PTSD and Traumatic Brain Injury: What You Need to Know

Laurel Shaler, Ph.D.

 

Did you know that March 10-16^th is Brain Health Awareness Week? As mental health professionals, it is critical to understand the various neurological issues that might impact our clients’ wellbeing. This post will focus specifically on Traumatic Brain Injury (TBI), as this is an increasingly common phenomenon in particular due to the wars in Afghanistan and Iraq over the last decade.

While the overall rates of injury are lower among those that have served in Operation Enduring Freedom and Operation Iraqi Freedom as compared to the Vietnam War and WWII, the percentage of those injuries pertaining to the head and neck have increased (Taber & Hurley, 2010). These authors explain that 80% of injuries are related to explosions, which resulted in 30% of those injuries related to traumatic brain injury.

It is important to understand the meaning of the term Traumatic Brain Injury. According to Taber & Hurley (2010):

A TBI has occurred when an external force has significantly disrupted brain function as indicated by any of the following: a period of loss of consciousness or alteration in consciousness (e.g., confusion, disorientation); loss of memory (amnesia) for events immediately before or after the injury; neurological deficits (e.g., weakness, loss of balance, change in vision); or intracranial lesion. The presence/absence or duration of each of these defines the severity level.

Since as early as the mid 1880s, the impact of brain injury on mental health has been noted (Schwarzbold, et al., 2008). According to these same researchers, depression is a common occurrence among those who have experienced TBI, and is the most commonly experienced psychiatric disorder following a TBI. Additionally, other mental and behavioral health concerns experienced as a result of TBI can include “anxiety, personality changes, aggression, acting out, and social inappropriateness” (Society for Neuroscience, 2014, para. 3).

Another concern related to veterans is the incidence of Posttraumatic Stress Disorder (PTSD)after experiencing a TBI. The rates of  (PTSD) following TBI vary from study to study. One explanation for this is because some of the symptoms of TBI and PTSD overlap, including poor concentration and irritability (Schwarzbold, et al., 2008). Other symptoms that might be related to either or both TBI and PTSD can include amnesia and numbness (Byant, 2011).

Accordingly, it is sometimes difficult for mental health professionals to differentiate between the TBI and PTSD because of this symptom overlap, which makes it even more important for careful and thorough evaluation by a comprehensive treatment team which involves a variety of healthcare professionals that can work together to best meet the needs of this unique population of clients. This team might include physicians, neuropsychologists, and psychotherapists, such as licensed professional counselors.

Following evaluation, treatment needs to be tailored to the diagnosis. If a client is diagnosed with both TBI and PTSD, the same evidence-based cognitive treatments used for PTSD can still be utilized, but attention should also be paid to the actual event that led to the brain injury (Bryant, 2011). In fact, it can be difficult to recover from either TBI or PTSD without processing that narrative, although research is still not clear as to whether or not the traumatic event should actually be reconstructed (Bryant, 2011).

In other words, the client can work on processing what they remember without investing too much focus and attention on what they cannot remember. This can include the imaginal exposure component of both Prolonged Exposure or Cognitive Processing Therapy.

Additionally, the specific treatment for the TBI should only be implemented by professionals trained to work with this specific medical condition. According to the Brain Injury Association of America, these interventions can include a variety of therapies such as occupational, physical, recreational, and speech in addition to medication, dependent upon the individual client’s needs (2014).

One other important aspect to consider is the impact spirituality and faith have on the recovery of an individual with TBI. One study of 88 participants, with the majority reporting to be of the Christian faith, found that a personal relationship with their identified higher power was associated with positive subjective and objective outcomes related to the brain injury rehabilitative efforts (Waldron-Perrine, 2010).

Finally, the Defense Centers of Excellence advises providers working with clients who have TBI and PTSD to understand that having multiple problems, diagnoses, and treatment options is very overwhelming, but helping the client stay focused on their particular treatment plan is critical for success (n.d.). Working closely with family members and encouraging clients to maintain contact and communication with sources of support are also important factors in treatment success.

Laurel Shaler, Ph.D., is a Licensed Social Worker and an Assistant Professor at Liberty University in the Center for Counseling and Family Services where she was recently named the Director of the Human Services Counseling program. She is a former psychotherapist for the Department of Veterans Affairs where she provided individual, marriage, and group therapy services.

http://www.aacc.net/2014/03/13/ptsd-and-traumatic-brain-injuries-what-you-need-to-know/