a time.
6. If you abstain from alcohol and drug use after TBI, your thinking will be
more efficient and your brain’s ability to heal from injury may be a lot
better. Alcohol has been shown to more negatively affect people with TBI.
7. Protect yourself from having an additional brain injury by avoiding contact
sports as recommended by your doctor. It is very important to participate
in activities you still enjoy, so check with your doctor on other activities
that might still be safe and fun.
8. One good self-help book for recovery tips on brain injury is Brain Injury
Survival Kit: 365 Tips, Tools, and Tricks to Deal with Cognitive Function
Loss, by Cheryle Sullivan (2008; Demos).
How Do I Find Doctors That Specialize in Diagnosing Brain Injury, and Who Can Help Me After Brain Injury?
You can start by asking your primary care doctor or local hospital for suggestions.
The Brain Injury Association of America (http://www.biausa.org) can
also give you names of doctors, support groups, and educational materials of
people who can help.
For military personnel and veterans, the Defense and Veterans Brain
Injury Center (DVBIC; see http://www.dvbic.org) and the Veterans Affairs
(VA) Polytrauma System of Care (http://www.polytrauma.va.gov) can connect
you with the care you will need.
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.
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