Personality & Coping with Brain Injury

Mike Martelli, Ph.D

Injuries do not occur in a vacuum or to people with uniform histories and personalities. Each of us possesses a unique history and style and strengths and weaknesses in coping. Each injury also brings a unique set of stressful demands. The more the demands of the injury conflict with an individual's personality and coping style, the greater the difficulty that can be expected in adapting to its residual effects.

The following table depicts several personality styles associated with difficulties in adaptation following brain and other injuries. Often, conflicts between personality style and injury cannot be overcome without special support. Psychological intervention can often help reduce such mismatches and bolster more adaptive coping styles and facilitate better adaptation to impairments following injury.

Vulnerable Personality Styles
Style Premorbid traits Post morbid reactions
Overachiever Sense of self derived from driven accomplishments, which is frequently accompanied by obsessive compulsive traits Catastrophic reaction if drop in performance is perceived
Dependent Excessive need to be taken care of, frequently leading to submissive behaviors and a fear of separation Paralyzed by symptoms if critical erosion of independence occurs
Borderline personality traits Pattern of instability in interpersonal relationships and self-image with fear of rejection or abandonment Exacerbation of personality disorganization, including despair, panic, impulsivity, instability, and self-destructive acts
General Insecurity Weak sense of self, which can include shame, guilt, and dependency needs Magnification of symptoms
Grandiosity Overestimation of abilities and inflating accomplish- ments, can include need for admiration and lack of empathy Minimization or denial of symptoms. If failure results, crash of self-esteem can result in catastrophic reaction
Antisocial traits Tendency to be manipulative or deceitful, temperamental, impulsive and irresponsible; lacks sensitivity to others Possible exaggeration or malingering, increased risk taking, irritability, takes little responsibility for recovery
Hyperactivity Restless, unfocused and sometimes disorganized Attentional difficulties and impulsivity may be compounded; possible oppositional behavior
Depressed Mood fluctuations dominated by negative affect Increase of depressive symptoms, despondency
Histrionic style Emotionality and attention seeking behavior Dramatic flavor to symptom presentation; blaming behavior
Somatically focused Preoccupation with physical well being, reluctance to accept psychological conflicts. Endorsement of multiple premorbid physical symptoms intermixed with new or changing post morbid residua
Post traumatic stress disorder Prior stressors produced an emotional reaction of fear and helplessness Decreased coping ability, cumulative effect of traumas with exaggerated reaction to current crisis
from Ruff, RM, Mueller, J and Jurica, P. (1996). Estimation of Prermorbid Functioning after traumatic brain injury. NeuroRehabilitation, 7, 39-53.

Protocol for Management of Emotional Reactions Associated with

Temporal Lobe Epilepsy (TLE)

and Temporal Lobe Injures Resulting from Brain Injury

Mike Martellli, Ph.D.

In our neuropsychological and neuromedical rehabilitation practice, persons with seizure disorders frequently experience the following emotional reactions:

Four common themes in emotional reactions for persons with TLE seen in our service include:

(1) Intensified feelings of being deprived, mistreated, or victimized; (2) Intensified anger, and (3) Intensified idealization and positive attraction; (4) Excessive abstraction which interferes with developing and maintaining stable social and vocational adaptation.

In working with patients to increase control of emotions and improve problem solving and general stress management and coping, we have developed a 4 step self-control procedure called Re-L.I.F.E.. The general outline for the Re-L.I.F.E. procedure is as follows:

Re:

L-Label: re-label the feelings as illegitimate, hyper-intensified emotions I - Interpret: re- interpret them as emotional amplifications or hyperintensifications caused by electricity (i.e., kindling or hyperconnectivity) or B.S. (Between Seizure electrical amplification)

F- Focus: re-focus on anything less distressing, more pleasant, different, in order to disrupt the developing escalation of electricity and intensified emotions

E - Evaluate: re-evaluate the theme of electricity intensifying emotion as a component of epilepsy, as requiring that the primary red flags be monitored, and, when identified, re-interpreted more accurately, so that they can be controlled.

When this "self-talk" self-control procedure is used before the amplification of emotions progresses too far, it can counter amplification, preventing the escalation of emotions that leads to: psychic changes and increased emotional distress; increased fatigue and possible eventual exhaustion; and increased probability of eventual seizures - and a recurring pattern of poor emotional and/or seizure control.

Notably personalized posters & graphic representations are typically employed to assist with learning and application of this intervention.

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Protocol for Management of Emotional Incontinence Following Stroke and Neurologic Illness

Michael F. Martelli, Ph.D

Concussion Care Centre of VA and Pinnacle Rehabilitation

Emotional incontinence is a frequently observed phenomenon following stroke. Emotional incontinence is typically characterized by easy, frequent tearfulness and is usually triggered by relatively innocuous events that usually elicit only milder emotional reactions. The emotional expression associated with it is usually relatively superficial, is most often regarded as exaggerated and unintentional, and is often easily redirected. It is frequently experienced after neurologic insult, especially stroke, and especially early after insult, although it can also be quite persistent. It is thought to be accounted for by disconnection between temporolimbic emotional processing centers and bulbar centers that control gestural / emotional expression. It is contrasted with genuine grief and distress reactions where the releaser is singificant and powerful and the emotional reactions strong and consistent (e.g., catastrophic reaction to inability to express an important need or recent discovery of paralytic limb).

Importantly, emotional incontinence. It can be disruptive socially and vocationally and can be accompanied by significant anticipatory and reactive embarassment that can lead to social avoidance. In working with patients to increase control of emotional incontinence, we have developed a 4 step self-control procedure called Re-L.I.F.E..

The general outline for the procedure is as follows:

Notably, personalized posters & graphic representations are typically employed to assist with learning and application of this intervention. Case study efficacy data are presented that show that when this"self-talk" self-control procedure was employed consistently, especially with reminders from others, it developed into an effective control mechanism that greatly reduced incontinence expressions.

Rehabilitation is the SystematicProcess of

Removing Obstacles

to Independence

& Accessing Opportunities

for Achievements

(Of Desired Goals)

in the areas of

Love, Work and Play!

The Purpose of Rehabilitation

is to Change Destiny!

© 1997: M.F. Martelli, Ph.D. & "Obstacle Busters" Cope Group Members: Jan Flowers, Tom Byrnes, Jack Hodges, Dr. Joel Finklestein, Brain Stephens, John Mitchell, Tom Hale, Jim Fenerty, Evelyn Phillips, Rick Peters, J.P. Gibson, John Mitchell, Tom Hale, Jim Fenerty, Evelyn Phillips, Rick Peters, J.P. Gibson, Danny Burnett, Chris Hignutt, Tommy Peden, DavidBrummet, Sarah Goldmann, Matt Tacey, Jay Weaver & Lynn Batley, David Mourer, Rudy Lee, Patrick Quinn, Dennis Weymouth, Laura Watts, Laura Hunter, Barbara Watts, JD Smith, Jamal Alkayed, Charles Smith, Linda Beales, and others...

For Additional Habit Retraining and Rehab Related Readings

Simplified Neurophysiology & Recovery Requirements, Catastrophic Reaction & Recovery, Etc.

Vulnerable Personalities, Sample Protocols for Emotional Management, Etc.

HeadsUp - A Great Online Survivor Newsletter with many features and good articles!

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