Cognitive Therapy: Learning to Avoid the Overwhelming

Cognitive Therapy: Craig Part Fifteen 

Craig talks about the kind of cognitive therapy he received and the different issues that this type of therapy dealt with and helped him with.

Now, you said you had a separate person that was helping you with cognitive therapy.

Correct.

The Difference Between Cognitive Therapy and Speech Therapy

How is cognitive therapy different from speech therapy?

Well, I was having some, I guess you would call them environmental issues.  And a lot of  them were normal things that you can fix.  Like my memory – if I parked my car, I couldn’t remember where I parked it.  And so we practiced.  I wouldn’t remember where I’d park in the mall. We would walk in the store and walked around and I had to find these different things.

I mapped  them out ahead of time.  And then when we were done we’d walk out the door and (the therapist said): “All right find your car.”  And the first couple of times I didn’t do so well, but it’s retraining yourself to remember.

And then as far as the behavioral, coming up with like, kind of just plans, for myself, little time outs for myself.   And I take them  to this day and I push myself. And everyone that I work with knows that, if I don’t call you back it’s because I’m overwhelmed.

What you’re talking about is essentially relearning much of what you do as you become an adult, through cognitive therapy.  Do you agree?

Correct.

Explain how cognitive therapy helped.

Well, one time I remember taking my daughter shopping,   when a lady comes out and asks does this dress make me look fat.   You don’t say “it’s not the dress ma’am.”   That’s not the first thing that’s comes out, but those are the types of things (that do after TBI). Be inappropriate with people, not letting, not putting your thoughts out there because what I thought is what I said.  And I was always a pretty honest person, but it was to the point where it was hurtful sometimes.

Cognitive Therapy Helps Inhibition

Now this inhibition, that lack of social appropriateness, is a common problem that can persist long term for people after a brain injury.  How did you make progress from the extreme end of that to the point where you can function, with people without offending people?

Well, it’s questionable that I do that to this day, but  just a lot of error.  I remember a lot of mistakes I made.  You burn your finger on a burner a couple of times, you hurt enough people and you stop.  And I hurt a couple of people close to me.  So I made a real effort to watch it.

And when I was in those positions where I was overwhelmed – it was not getting to that point for a good year.  I had to just really limit, my exposure to things.

One of the things Craig said earlier, about not feeling guilty, meshes well with the concepts of this Part.  So many judgments are made about people with TBI, that if they would just try harder, show more will power, they would be just fine.  But what such attitudes don’t account for is that it is the very part of the brain that gives us will power, that often suffers the disabling injury, especially in motor vehicle wrecks.

The nature of the external force on the head and neck in a motor vehicle crash result in a rapid acceleration and deceleration of the brain inside of the skull. See http://subtlebraininjury.com/biomechanics2.php and the pages that follow.

Almost any time the brain is rapidly moved outside of its normal axis of rotation, the undersides of the frontal lobes are at risk for a scraping type of injury. The undersides of the frontal lobes are very critical structures for many of the initiation type functions, that adults do so much better than younger people.

Many professionals believe that, such damage, even in a mild brain injury, can permanently rob the survivor of the capacity to behave like an adult.  I am not convinced that is necessarily the case, but there is no question that such injuries do require a long tedious rehabilitation.  While social behavior skills can be relearned, the process is much more work than it was the first time, with mixed results.

The lesson that took a long time for Craig to learn, through cognitive therapy, to make a real effort to avoid overwhelming situations, is an extremely important one to keep in mind. It might be the single most concrete thing that professionals could warn survivors about.  Limit the multi-tasking demands upon your brain and it will work better.

Next in Part Sixteen – Transitioning Out of Therapy After a Severe Brain Injury