The Psychology of Concussion
April Clay, Registered Psychologist
It had been three months since Laura, a junior rider had sustained a simple concussion during a fall from her horse. Her parents were becoming increasingly concerned she was not progressing in her recovery. Laura was having difficulty focusing at school, problematic sleep patterns and intermittent headaches. Because they were fearful of creating any further escalation in her symptoms, she had not returned to her sport or any activity.
Laura was frustrated about not being able to ride, while her parents feared the worst had happened. Could she be suffering some sort of permanent brain damage?
Laura and her family decided to consult with a neuropsychologist for an assessment. Her results revealed no evidence of physical damage, and the neuropsychologist informed them that she had likely healed from a concussion perspective. She further added that the sum of her objective testing and clinical interviews suggested that Laura was most likely suffering from moderate levels of anxiety and some mild depression.
It turns out Laura and her family had been given considerable misinformation and mixed messages from their initial emergency room care and well-meaning family and friends. This included remaining in a dark room and avoiding all electronics, physical activity and social interaction. Laura had become increasingly frustrated with her situation, and began to develop feelings of hopelessness about her recovery. This in turn led to difficulty sleeping and escalating fears she may never be allowed to ride. She also felt like she was living under a magnifying glass, in that her parents watched her every move and often denied her requests to be social, insisting she needed to rest.
Emotional and psychological aspects of concussion are emerging as important factors in recovery. Responses to an injury of this nature can produce a sense of loss- in skills, normalcy and physical activity. Others, like Laura begin to develop symptoms of depression and anxiety that can go undetected and untreated, masquerading as ‘post concussive symptoms’. Many can experience confusion, “I just don’t feel myself somehow” and feel vulnerable and isolated. Without a bandage or cast, others may not be understanding of their invisible injury and judge their non-participation in school or sports negatively.
Now that she had been cleared of her physical concussive symptoms, Laura was referred to a psychologist to begin to untangle the sources of her anxiety. She was given accurate information regarding concussion recovery and underwent cognitive behavioral therapy to correct thinking errors that sparked anxiety and fear.
For example, she discovered that thoughts such as “What if I am never as smart as I used to be”, “What if I cannot ride as well again” and “why did this happen to me?” were causing considerable stress which in turn caused her to lose sleep and not perform as well on school tests. Her parents (well-meaning) reluctance to allow any physical activity made her feel isolated from her sport and doubt her future.
After a few sessions Laura’s symptoms began to clear, her focus returned and she was engaging in a gradual return to her beloved sport. This family offers a poignant example of how important accurate information and appropriate messaging can be to concussion recovery. Excessive media coverage of especially traumatic brain injuries of high profile athletes has to some extent created a culture of fear. Understandably parents are worried their child may suffer similar permanent consequences. Laura and her family were unfortunately exposed to inaccurate information that sparked fear and a secondary issue in her recovery.
The research suggests that most concussions or mild traumatic brain injuries (mBTIs) usually resolve within days to three months. No prolonged sequestering in dark rooms is required, nor is a complete cessation of thinking and movement. Rather, a gradual return to normal activity is recommended with supervision and follow-up. Equine Canada now has a return to sport protocol to assist riders in navigating a safe return to sport (see www.equestrian.ca)
There will always be a psychological response to physical trauma. Recovery can go awry if psychological and emotional factors, both present and preexisting, are not taken into consideration. Successful recovery is best obtained through a multi-disciplinary approach, utilizing qualified physicians, neuropsychologists, physiotherapists and clinical psychologists. The latter can ensure that relevant psychological factors are managed and provide useful guidance in navigating the various challenges a concussion can entail. With the right support on your side, a return to the saddle might not be as far off as you first thought.
Consider psychological help if:
*Research citations for this article are available upon request.
April Clay is a Calgary based Psychologist specializing in sport psychology and injury rehabilitation. For more information click here.
April Clay, Registered Psychologist
It had been three months since Laura, a junior rider had sustained a simple concussion during a fall from her horse. Her parents were becoming increasingly concerned she was not progressing in her recovery. Laura was having difficulty focusing at school, problematic sleep patterns and intermittent headaches. Because they were fearful of creating any further escalation in her symptoms, she had not returned to her sport or any activity.
Laura was frustrated about not being able to ride, while her parents feared the worst had happened. Could she be suffering some sort of permanent brain damage?
Laura and her family decided to consult with a neuropsychologist for an assessment. Her results revealed no evidence of physical damage, and the neuropsychologist informed them that she had likely healed from a concussion perspective. She further added that the sum of her objective testing and clinical interviews suggested that Laura was most likely suffering from moderate levels of anxiety and some mild depression.
It turns out Laura and her family had been given considerable misinformation and mixed messages from their initial emergency room care and well-meaning family and friends. This included remaining in a dark room and avoiding all electronics, physical activity and social interaction. Laura had become increasingly frustrated with her situation, and began to develop feelings of hopelessness about her recovery. This in turn led to difficulty sleeping and escalating fears she may never be allowed to ride. She also felt like she was living under a magnifying glass, in that her parents watched her every move and often denied her requests to be social, insisting she needed to rest.
Emotional and psychological aspects of concussion are emerging as important factors in recovery. Responses to an injury of this nature can produce a sense of loss- in skills, normalcy and physical activity. Others, like Laura begin to develop symptoms of depression and anxiety that can go undetected and untreated, masquerading as ‘post concussive symptoms’. Many can experience confusion, “I just don’t feel myself somehow” and feel vulnerable and isolated. Without a bandage or cast, others may not be understanding of their invisible injury and judge their non-participation in school or sports negatively.
Now that she had been cleared of her physical concussive symptoms, Laura was referred to a psychologist to begin to untangle the sources of her anxiety. She was given accurate information regarding concussion recovery and underwent cognitive behavioral therapy to correct thinking errors that sparked anxiety and fear.
For example, she discovered that thoughts such as “What if I am never as smart as I used to be”, “What if I cannot ride as well again” and “why did this happen to me?” were causing considerable stress which in turn caused her to lose sleep and not perform as well on school tests. Her parents (well-meaning) reluctance to allow any physical activity made her feel isolated from her sport and doubt her future.
After a few sessions Laura’s symptoms began to clear, her focus returned and she was engaging in a gradual return to her beloved sport. This family offers a poignant example of how important accurate information and appropriate messaging can be to concussion recovery. Excessive media coverage of especially traumatic brain injuries of high profile athletes has to some extent created a culture of fear. Understandably parents are worried their child may suffer similar permanent consequences. Laura and her family were unfortunately exposed to inaccurate information that sparked fear and a secondary issue in her recovery.
The research suggests that most concussions or mild traumatic brain injuries (mBTIs) usually resolve within days to three months. No prolonged sequestering in dark rooms is required, nor is a complete cessation of thinking and movement. Rather, a gradual return to normal activity is recommended with supervision and follow-up. Equine Canada now has a return to sport protocol to assist riders in navigating a safe return to sport (see www.equestrian.ca)
There will always be a psychological response to physical trauma. Recovery can go awry if psychological and emotional factors, both present and preexisting, are not taken into consideration. Successful recovery is best obtained through a multi-disciplinary approach, utilizing qualified physicians, neuropsychologists, physiotherapists and clinical psychologists. The latter can ensure that relevant psychological factors are managed and provide useful guidance in navigating the various challenges a concussion can entail. With the right support on your side, a return to the saddle might not be as far off as you first thought.
Consider psychological help if:
- Symptoms persist beyond expected recovery. if physical and psychological symptoms persist, it can be a sign other factors are at play.
- The concussion occurred as result of traumatic incident. Riding accidents, like others, can result in Post-Traumatic Stress which requires assessment and appropriate treatment.
- Anxiety about return to riding interferes with progression: If riders are struggling with anxiety and fear issues, sport and rehabilitation psychologists can help break down and manage individual barriers.
*Research citations for this article are available upon request.
April Clay is a Calgary based Psychologist specializing in sport psychology and injury rehabilitation. For more information click here.