A Traumatic Brain Injury (TBI) & Mental Health: How To Get Help

A traumatic brain injury (TBI) typically occurs due to significant force to the head. TBIs, also known as acquired brain injuries, can be mild, moderate, or severe, and the injury's severity usually dictates the side effects’ severity. Even if someone experiences a mild TBI, it can be vital for them to seek assistance and support. Resources like the Brain Injury Association of America, NIDILRR, and the Family Caregiver Alliance can be helpful in addition to seeking immediate medical attention. For additional support in managing the mental and emotional effects of a TBI, consider reaching out to a therapist locally or through an online therapy platform.

How do traumatic brain injuries happen?

TBIs damage the brain as a result of outside impact to the head from falls, sports injuries, motor vehicle crashes, blast injuries, adult or child abuse or assault, or other events. Traumatic brain injuries may also occur if an object, such as a bullet, goes through the head and affects the brain and surrounding tissues (known as a penetrating TBI, as opposed to a non-penetrating TBI or closed head injury). Even violent shaking can be a major cause of a TBI, such as in the case of shaken baby syndrome. 

The trauma can either cause:

• A focal injury, which is limited to one part of the brain
• A diffuse injury, also known as a diffuse axonal injury, occurs when there is more widespread damage to the brain

A TBI sometimes involves bleeding in or around the brain (as in the case of a subarachnoid hemorrhage or epidural hematoma) that may exert pressure on the brain itself, negatively affect blood flow, or cause dangerous fluid buildup. Infections or low blood pressure can make injuries and the intracranial pressure they cause even worse. 

In other words, there is significant potential for serious complications with TBIs. That’s why taking measures to prevent head injuries and seeing a doctor right away if one does occur can be important.

What are the types of traumatic brain injuries?

Brain injuries are typically categorized based on severity. A person can have a mild, moderate, or severe TBI.

Mild TBIs

Mild traumatic brain injuries are often referred to as concussions. A mild TBI is typically characterized by unconsciousness lasting less than 15 minutes. This type of blunt TBI can happen when someone hits their head, is in a car crash, or experiences another jolt or bump to the head. 

Common symptoms of a mild TBI can include headache, dizziness, blurred vision, and changes in sleep. Someone with a mild TBI will likely recover within a week to a few months. 

Moderate TBIs

Like a mild TBI, a moderate TBI can result from car accidents or other head traumas. A brain injury is usually considered moderate when the individual loses consciousness for a period of time between 15 minutes and six hours. A moderate TBI may feature all of the symptoms of mild TBI, as well as additional symptoms. 

Someone with a moderate traumatic brain injury may also experience amnesia for up to 24 hours after the initial injury. People with a moderate TBI may experience acute symptoms, like confusion, for a few weeks after their injury, too. They can also have physical, cognitive, and behavioral impairments for several months or for life.

Severe TBIs

Someone is normally considered to have a severe TBI if they experience a loss of consciousness for more than six hours. Some people with severe TBIs can be in a coma for days or weeks and face permanent disability. According to the Centers for Disease Control (CDC), falls and firearms tend to be responsible for the most severe traumatic brain injuries. 

People with severe TBIs typically need assistance from loved ones to complete daily tasks in the months and years following the injury, and many individuals with a severe TBI utilize rehabilitation services to improve cognitive, physical, and behavioral impairments. Recovery time can vary, but someone with a severe TBI may recover within three months to a year or more, when recovery is possible.

What are the symptoms of traumatic brain injuries?

Though the effects of TBIs can vary significantly depending on severity and other factors, some common symptoms can include the following:

• Amnesia, confusion, or challenges in forming new memories
• Difficulties speaking or understanding conversations
• Trouble concentrating
• Dizziness, balance issues, or fainting
• Mood changes, such as increased irritability, depression, or aggression
• Disrupted sleep patterns and fatigue
• Impulsivity
• Slurred speech
• Blurred vision or sensitivity to light
• Headaches

In addition to medical treatments recommended by a doctor, people with a TBI may also find it helpful to work with a mental health therapist. They can provide support in recovering from any emotional trauma associated with the injury and coping with the mental health aspects of recovery. Meeting with an online therapist may be a convenient and affordable way to get this kind of care.

Red-flag symptoms that indicate a need for immediate care

It’s typically recommended that anyone who sustains a head injury seek immediate medical attention, especially if they’re experiencing symptoms like:

• Repeated vomiting
• Recurrent seizures
• Slurred speech
• Loss of consciousness
• One or both pupils enlarged, or one larger than the other
• Increasing agitation or other unusual behavior
• In children, changes in eating or nursing habits, or loss of a certain skill
• Any worsening symptoms

TBI risk factors and prevention strategies

Certain protective measures may be able to help prevent TBIs from happening. Examples of TBI and concussion prevention measures include:

• Wearing a helmet
• Wearing a seatbelt
• Installing grab bars and non-slip mats in bathrooms, a common place for older adults to experience falls
• Doing exercises to improve balance and coordination, especially for older adults
• Installing gates and window guards for children

Anyone may benefit from participating in concussion and TBI prevention, especially those with additional risk factors for developing a more severe brain injury. For example, children, teens, and older adults may be at higher risk of brain swelling. Also note that, although further research is required, studies suggest that people with certain genetic markers may be at higher risk of complications from a head injury.

How TBIs are diagnosed

A person must consult a medical professional to get screened for a TBI. Especially in cases of mild TBI symptoms or concussion symptoms, they’ll often start with an evaluation of the person’s primary injury as well as their basic motor functions, speech, and any new behavioral symptoms, nervous system issues, or cognitive difficulties. 

They may also order or conduct specific neuropsychological tests and blood tests, as well as neurological imaging (like a CT scan or MRI). Note that a doctor will often recommend additional check-ups in the following months, since additional damage can develop after the initial injury.

The traumatic brain injury recovery process

The recovery time for a head injury can vary based on TBI severity. A mild TBI tends to have a shorter recovery period than a moderate TBI, while moderate TBIs tend to have a shorter recovery period than a more severe or serious TBI. 

People with a mild TBI tend to fully recover within three months, if not sooner. People with a moderate TBI tend to recover all brain functions within six months, but additional steps are sometimes needed.

Treatment and rehabilitation options

A doctor’s recommendation for treatment of a TBI may depend on many factors, including but not limited to the injury’s severity and the patient’s health status otherwise. Neurosurgery is sometimes required. Occupational therapy, speech therapy, physical therapy, cognitive rehabilitation, and other social services may be recommended as well. Mental health therapy is often helpful in managing emotional symptoms.

Length of recovery and potential complications 

People with a moderate to severe TBI may have a long road to recovery. Some people with a moderate TBI may recover in just a few weeks, while those with the most severe TBI will likely go through the following steps over the course of months or years, as long as they do not experience the most severe state, called brain death. If not, they may experience one or more of the following: coma, vegetative state, minimally conscious state, emergence from a minimally conscious state, and post-traumatic confusion state. Each of these states typically allows the individual to regain a bit more consciousness and the ability to interact. After the post-traumatic confusion state, some individuals slowly improve over time. 

Resources for people with a traumatic brain injury and their families

Traumatic brain injuries may not just impact the injured individual; they can also significantly impact their family and loved ones. Caring for someone with a traumatic brain injury can take a lot of time and energy, and caretakers can easily find themselves stressed and overwhelmed with worry, fear, and exhaustion. Several resources, from national organizations to local support groups, may be available to provide support, from helping people find caregivers to informing them of the latest clinical trials for new treatments.

Brain Injury Association of America

This organization generally focuses on increasing awareness, advancing treatment, and supporting those living with traumatic brain injuries. On their website, you can find informative webinars, information about local support groups, survivor stories from those with TBIs, and plenty of educational resources.

National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR)

The NIDILRR can be a helpful resource for those with a disability from a TBI or for caretakers of someone with a TBI. The NIDILRR frequently offers educational materials, funding and grant opportunities, and insight into current research on TBIs. 

Family Caregiver Alliance

This organization typically works to advocate for caregivers of those with cognitive impairments. Through its website, the FCA can connect caregivers with support services, such as wellness programs, legal and financial consultant vouchers, human services and care planning, and respite services. This organization can also offer self-care tools for caregivers who may be experiencing burnout, anxiety, or depression. 

Other resources that may be helpful to the TBI patient’s family members include national support groups like Severe BI Caregivers, TryMunity, and the Smart Patients Brain Injury Discussion Forum. Each of these resources can provide opportunities for family members of TBI patients to connect with others who understand their unique situation and can provide solidarity and comfort. Each support group normally meets virtually, making them more readily available to all.

TBI: Veterans and Service Members

Traumatic brain injuries tend to be more common in veterans and active duty service members. Veterans and service members may be more likely to experience ongoing symptoms related to TBIs and an increased risk for psychiatric disorders like post-traumatic stress disorder (PTSD) and depression.

Due to the higher prevalence of TBIs among this population, it can be critical to be aware of the resources and support systems in place for active-duty service members and veterans. Programs like the Air Force Wounded Warrior Program, the Army Reserve Family Program, and the National Intrepid Center of Excellence can all be helpful resources for education, support, funding, mental health care, and rehabilitative services. 

Therapy for mental health support

Whether you have experienced a traumatic brain injury or are caring for a loved one with a TBI, you have likely experienced a range of difficult situations and emotions. People who experience TBIs may go on to develop depression and/or experience mood changes, problems with social functioning, and decreased overall mental health. Family caregivers often experience psychological distress as well. In both cases, a TBI (or caring for someone with a TBI) can lead to mental health concerns. 

Benefits of online therapy

Connecting with a licensed therapist can be one way to address mental health concerns associated with a TBI. For those with limited mobility or busy schedules, online therapy may be a convenient option for improving mental health.

Online therapy generally offers the same benefits as traditional, in-person therapy, but from the comfort of your home. Whether you’re experiencing symptoms that may prevent you from driving to an in-person practitioner or are caring for someone who requires constant supervision, online therapy may remove barriers to receiving professional support.

Effectiveness of online therapy

Online therapy can often be similarly effective to in-person therapy. Consider a 2023 study seeking to investigate the efficacy of an online intervention in reducing distress in caregivers of patients with TBIs, which indicates the tool’s effectiveness. Caregivers typically experienced reduced anxiety after the online therapy intervention, while TBI patients demonstrated improvement in motor control, functional independence, cognitive functioning, and behavioral responsiveness. Keep in mind, however, that online mental health therapy is not a replacement for any in-person medical or physical therapy treatments a person with a TBI may need.