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Re-establishing Self-Control After A Brain Injury Many brain injury survivors find that after they have struggled with the recovery from the injury, hospitals, doctors, rehabilitation professionals, insurance company representatives and a host of other issues and people involved with their accident, they still have numerous challenges to face. One such issue involves another person, not mentioned above, with whom it may be quite difficult to resolve problems. That person is the survivor, him or herself. The injury may have changed the way that the individual is able to handle their own emotions and the way that problems effect their emotions. Survivors have talked about how it feels to have significantly reduced self-control. One survivor said "Sometimes I feel like I spend half my time out of control yelling at people and the other half trying to make up for what I said or did the day before." This temporary loss of control is not uncommon. Many people have this problem without a brain injury but when a person sustains a brain injury they often sustain damage to parts of their brain responsible for inhibiting angry impulses. As a result, they find that their emotions are more likely to drive them to say or do things that are outside their values. In the last issue of The Perspectives Network (Fall, 1994, Vol. IV-4), the article on crisis management focused on providing guidelines for families and friends of survivors. This article is intended for survivors themselves. If you are a survivor who sometimes loses control and wants to re-establish control over your emotions, this article is written for you. The concepts and approaches presented here are necessarily general but can be adapted to your unique situation. First of all, if you have problems with self control you must decide if you really want to change those behavior patterns. Some people say that they want to change something in themselves but really only feel that they should change. If you think you should change but do not really want to you will stay the same. Real change begins with an act of will; a clear decision and a willingness to do whatever it takes. Regaining self-control is not easy and only a serious commitment will carry you through the difficult challenges you will face. Next, you must understand yourself not only in terms of the patterns you have now but also the deficits that resulted from your injury. Do you have problems with memory? If so, you may need to rely on other people or written notes to remind you of your plans to strengthen your self-control. Do you have problems that reduce your self-control, like ongoing physical pain or do you easily overload from too much stimulation? These issues may be addressed directly without trying to modify your behavior. If you have pain when you walk for extended periods, you may be able to plan to take frequent rests when you have to walk for more than a few minutes. If you become overloaded by stimuli and lose control, you can plan to shorten your exposure to those situations. Do you preseverate (becoming obsessed or fixated, usually accompanied by thinking or talking about the issue excessively) when focusing on an emotionally charged issue? If so, you may be able to increase your self-control by reducing your preseveration through redirecting your attention .. go for a walk, do something enjoyable or even take a nap. Some survivors experience rapid changes in their emotions that are unrelated to what is going on in their lives. This may sometimes be addressed with medications if the problem is severe. This is, of course, an individual decision. The options are presented here for survivors to sort out for themselves. If you have problems with substances, like alcohol or drugs, then you may be losing control due to the disinhibiting effects of these substances. Brain injured persons often experience much greater effects from drugs/alcohol than do non brain injured persons. It may be that you need to first seek help for substance abuse rather than needing to change your behavior. For many persons, brain injured or not, when problems with substance abuse are resolved they discover that their behavioral issues have been resolved also. If you have decided that you want to change and none of the issues adore are relevant to you then the next step is to begin to arrange your life to avoid problems. Structuring Your Life to Prevent Crises What events or experiences serve as triggers for a loss of self-control? Identify those situations that 'set you off' and make a list. When the situations are on paper it is easier to think about them rationally than when they just occur and your emotions flare in reaction. Do you get angry when you talk with a certain person, company or agency? If so, then you can either write letters, prepare what you want to say or take a friend or family member who will help you express your point. Do you tend to lose control during certain holidays? Perhaps a change of setting is in order. You may find that it helps to stay with a relative or friend. Maybe you need to change some ritual, associated with that particular holiday, that has associations that upset you. For instance, if you become overloaded by stimuli and your whole family gathers for several hours at Christmas perhaps you could set s specific time limit for joining the gathering. There are as many specific triggers as there are people. You must identify your own unique set of triggers as well as the approaches that will help you avoid a crisis. Using the list will help you overcome possible memory deficits and it will allow you to put the issues on paper in front of you rather than inside your head where everything can seem too confusing. Practice a slow reaction. When you are calm and your determination is strong, practice reacting to potentially upsetting information slowly. Get the feel of thinking a bit longer before reacting. Take that extra time to organize your thoughts and to choose a response that you are going to feel good about later. Set up situations with a key person, whom you trust, in which you then deal with real situations and have to choose real responses. This is a graduated approach that allows you to increase the intensity of situations incrementally while you remain in control. Use the 'I statement' whenever possible. This is one of those approaches that sounds trivial but when used properly it can help you express your feelings and needs in a clear, concise way without lapsing into hurtful verbal attacks. Start your response to an upsetting situation with: "I feel __________ when you __________. You fill in the blanks with words that make sense to you. For example: "I feel angry when you tell me I can't make good decisions. It is so simple yet it can make a big difference if you tend to lose control when trying to express your feelings. Practice good problem resolution skills. Analyze each problem situation breaking it down into parts. Then find one small step toward resolving that problem that you can do today. Many problems appear monumental and this can lead to paralysis and depression. But, when that same problem is broken down, it has many discreet steps that can be taken one at a time until the big problem is resolved. For example buying a home is a huge task. However, if you break it down into small steps, it is more manageable. Today you might only need to make 3 phone calls to realtors to ask for listings. The old saying 'A journey of a thousand miles begins with a single step' applies here. Ask for pauses to help you remain calm when you are feeling the internal / emotional changes that signal that you are about to lose control. There is nothing wrong with thinking things through for a few extra seconds before speaking. You may need to go further and ask for a 'time out' during which you leave the immediate area for a few seconds or minutes. You may even find that, in order to stay in control, you may need to stop a situation for a longer period of time perhaps even several days. If you are going to take a time out, you can use an 'I statement' to tell the other person/s involved that you cannot handle this situation right now but you will get back to them as soon as you can. When you take the time necessary to remain in control of your emotions, you are building a pattern that will be stronger each time you repeat it. The Support Person When the part of your brain that previously dampened flaring emotions has been damaged, you must replace that function with external support. One excellent form of support is to enlist the aid of a person who will serve as the support person in your quest to regain self- control. Choosing that person or persons can be an important part of your efforts. Having someone who will help you allows you to receive feedback when you are straying from the course you have set for yourself. It is important that you have a strong trusting relationship with this individual because he or she is going to have to tell you things about yourself that you do not want to hear (at that moment anyway). It is usually best to choose someone who is around you much of the time when you are likely to have the most challenges. A spouse, family member, roommate or co-worker are likely choices. You can establish a set of expectations with that person based around your particular needs. If you can get alone with that person when you feel loss of control is likely, you can completely prevent the crisis. If your support person is present when you have already begun to react, you can have a code word to indicate allow subtle communication. Your support person might say something like: "That situation sounds like one we could talk about at home later this afternoon, OK?" as a means to put off reactions until later. You can ask that person to give you direct feedback when you are upset but are not sure if you are going too far. Asking "Do you think I am perseverating on this?" can give you valuable information. Your support person can help sort out important issues from the merely upsetting issues you face and can also help establish an effective approach to the problems that are worthy of your attention. In Closing After a brain injury, many survivors find that they have undergone a change in their ability to control their reactions. Flaring emotional interactions can lead to ongoing conflicts with family, friends, co- workers and the world at large. While trying to overcome so many obstacles, this change in self-control can be overwhelming to the survivor. The good news is that with a commitment to self-control, the assistance of supportive friends and family and the techniques presented here many survivors are able to handle potential crisis situations effectively and maintain self esteem and good relationships. |
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