While serving in the Marine Corps, I experienced a number of concussive events—episodes in which excessive force to the head through direct impact results in injury. Consequently, after the military I was diagnosed with traumatic brain injury (TBI). According to the Mayo Clinic:
Mild traumatic brain injury may affect your brain cells temporarily. More-serious traumatic brain injury can result in bruising, torn tissues, bleeding and other physical damage to the brain. These injuries can result in long-term complications or death.
Fortunately, my concussive events didn’t result in TBI severity to where long-term effects significantly impair my activities of daily living (e.g., that which requires a fulltime caregiver). Nevertheless, the consequence of my head injuries resulted in the following symptoms:
Physical symptoms – Loss of consciousness for a few seconds to a few minutes, frequent headaches, nausea and vomiting activity, fatigue and drowsiness, sleep disturbance, and dizziness with loss of balance.
Sensory symptoms – Sensory problems, such as blurred vision, ringing in the ears, and sensitivity to light and sound.
Cognitive and/or mental symptoms – Memory and concentration problems, drastic mood changes/swings, and feelings of anxiousness and depression.
The symptoms I experienced reflect those of the National Institute of Neurological Disorders and Stroke:
Noteworthy, literature related to brain injury sometimes uses “ABI” to indicate acquired brain injury. Describing this condition, the Brain Injury Association of America states:
An acquired brain injury (ABI) is an injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma. Essentially, this type of brain injury is one that has occurred after birth. The injury results in a change to the brain’s neuronal activity, which affects the physical integrity, metabolic activity, or functional ability of nerve cells in the brain. An acquired brain injury is the umbrella term for all brain injuries. There are two types of acquired brain injury: traumatic and non-traumatic.
Traumatic injuries include events such as motor vehicle accidents (MVAs), falls, assaults, or sports injuries. Non-traumatic injuries include episodes such as aneurysms, strokes, tumors, or infectious diseases which impact the brain.
When being examined for TBI by a physiatrist, I was informed that it was unusual for a military veteran to have visual proof of a concussive event. Although I didn’t maintain photo or video evidence of my all injury episodes, I did have a video of an MVA in which I was involved while stationed in Okinawa, Japan:
A non-commissioned officer (NCO), a couple junior Marines, and I were returning from a social gathering one evening when the NCO driver decided to speed around a slow-moving van. The Nissan Skyline he drove was fast, so it’s understandable how the NCO may’ve thought he could complete the maneuver.
Darting into the adjacent lane and accelerating, an opportunity to transition back into the original lane was lost, as a parked vehicle provided an instant brake to the NCO’s Skyline. The camcorder with which I filmed the incident slammed into the front of my head, causing TBI.
For months afterwards, I was nauseous and dizzy. I vomited and experienced severe headaches, as well. Additionally, I endured difficulty falling and remaining asleep, became irritable, and had problems with short-term working memory.
I also experienced fatigue, mood changes, light sensitivity, and hearing issues. It didn’t help that I sustained multiple training-related concussive events prior to and after the MVA.
According to Johns Hopkins Medicine:
Brain injury may happen in one of two ways:
· Closed brain injury. Closed brain injuries happen when there is a nonpenetrating injury to the brain with no break in the skull. A closed brain injury is caused by a rapid forward or backward movement and shaking of the brain inside the bony skull that results in bruising and tearing of brain tissue and blood vessels. Closed brain injuries are usually caused by car accidents, falls, and increasingly, in sports. Shaking a baby can also result in this type of injury (called shaken baby syndrome).
· Penetrating brain injury. Penetrating, or open head injuries happen when there is a break in the skull, such as when a bullet pierces the brain.
Each of my concussive events was the result of closed brain injuries. Two of my family members weren’t as well-off in their experiences, as both sustained penetrating brain injury – one from a shotgun pellet and the other whose skull was run over by a car.
The reason I’ve chosen to discuss TBI herein relates to a subjective observation. I’ve noticed that my practice of Rational Emotive Behavior Therapy (REBT) seems to be somewhat impacted by TBI.
For instance, when using disputation of irrational beliefs, I sometimes experience a block in my ability to cognitively process information. Although I didn’t know of REBT prior to sustaining multiple concussive events, I don’t recall having difficulty of this sort.
Also, I occasionally find it helpful to use grounding techniques during activating events rather than going straight to disputation, because centering myself in my body or focusing on my immediate environment disrupts whatever cognitive blocking phenomenon prevents me from thinking rationally in the moment.
Interestingly, my experience comports with one study that suggests:
The effectiveness of CBT [Cognitive Behavior Therapy] in individuals after TBI is dependent on his/her present level of cognitive functioning. CBT adapted for ABI shows enduring benefits for mood and community integration. Additionally, in REBT, self-defeating thoughts and feelings are challenged by the therapist. Therefore, it has been suggested that a more flexible protocol of REBT be implemented for these patients, which is less directive and more adjustable.
Still, one questions the component cited in the study which suggests that self-disturbing beliefs are challenged by a psychotherapist. My approach to REBT doesn’t establish interdependency whereby a client needs me in order to practice the psychotherapeutic modality.
Minor quibble aside and personal challenge to the practice of REBT having been duly noted, one source states the following:
CBT is a ‘symptom focused’ psychological approach, aimed at improving self-management of symptoms typically associated with mild TBI [mTBI] presentations. These include anger, depression, anxiety and PTSD symptoms, all of which lend themselves to this treatment approach.
For context, one source states, “REBT is considered to be the original cognitive-behavior therapy (CBT) by many scholars.” One imagines that for treatment and management of mTBI symptoms, the practice of REBT and CBT may alleviate residual effects of concussive events.
Ultimately, I find value in grounding techniques which offset personal shortcomings of REBT. However, one remains uncertain about how effective this modality may be at addressing symptoms of severe TBI.
Likewise, one remains open to review of additional literature regarding this matter. For now, the purpose of the current blogpost is for informational purposes only and one makes no attempt to prescribe what should, must, or ought to be a method of treating or managing symptoms of TBI or ABI for all people.
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At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply helping you to feel better, I want to help you get better!
Deric Hollings, LPC, LCSW
References:
Brain Injury Association of America. (n.d.). What is the difference between an acquired brain injury and a traumatic brain injury? Retrieved from https://www.biausa.org/brain-injury/about-brain-injury/nbiic/what-is-the-difference-between-an-acquired-brain-injury-and-a-traumatic-brain-injury
Chopra, S., Sinha, S., Gupta, D., Satyarthee, G. D., Agrawal, D., Kaloiya, G., Sagar, R., Tripathi, M., Nehra, A. (2017). Does functionality cease after acquired brain injury? Vignettes from a neuropsychosocial perspective. Indian Journal of Neurotrauma. Retrieved from https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0037-1602722
Hollings, D. (n.d.). Blog – Categories: Disputation. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/blog/categories/disputation
Hollings, D. (2022, October 5). Description vs. prescription. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/description-vs-prescription
Hollings, D. (2022, March 15). Disclaimer. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/disclaimer
Hollings, D. (2023, September 8). Fair use. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/fair-use
Hollings, D. (2023, October 12). Get better. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/get-better
Hollings, D. (2024, January 9). Grounding. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/grounding
Hollings, D. (n.d.). Hollings Therapy, LLC [Official website]. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/
Hollings, D. (2023, May 18). Irrational beliefs. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/irrational-beliefs
Hollings, D. (2023, September 19). Life coaching. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/life-coaching
Hollings, D. (2023, September 15). Psychotherapeutic modalities. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/psychotherapeutic-modalities
Hollings, D. (2022, March 24). Rational emotive behavior therapy (REBT). Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/rational-emotive-behavior-therapy-rebt
Hollings, D. (2022, November 1). Self-disturbance. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/self-disturbance
Hollings, D. (2022, October 7). Should, must, and ought. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/should-must-and-ought
Johns Hopkins Medicine. (n.d.). Traumatic brain injury. The Johns Hopkins University. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/traumatic-brain-injury
Kjpargeter. (n.d.). 3d human figure with headache [Image]. Freepik. Retrieved from https://www.freepik.com/free-photo/3d-human-figure-with-headache_896886.htm#fromView=search&page=1&position=41&uuid=7124c598-027b-4426-8786-e46fac9c6e69
Mayo Clinic. (2021, February 4). Traumatic brain injury. Retrieved from https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/symptoms-causes/syc-20378557
National Institute of Neurological Disorders and Stroke. (n.d.). Traumatic brain injury (TBI). National Institutes of Health. Retrieved from https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi
Thompson, C. and Maddicks, R. (2022, March 18). Treating mild TBI – Mid-term report: Trying hard but could do better. Psychology Chartered. Retrieved from https://psychologychartered.co.uk/blog/treating-mild-tbi-mid-term-report-trying-hard-but-could-do-better/
Turner, M. J. (2016, September 20). Rational emotive behavior therapy (REBT), irrational and rational beliefs, and the mental health of athletes. Frontiers in Psychology. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028385/
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