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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5170
Experience:  Dr. Mark is a PhD in psychology in private practice
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I suffered a brain injury over 2 years ago and have been passed

Customer Question

I suffered a brain injury over 2 years ago and have been passed from neuro psychologist to psychologist. All experts agree on is that I need treatment and some form of help but they all point the finger at the other group. The affects resulted in suspension from my job and that remains so. Two neurologists have diagnosed post concussion syndrome. I have undertaken a QEEG which identifies anxiety and various cognitive deficits.
Who should treat this?
Will I get better?
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 3 years ago.

Hi! You know, to give you the best answer, I think I should ask you a few questions first that will help define the problem and the situation.


We know you've had a TBI and PCS. There were no mental health issues prior to the TBI. Is that correct? If there were, what were they and how were they treated?

The most perplexing thing here is that PCS is not a symptom to be treated (same for TBI after initial hospital treatment). It describes an event: you had a concussion. What would be treated would be the symptoms this concussion caused. For example: headaches, memory problems, cognitive impairment, depression, anxiety, etc.

What, then, are the symptoms they are trying to treat?

Any extra information that will help, feel free to share.


Dr. Mark

Customer: replied 3 years ago.

No previous mental health issues.

QEEG shows anxiety and intensity, poor reading retention and comprehension, poor stress tolerance, racing thoughts, sleep disturbance, problems with organisation, sequencing and sustaining focus, passive personality, cognitive insufficiency, deficit in memory and cognitive processing.

I would agree with the QEEG but I am not aware of sleep disturbance and I would add irritability and anger issues.The memory issues are pertaining to timely recall rather than the memory not being stored.

I am a member of Mensa and have found the adjustment to not being in control of my ange rand emotions difficult and the fact I am no longer able to 'think on my feet'.

The diagnosis was mild TBI so I would have expected to have made a full recovery by now but this is far from the case.

Treatment would ideally help me recover fully, if this is not possible then to help me adjust to the issues I now face, but as yet no treatment is offered, I take Citalopram which helps with some of the anxiety but still leaves me with a lot to deal with. Next step is to see a psychiatrist.

Expert:  Dr. Mark replied 3 years ago.

Thank you for the added information. It helps a lot. I believe I can now be of help with this issue.

You know, I have a fried who had a TBI from a car accident who was an attorney, Mensa, 13 years ago. He still hasn't regained all back, knows he won't, but is amazed that he's still having cognitive gains. He works at it, though: reading high level material, meditation, conversing, etc. He became a massage therapist to develop other parts of his brain to compensate for the anger and anxiety. Interesting, isn't it?

Okay. So or psychologist? I don't think you have any use any longer for neuropsychologists. They've told you what they can. Therapy would be the way psychology can help you now. Part of this is going to be acceptance therapy, because you've had loss and you're going to be dealing with handling that loss.

I don't know about brain enhancement software and Mensa to know whether to recommend it. So I'll put it out there for you to explore. Lumosity (www.lumosity.com/) is a game I've read about: studies that used it in patients with TBI. But again, I don't know about Mensa, whether that changes the usefulness. The website I think has a number of different games.

Memory is also something that you are going to have to actively work on. Spending time reminding yourself and "mining" your memory may have to become a meditative activity.

The point? You're going to have to experiment with lots of different possibilities that take effort. Because your brain is unique and no one else has gone through your trauma with your brain before.


Now that we've said this, let me recommend a behavioral component to your treatment of the anxiety and anger issues. I'll at the end of the answer give you a behavioral technique to get started with this. You can use this technique throughout the day when you are having anxiety. It is not a cure; it is something you can use to help yourself.

Let's work on three ways you can begin to build a behavioral program for yourself: diet, exercise, and psychotherapy. The first two are to help you feel more involved and in control of yourself and what's going on inside. The psychotherapy can actually teach you skills and give you tools for managing your symptoms. You may know all this, but I'm trying to be thorough on your behalf.

Diet: cut out coffee, sugar, white flour. That may be tough. But you will see results as some of the newer research shows. And lean meats only. No fast food restaurants, no fatty foods. See what I mean about getting involved in controlling what's happening? With diet changes you are treating your problem with respect: you are acknowledging you need to make changes to get your body feeling better.

Vitamins can be useful for moods. A good quality daily vitamin, for example. One of the most important supplements is Omega 3 fatty acids, either in fish oil or capsules or in flax seed oil. Buy good quality. The clinical dosage is 2-3,000 mg daily. All these things you should get at the biggest and most frequented health food store and ask them for the best brands they trust in terms of quality. Omegas are important.

Exercise: 5 days a week moderate exercise, to include 3 days of strength training as you get more used to it. Pretty amazing isn't it? I told you it would require work, but what you put in to it you will get out of it. Your doctor will verify the research results showing the benefit.

Which brings us to psychotherapy. You need to find a psychologist or psychotherapist to help manage the anxiety. Fortunately, anxiety, phobias, and panic are among the most researched disorders in terms of effective treatments. And the therapies today are very effective. The preferred form of treatment today is Cognitive Behavioral Therapy (CBT) to learn skills. Here is the American Amazon web page address for the classic workbook for anxiety and phobias by Edmund Bourne:

http://www.amazon.com/Anxiety-Phobia-Workbook-Fourth/dp/1572244135/ref=sr_1_1?s=books&ie=UTF8&qid=1286170992&sr=1-1

Here is the British Psychology Society's directory. I don't know how receptive anyone there would be to a reduced fee but you or your wife can still ask. Don't be embarrassed:

http://www.bps.org.uk/bpslegacy/dcp


I wish you the very best!

Now, I want to give you a tool to use for when the anxiety is present for you. It is quite easy to do almost anywhere. My patients suffering from anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.

I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety states is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

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Dr. Mark is a PhD in psychology in private practice