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The Pyschology of Concussion

During a game a few months ago, Katie, a young hockey player, sustained a concussion. Her parents were concerned that her recovery was not positively progressing. Katie was still having difficulty focusing at school, and by her parents’ insistence, Katie did not return to her sport of hockey or any other activity.

Katie then met with a neuropsychologist who conducted objective testing on her. Her results revealed no evidence of physical damage, and the neuropsychologist informed her and the parents that she had likely healed from a ‘concussion perspective.’

But her parents remained fearful that something was wrong with their daughter’s brain. What could be causing Katie’s lingering symptoms? After all, Katie followed her physician’s orders about post-concussion recovery and stayed in a dark room as well as avoided electronics, physical activity, and social interaction with others. But this isolation made Katie increasingly frustrated with her situation, and her parents remained anxious and on alert, vigilant to what they believed to be unresolved physical post-concussive symptoms. However, the ‘symptoms’ Katie was experiencing instead were psychological; the result of heightened stress and anxiety due to the isolation she had undergone in order to physically heal her brain.

The family was given accurate information regarding concussion recovery and underwent cognitive behavioral therapy to correct her thinking errors that then sparked her anxiety and fear. After a few therapy sessions, Katie’s symptoms began to clear, her focus returned, and she engaged in a gradual return to her beloved sport of hockey. This family offers a poignant example of how important accurate information and appropriate messaging about concussion recovery can be. Excessive media coverage of especially traumatic brain injuries of high profile athletes has, to some extent, created a culture of fear and understandably, parents are worried their child may suffer similar permanent consequences of a concussion.

It is important to work within the guidelines set by your physician and health care team to allow concussions to heal, and research suggests that most concussions or mild traumatic brain injuries (MBTIs) usually resolve within 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.

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 Katie and her family, begin to develop symptoms of depression and anxiety that can go undetected and untreated, masquerading as ‘post-concussive symptoms.’ Many can experience confusion and feel vulnerable and isolated: “I just don’t feel like myself somehow.” Without a bandage or a cast, others may not be understanding of a person’s invisible injury (concussion), and may negatively judge that person’s non-participation in school or in sports.

There will always be a psychological response to physical trauma. Recovery can go awry if psychological and emotional factors, both present and pre-existing, 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 useful guidance is provided in navigating the various challenges a concussion can bring.

Consider psychological help if:

  • symptoms persist beyond expected recovery (possible development of depression/anxiety)

  • pre-existing anxiety or depression returns and/or seems intensified

  • thoughts of self-harm or sense of hopelessness emerge

  • concussion occurred as result of traumatic incident/other injuries involved

  • anxiety about the return to school/work/sport interferes with progression

  • persistent changes in mood, including anxiety, sadness, anger/aggression

April Clay is a Calgary-based Psychologist specializing in sport psychology and injury rehabilitation. Visit her website at Research citations for this article are available upon request. 

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