Throughout my training in Sport & Performance Psychology I never felt a keen interest in concussions. I had neither experienced one personally nor played in a contact sport with any risk of developing one. However this abruptly changed in 2019 after two back-to-back car accidents only several days apart. I not only suffered the emotional, physical and financial impact of my own severe concussion, but also the frustration of immense difficulty in finding knowledgeable clinicians. This experience led to a painful year-long recovery as well as a passion to serve other concussion sufferers.
Yet as I’ve questioned in my other posts related to physical injury, how can I help clients suffering from a physical condition using mental health tools? Do therapists like myself have any business being on your treatment team?
While we may not be the primary driver, we can serve a critical role in your recovery.(1) Here is how we can help.
Behavioral Management adherence
What is Behavioral Management? Sleep, nutrition, hydration, exercise and stress management.
Sleep in particular has been repeatedly highlighted as one of the most powerful, inexpensive and scientifically supported tools for recovery.(2) Sleep - and the lack of - impacts mood, memory, cognitive functioning, emotional regulation, etc.
In fact, at the 2024 UPMC Sport-Related Concussion Conference, Dr. Micky Collins stated “Even with our 5 Profiles model [which we’ve researched and customized extensively], we may not focus on it at all until the client has dialed in their Behavioral Management. We simply cannot fix what poor sleep takes away.”(3)
In addition, according to a 2021 research study, a Behavioral Management program alone improved symptoms in concussion sufferers.(4) While the best results occurred with both Behavioral Management AND targeted concussion treatment, these behaviors are a key component to maximized recovery.
Therapists can help by … Providing basic information, asking questions to assess your quality AND adherence to these critical behaviors, and helping you address any barriers.
Anxiety is a primary symptom
According to Dr. Micky Collins and Dr. Anthony Kontos, there are 5 key concussion symptoms which should be assessed and actively treated as soon as possible:
Vestibular
Ocular
Cognitive
Migraine/Headache
Anxiety
While anxiety symptoms and autonomic nervous system over-activation can be a response to damage in the vestibular system, they can also be caused by:
Sadness due to loss of important sport and/or life events.
Fear around how long symptoms will last.
Discomfort due to pain, especially if this is a new experience.
Suicidal ideation due to brain inflammation.
Grief due to the length of time one has suffered, especially if over months or years.
Frustration and anger at the lack of results or impersonalized treatment from medical providers. Also, the number of times one is told, “I don’t know how to help you”, even by neurologists, vestibular and physical therapists.
Therapists can help by … Providing psychoeducation (aka, information) to help you understand what you’re experiencing and what to expect, lowering your stress. We can also offer critical coping tools such as Thought Challenging (CBT), Wise Mind (DBT), Emotional Regulation and Grounding, Safety Strategies for suicidal thoughts, etc.
Desensitization and exposure therapy
One major element presented by the UPMC Concussion Team is the emphasis on actively challenging symptoms. No naps. No hiding in dark rooms. No sunglasses or hats. Dr. Collins stated “I’ve become increasingly aggressive in how I push clients and their treatment because frankly, I've seen how well it works.”
Your concussion treatment team will help you customize what I call “interval training” (aka work + recovery cycles) including:
What exactly you should be doing + How much (work phase)
What active recovery is + How much to recover between exposures (recovery phase)
Desensitizing - rather than fearing - your symptoms is a critical part of fast, long term healing.
Therapists can help by … Yes, your concussion team should be spearheading your treatment plan including type and amount of exercises (aka, exposures) to do. However many therapists also have extensive experience in helping clients use exposure therapy techniques, rather than avoidance, to build confidence and self-efficacy around anxiety provoking stimuli. Fear, resistance and inconsistency are areas we often help clients understand and overcome.
Therefore, we can help you understand the process of planned exposures, introduce this for management of your symptoms while you set up your concussion team, and work through emotional barriers or resistance that arises.
Long term symptoms and negative healthcare experiences
While concussions are highly treatable contrary to what was previously thought, they can still feel scary and overwhelming. If your symptoms have lasted for months or years you may begin to sink into hopelessness, start accommodating to your symptoms rather than trying to heal them, or doubt the efficacy of treatment options.
In addition, many concussion sufferers:
Don’t have access to providers using the most up-to-date research and methods.
Have sought out care from the “right” providers with little to no results.
Have felt ignored or uncared for by their treatment team.
Have had frustrating experiences with insurance coverage.
Therapists can help by … See my article on Chronic Pain. In short, in addition to the tools noted above (behavioral management strategies, education, anxiety management, coping tools) we can be a steady, caring and supportive resource. In addition, we can help you shift your relationship with your symptoms as responding with worry, anger or fear will only exacerbate their intensity. Together we can change this.
Case management
In addition to the reasons noted above, some concussion sufferers start their treatment journey in our offices when their anxiety or suicidal thinking is at a crisis level. Therefore we are not just a helpful addition to your team but may also serve as a life saving first line of defense. At the same time, a specialized concussion team should take over the planning and primary execution of your care.
At the time of this writing, I am still seeking advice around how to determine if a local treatment provider or team (PT, vestibular, neurology) is using the most current methods versus the former “rest until symptoms magically go away” approach. However in the meantime, here are several trusted resources:
UPMC Concussion Clinic
Pittsburgh, PA
INOVA Concussion Program
Various sites in Virginia
Aptiva Health Concussion Program
Louiseville, KY
If you'd like to reach out or are interested in setting up a consultation call, feel free to reach me here.
Sources referenced:
1 All information presented is sourced from the data presented by speakers at the 2024 Sport-Related Concussion Conference, UPMC Concussion team, and related specialist facilities.
2 Aschwanden, A. (2019). Good to Go: What the athlete in all of us can learn from the strange science of recovery. W.W. Norton & Company.
3 Paraphrased quote from Dr. Micky Collins.
4 Kontos, A.P., Eagle, S.R., Mucha, A., Kochick, V., Reichard, J., Moldovan, C., Holland, C.L., Blaney, N.A., Collins, M.W. (2021). A Randomized Controlled Trial of Precision Vestibular Rehabilitation in Adolescents following Concussion: Preliminary Findings. PubMed. Dec(239)193-199. doi: 10.1016/j.jpeds.2021.08.032.
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