Traumatic Brain Injury overview

Traumatic Brain Injury Dynamics and Strategies for Counseling Prevalence    1.5 – 2.0 million individuals in the U.S. are victims yearly (National Health Interview Survey) Approximately 1 million receive emergency treatment About 1 in 1000 people yearly Risk Factors      Males 2x as likely 15-24 years of age Over 65 Had a prior TBI Alcohol or Substance abuser Substance Abuse and TBI   1/3 – ½ were legally intoxicated at the time of injury (Corrigan et al., 1999; Taylor et al., 2003) 40% - 50% of adolescents and adults with TBI have histories of alcohol abuse (Corrigan et al. 1995) Etiology of TBI 1. 2. 3. 4. Motor Vehicle Accidents Falls Firearms Sports and Recreational Activities Types of Injury and What Happens      Penetrating Injury Bleeding out and stroke Pressure from swelling Contusions Shearing effect (Diffuse axonal injury) Executive Functions       The supervisor of your mind Controls attention Highest level thinking and reasoning Allows us to inhibit responses, including inhibiting emotions and emotional responses Allows us to control impulsive behaviors Tied to ability to initiate action What do EF deficits look like?  Problems with control:       Cognitive difficulties:      Control of attention Control of behavior Control of emotions Control of impulses Appropriate social interaction Abstract reasoning or scientific logic Goal directed behavior Following and applying rules Sequencing tasks Inhibiting cognitive action Emotional and Psychiatric Symptoms    Caused by injury to the brain (organic) Resulting from dealing with the acquired disability associated with the injury (reactive) Drastic life change Emotional and Psychiatric Symptoms (continued)  Organic         Reactive        Flat affect, apathy Explosive behavior Socially inappropriate behavior Emotionality Impulsive behavior Aggression/Irritability Hypersexuality Depression Guilt Hopelessness Helplessness Anxiety Loss of Self-Esteem Paranoia/Psychosis Treatment Options      6 months – 1 year recovery of function Neurorehabilitation Pharmacological intervention Counseling Behavioral interventions Psychopathology      Depression Psychotic Disorders Generalized Anxiety Disorder Apathetic Syndromes Impulse Control Disorder Therapeutic Interventions   Severe TBI –usually treated “behaviorally” Cognitive therapies work better with mild or moderate cases, with reactive symptoms. Behavior Modification Techniques       Be concrete Choose specific behaviors and clearly explain them to the client (Only 1 or 2) Push rewards!!!!!!! Choose consequences, explain them and stick to them BE CONSISTENT Watch out for reinforcing (-) behavior Cognitive Behavioral Therapy      Replacing negative thoughts and cognitive schema with more positive schema Perceptions shape their experience Cognitive distortions Show client link between beliefs, thinking, emotional reaction, and behavior Train them to identify and change these automatic negative thoughts and beliefs Roadblocks to Cognitive Therapies with TBI victims        Lack of awareness Communication Attention/Concentration impairment Emotional lability Decision-making, problem-solving, organization Motivation and initiation Memory Goals of Counseling for Clients with TBI        Education Support Develop self-awareness Adjusting to deficits Identifying strengths Coping Improving social skills /reducing social isolation Substance Abuse Treatment       J. D. Corrigan ½ of severe TBI victims are at high risk for SA. Remove from negative environments Get them active and working Traditional individual therapy Traditional substance abuse groups Family Needs        HUGE effect on family as well Stress, depression, anxiety, social isolation Report lower quality of life Education Support Family Therapy Ease the transition