Coping with Injury

Car accidents, work-related accidents, slips and falls, and other types of accidents can have a major effect on our lives. The impact does not necessary correlate with the extent of our physical injuries. Some people who suffer severe physical injuries experience little long-term emotional effects, while others who suffer only minor physical injuries experience serious emotional effects. Why does this occur?

The way we experience any event depends on a complex interaction of our unique psychological and physical factors at that point in time. Our experience of events and reaction to them depend on our previous experiences, our mood, our beliefs about ourselves and the world, our personality characteristics, our emotional and physical resources, the reaction of other people, and a myriad of other psychological and physical factors. For these reasons, it is difficult to predict a person’s experience in a car accident if we look only at the damage to the vehicle. Many times people walk away from totalled cars with little long-term anxiety, while others may experience long-term post-traumatic anxiety after an apparently minor accident.

Whatever emotions we experience following any type of personal injury or accident, we have a right to feel them. They are not a reflection of personal weakness, but rather a reflection of the unique psychological and physical factors that combined to produce those emotions. Our goal at such times is to use our inner resources to cope better and to help our bodies and minds heal.

Pain Problems (see also Pain article)

Some people who are involved in accidents experience acute pain that becomes chronic. When the person has healed outwardly and appears to be physically normal, family, friends, and coworkers may relate to the person as if there is no pain problem. This can create enormous stress for the person with pain and can lead to self-doubt, self-denigration, and depression.

All painful sensations are real, whether or not we understand the underlying physical and psychological factors giving rise to them. The only way we can understand someone else’s pain is to ask directly about the experience. Just as we cannot know the reaction of a person who was involved in a car accident just by looking at the amount of damage to the car, we cannot know the experience a person is having just by looking at the body. For this reason, using a simple 10 point pain scale helps us communicate about pain and other sensations more accurately. 0 means no pain whereas 10 is the worst possible pain you can imagine. If your friend tells you that his pain is an 8, this gives you a more accurate indication of intensity than if he simply tells you, “It hurts bad.”

Psychological strategies for pain management are effective in helping people experiencing pain and other sensations, including itching, nausea, and stiffness. Since the brain is involved in all of our experiences, when we alter our thoughts, reactions, interpretations, and emotions, we can change our experience of uncomfortable physical sensations.

Post-Traumatic Stress Symptoms

Post-traumatic stress symptoms reflect anxiety that follows an experience that the personperceived as life-threatening or very frightening. This could be an event that involved the person directly or one that the person witnessed. Physical injury may or may not have occurred. Not all people who experience life-threatening or very frightening events experience post-traumatic stress symptoms. As discussed earlier, our reactions to any event depend on our unique psychological and physical makeup. If a person develops post-traumatic stress symptoms, those symptoms should not be viewed as a sign of personal weakness but rather a reflection of the interplay of psychological and physical factors that occurred at that point in time. The main goal should be to cope better. There are numerous studies that support the effectiveness of psychological treatments for post-traumatic stress symptoms.

The following lists contain common symptoms of post-traumatic stress. Not everyone with post-traumatic stress experiences all of these symptoms.

(A) Disturbing memories and intense reactions to reminders of the event

Frequent memories of the event on a day-to-day basis

Frequent dreams about the event

Flashbacks to the event as if it is occurring in the present moment

Intense emotional distress and physical symptoms with any reminder of the event

(B) Avoiding thoughts about the event and emotional numbing

Trying to avoid thinking and talking about the event

Trying to avoid going places and doing things that trigger memories of the event

An inability to recall important aspects of the event

Feeling much less interested in normal activities

Feeling emotionally distant from others

Experiencing difficulty feeling a wide range of emotions

Experiencing a sense that death is close or that one will not live for a long time

(C) Hyper-arousal

Difficulty falling and staying asleep

Experiencing angry outbursts and feeling much more irritable than normal

Experiencing difficulty concentrating

Being excessively watchful and guarded for fear of injury to oneself or others

Startling easily when there is a loud noise or sudden event

We are biologically programmed to experience anxiety after a perceived life-threatening or very frightening event. We have evolved to experience anxiety as a protective mechanism. All of the symptoms of post-traumatic stress have a purpose – to reduce our distress about the event and to increase the probability that we will be safe. However, the symptoms can interfere with day-to-day life and get out of hand. If that happens, psychological treatment should be considered.

Brain Damage

Some people who are involved in accidents and personal injuries experience injury to the head which results in brain damage. This can occur with or without a direct blow to the head. For example, many people who experience whiplash injuries in car accidents also experience brain damage because the brain collides with the skull when the head is suddenly moved back and forth upon impact. In this case, the head may not have actually hit any object but brain damage can still occur.

As is the case with other physical injuries, one cannot determine the degree of brain damage or even if there is brain damage just by looking at the forces acting on the head. Some people who experience concussions while playing hockey, for example, do not experience brain damage but others do.

People who have experienced mild to moderate brain damage after an injury often find it extremely difficult to cope. Since they appear to be normal to themselves and others, they often try to carry on as if nothing has changed. When they fail to complete tasks as they did before, they often become anxious, depressed, and frustrated. Brain damage that is severe cannot be denied. However, mild to moderate brain damage can be difficult to accept because the signs are often subtle.

One of the hallmark signs of brain damage is cognitive inefficiency. It takes the person longer to think things through, to remember, to organize, to complete tasks, and to learn new information. The brain needs longer to make the connections. This problem can seriously disrupt conversations with others, as well as day-to-day life at home and at work. It can lead to misunderstandings. Others may think of the person as lazy or unmotivated. The person with mild to moderate brain damage may experience self-doubt and self-criticism.

We now know that the brain can grow new connections if a person with brain damage works toward healing. However, the person must first accept that the damage has occurred. This is no small achievement. For most of us, accepting that we have a problem with a leg or an arm comes much easier than accepting that something is wrong with our brain. The brain is, for most of us, the centre of who we are. To accept that something is wrong up there is especially frightening.

Psychological treatment can help people move toward accepting the problem, and can also help them cope better and help their brain function improve. Once a person is working toward healing, various psychological interventions can help the person emotionally. Techniques to help the person improve brain functioning can be tailored-made, often involving day-to-day activities at home and at work.

Anger-Management Techniques

Many people who experience an accident or personal injury are primarily angry about the accident and the impact it is having in their lives. They may become more irritable and experience frequent verbal or physical outbursts. Sometimes this problem occurs in day-to-day life at home and at work. Other times it becomes more evident as road rage.

Regardless of the way in which angry feelings are experienced, a person with anger-management issues can learn to cope better. Psychological treatment aims to help each person with an anger-management problem find the best strategies to constructively express their angry feelings without harming themselves, others, or objects. One of the most important steps is teaching the person to monitor levels of anger and to take action to deal with the emotion more adaptively and constructively before it peaks. Learning to deal with outbursts when they do occur is also an important part of treatment.

Some people participate in anger-management group therapy programs, while others benefit more from individual treatment. I believe that people usually know the approach and techniques that fit best for them.

Legal Involvement

Sometimes people who have experienced an accident or personal injury decide to take legal action. Psychologists not only help people directly by providing them with treatment but can also help by completing assessments and reports for legal purposes.

I have many years of experience completing psycholegal assessments and reports. I have also provided expert testimony at trials and arbitrations. Not all treating professionals have experience in this area.

Call for a free telephone consultation or to arrange an appointment

For further information

Pain

Chronic Pain Association of Canada

Canadian Pain Coalition

The Canadian Pain Society

Chronic Pain Information Page: National Institute of Neurological Disorders and Stroke

American Chronic Pain Association

American Pain Society

Post-Traumatic Stress Symptoms

PTSD Association

Body and Health Canada: PTSD 

National Institute of Mental Health: Post-Traumatic Stress Disorder

American Psychological Association: PTSD Treatments Grow in Evidence, Effectiveness

Brain Damage

Brain Injury Association of Canada

Ontario Brain Injury Association

Brain Trauma Foundation

Brain Injury Association of America

Anger Management

American Psychological Association: Controlling anger before it controls you

Mayo Clinic: Anger-Management

Help Guide: Anger Management

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