Anger and Frustration After Brain Injury
Dr. Neumann is an Associate Professor at Indiana University (IU) School of Medicine, Department of Physical Medicine and Rehabilitation and Research Director at the Rehabilitation Hospital of Indiana (RHI). She is also the Director of the IU Interactive and Functional Assessment of Communication and Emotion (InterFACE) Center at RHI.
Questions & Answers
- As a clinician, how do I best support families when they are displaying mood swings?
- My husband can be non-communicative and withdrawn. This lack of interaction can make me feel frustrated and alone. How do I help him and still keep my own emotions under control?
- I'm a veteran with a TBI and my young son has had a TBI since birth. How can we navigate our relationship and minimize being negatively affected by each other?
- I received a brain injury in a motor vehicle accident in 1964 and it's been made worse by other illnesses. I have trouble doing basic tasks, managing my time, and interacting with others. How do I deal with the aggravations and frustrations that I've been living with for so long?
- How can you transition from what you're doing to what someone else wants you to do, without getting irritable?
- My 60-year-old son can't manage alone, so I need to find and fund things for him, like affordable housing. I love him and want to help, but these extra burdens can sometimes cause me to become angry or frustrated. What can I do to try and avoid or manage those feelings?
- Sometimes family members or medical professionals don't take a strong lead in helping someone move beyond a TBI. Dealing with that lack of involvement can make me feel angry and frustrated. I don't want to take it out on my loved ones, but how can I manage those feelings?
- Why is it my reaction can be so nasty toward my caregiver?
- How can I control my anger when I'm trying to process too much sensory input at one time?
- My fiancé had a TBI 20 years ago. When he gets into his "rages" the only way he makes himself feel better is by apologizing for being an "a-hole". I understand how he lacks empathy (he also lost the ability to cry), but his "bits of rage" can be very frightening. He can get very vulgar in his language and slam doors. How can I help him manage his anger and my own emotional response to it?
- I feel frustrated because I am frequently misunderstood. I have to spend a lot of time fixing messes that others put on me to keep the world safe from me. I've lived alone for 30 years and my husband's prevented me from driving. He's explained that I am a terrible accident just waiting to happen. I spend a lot of time fixing setbacks that were unnecessary. How do I control my emotions and learn to deal with these issues with a cool head?
- My daughter's anger manifests with hitting and throwing. It is so disruptive and unpredictable. She is endangering herself and others. How do we help her to her stop herself before it escalates?
- My husband spent 23 days in a coma in 1986. Today he seriously believes men call me, that I have affairs, etc... Every day I'm punished for things I've never done. How can I help him manage his emotional reactions?
- Is loss of sleep caused by TBI? How does that impact my emotional response? What helps?
- It appears that when my son who has acquired brain injury has difficulty attending to a task or reading he becomes frustrated and becomes extremely aggressive towards me and my husband. Is there any way to help him cope with frustration before he becomes agitated and angry/ aggressive and loud?
- I have had and still have issues with behavioral and emotional problems. I am usually ashamed of my behavior after I get through my "funk" and look back at my actions, or see the stress that I have caused on my family due to my behavior. Sometimes it really hurts me to see my wife’s reactions to my f%^@ed up ways, and unfortunately, due to my lack of apathy and empathy, I am left standing there watching her hurt, yet all I do is just stand there watching. That destroys me inside. I wish I could turn the a**hole off, but I can't seem to flip that switch off.
- How come I don't want to be angry or yell, but it still happens?
BrainLine user: As a clinician, how do I best support families when they are displaying mood swings?
Dr. Neumann: 1) Learn what "triggers" or leads to mood swings. When possible avoid the triggers (e.g. avoid going to a busy mall on a Saturday if noise is a trigger. Instead, pick a smaller shopping place or an off-time to go). If triggers can't be avoided (e.g, you have to go that particular mall), plan ahead and prepare. Be mentally prepared. Go well-rested and in a relaxed state. Have a plan if you do start to get upset. I will go find a quiet location or step outside if I get overwhelmed. I will take breaks often (e.g. sit on a bench). I will wear earbuds to block out the noise.. 2) Teach them to talk through what is upsetting them and how they feel and why. Have family/ friends give a signal when things start to escalate in order to cue the person and redirect.
BrainLine user: My husband can be non-communicative and withdrawn. This lack of interaction can make me feel frustrated and alone. How do I help him and still keep my own emotions under control?
Dr. Neumann: His injury may make it difficult for him to communicate and share his emotions and thoughts with others. This can change over time. It is also a possibility he is depressed, and if that is the case he should seek treatment. Does your husband know this is bothering you and why? If he doesn't, it may help for you to clearly share your needs and feelings with him. See if he can help you understand why he is non-communicative and withdrawn and if he is willing to try. You will need to initiate the discussion, but be careful to approach it in a patient, kind and understanding way, with the goal of helping, not demanding.
BrainLine user: I'm a veteran with a TBI and my young son has had a TBI since birth. How can we navigate our relationship and minimize being negatively affected by each other?
Dr. Neumann: This is a complicated question with not a lot of information to go by. Know that you only have control of yourself, your emotions and your reactions. If you change them, you could influence how the other person responds. I would say both of you need to do some work developing insight into your own limitations and learning what about the other person often gets you upset ('triggers') -- have a plan for dealing with them. You may want to share these with each other. Work towards putting yourself in the other person's shoes and understanding the other person's situation-- seek to understand the other person. Learn positive strategies for healthy communication. Come up with some ground rules for acceptable communication (e.g. not interrupting, no yelling or name-calling). Try not to point fingers or blame. Instead of blaming, accusing, or making demands, or being defensive, both of you should try to start conversations off by telling the other person your thoughts, feelings, and needs. Try to explain where you are coming from and the good intent; It is not always obvious to the other person. Focus on the problem or point of disagreement; do not attack the other person. If interactions get heated, take a break and come back with a new point of view at a later time when things have calmed down.
BrainLine user: I received a brain injury in a motor vehicle accident in 1964 and it's been made worse by other illnesses. I have trouble doing basic tasks, managing my time, and interacting with others. How do I deal with the aggravations and frustrations that I've been living with for so long?
Dr. Neumann: Limit the number of things you commit to. Create a to-do list. Organize by due dates, priority, and time commitment. Try to anticipate how long you think something will take and plan for it to take two to three times as long as you think it will. This will build in extra cushioning and if you get done early, then great. Learn to ask others for help when you need it or have a question. Before starting a task, work on planning out the steps - what you will do and what you will need to accomplish the task.
BrainLine user: How can you transition from what you're doing to what someone else wants you to do, without getting irritable?
Dr. Neumann: I would suggest having a conversation with whomever the person is to share with them that you sometimes have trouble shifting focus when involved in a task. Depending on the situation, request from the person to get as much advanced notice as possible when being given a new task. Also, ask the person when they need it by or if they could give you X more time to get to a good stopping point on your current project. If it is an urgent / priority task requested from your boss, this might be more difficult, unless you are willing to be forthright about your injury and your needs.
BrainLine user: My 60-year-old son can't manage alone, so I need to find and fund things for him, like affordable housing. I love him and want to help, but these extra burdens can sometimes cause me to become angry or frustrated. What can I do to try and avoid or manage those feelings?
Dr. Neumann: It is understandable that this could be frustrating, but keep in mind that he probably wishes he could be more independent as much as you wish he was. Put yourself in his shoes. Seek help from other resources like Brain Injury associations or other organizations (not sure what?) to assist you. Are there any others in your family that could help share the burden? Find outlets for your frustrations. Go to support groups for caregivers. Make sure to talk and vent with family and friends or start a journal. Write down and think about all the things you are grateful for when it comes to him. Is there anything at all he could do for you that would be helpful to you that he can earn an "allowance" to help fund his expenses. This way it might feel more like he is earning it and trying.
BrainLine user: Sometimes family members or medical professionals don't take a strong lead in helping someone move beyond a TBI. Dealing with that lack of involvement can make me feel angry and frustrated. I don't want to take it out on my loved ones, but how can I manage those feelings?
Dr. Neumann: People may not know how to help or that you want them to help. Have you asked for help? Have a discussion about your needs and how you would like them to help. Maybe they need a bit of guidance. Also, most people don't understand brain injury. Professionals and family members rely on you to help us understand what you are going through. Also, remember that the brain injury is also a lot for your family members to deal with as well. They may be having their own struggles they need help with too. Acknowledging you are all going through a lot is helpful. If you have enough family and friends, try to spread requests for help so it is not all on one person.
BrainLine user: Why is it my reaction can be so nasty toward my caregiver?
Dr. Neumann: It is not uncommon, unfortunately. I don't think we know exactly why the caregiver often takes the brunt of the anger, but the fact that you are both enduring a lot of stress at the same time is probably contributing to it. Also, you likely have known the person for a while and trust them which means that we often feel more comfortable to be ourselves and not hold back our emotions or behaviors. Those we don't know or trust as well, there is more of a need to control ourselves. That control runs out with caregivers often. Finally, your role with your caregiver may have changed. For instance, you may be the husband in the relationship, and now after the injury, roles change. There is likely a loss of independence that is hard to accept, which often makes people feel irritable that they have to have someone take care of them. The person doing the caregiving is a reminder of this and takes the brunt of it.
BrainLine user: How can I control my anger when I'm trying to process too much sensory input at one time?
Dr. Neumann: If possible, try to reduce situations where there is too much sensory information (e.g. crowded malls). What sensory information is the most disturbing? Focus on that. Keep lights dim, noises low. Avoid crowded, noisy places. Wear sunglasses for light sensitivity. Know the environments that are the least overstimulating to you and try to stick to them. if you cannot avoid them, see if you could do short spans of time in environments with lots of sensory info. Take breaks and find a quiet place for respite. Meditate and do breathing exercises.
BrainLine user: My fiancé had a TBI 20 years ago. When he gets into his "rages" the only way he makes himself feel better is by apologizing for being an "a-hole". I understand how he lacks empathy (he also lost the ability to cry), but his "bits of rage" can be very frightening. He can get very vulgar in his language and slam doors. How can I help him manage his anger and my own emotional response to it?
Dr. Neumann: Find help from a professional psychologist and physician who has expertise in treating people with brain injury.
BrainLine user: I feel frustrated because I am frequently misunderstood. I have to spend a lot of time fixing messes that others put on me to keep the world safe from me. I've lived alone for 30 years and my husband's prevented me from driving. He's explained that I am a terrible accident just waiting to happen. I spend a lot of time fixing setbacks that were unnecessary. How do I control my emotions and learn to deal with these issues with a cool head?
Dr. Neumann: It is frustrating to be misunderstood. If you are feeling misunderstood, it sounds to me that there needs to be more communication to possibly help prevent misunderstandings and to help you both to understand where each other is coming from. It is hard to have others tell you what to do or have others prevent you from what you want to do. Many things we often don't like to hear others say are often things that come from a place of love and concern. One way that could help you deal with these issues with a cool head is to try to think about the situation from your husband's position. It is unlikely that his reasoning for doing things is to intentionally hurt you or hold you back. Because this is a "hot button" for you, it will be difficult, but when you feel like you are in a place that your emotions are under control, initiate a discussion. Explain that you feel misunderstood and that you want the opportunity to share where you are coming from, and what your thoughts and feelings are about the situation.
BrainLine user: My daughter's anger manifests with hitting and throwing. It is so disruptive and unpredictable. She is endangering herself and others. How do we help her to her stop herself before it escalates?
Dr. Neumann: Find help from a professional psychologist and physician who has expertise in treating people with brain injury.
BrainLine user: My husband spent 23 days in a coma in 1986. Today he seriously believes men call me, that I have affairs, etc... Every day I'm punished for things I've never done. How can I help him manage his emotional reactions?
Dr. Neumann: His brain injury is skewing the way he sees things, jumping to conclusions that are not rationale. It is not uncommon for people with a brain injury to think in a paranoid way. It is not easy, but cognitive behavioral therapy may be able to help the way he interprets others' actions and the way he thinks about things.
BrainLine user: Is loss of sleep caused by TBI? How does that impact my emotional response? What helps?
Dr. Neumann: Very often sleep patterns get disrupted after a TBI leading to fatigue and irritability. Talk with your physician, but melatonin has been shown to help a bit with sleep after a brain injury.
BrainLine user: It appears that when my son who has acquired brain injury has difficulty attending to a task or reading he becomes frustrated and becomes extremely aggressive towards me and my husband. Is there any way to help him cope with frustration before he becomes agitated and angry/ aggressive and loud?
Dr. Neumann: If it is an option, therapy to help your son with these tasks would be helpful, as well as therapy to help with his frustration tolerance. Therapists (SLP, OT, Neuropsychologists) can offer techniques to compensate for some of the cognitive challenges he is having and leading to his frustration. Plan ahead before he engages in the tasks. Only engage in these tasks for 10 or 15 min at a time take frequent breaks. Learn to notice EARLY signs of frustration and take breaks when you notice these signs. Do some breathing exercises or something fun to divert the frustration.
BrainLine user: I have had and still have issues with behavioral and emotional problems. I am usually ashamed of my behavior after I get through my "funk" and look back at my actions, or see the stress that I have caused on my family due to my behavior. Sometimes it really hurts me to see my wife’s reactions to my f%^@ed up ways, and unfortunately, due to my lack of apathy and empathy, I am left standing there watching her hurt, yet all I do is just stand there watching. That destroys me inside. I wish I could turn the a**hole off, but I can't seem to flip that switch off.
Dr. Neumann: The fact that you are remorseful and has such a strong impact on you to see her hurting, says a lot. A hug and an apology could be a start. Does she know how much it hurts you to see her hurt? Sharing that with her could be helpful. Sounds like you may need help from a professional psychologist who has expertise with brain injury to help you control your emotions. taking actions to seek help to change your behavior could show her how serious you are and how much it bothers you. If you lack the follow-through, ask for someone's help to make sure you take these next steps.
BrainLine user: How come I don't want to be angry or yell, but it still happens?
Dr. Neumann: The part of the brain the controls your impulses to yell and respond are likely injured. Work on recognizing signs of anger earlier. The earlier you notice feelings swelling up, the easier it will be to control. Also, learn what types of things trigger your anger. Once you know what they are, you can try to figure out how to prepare for or avoid them.
This content is made possible by a partnership between the Indiana University School of Medicine and WETA/BrainLine.
The contents of this interview were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research the Indiana Traumatic Brain Injury Model Systems 90DP0036 and 90DRTB0002. NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this interview do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.