Anxiety After Brain Injury

Source: Mohamed Hassan/Pixabay

Anxiety after brain injury comprises different brain states, from direct neurophysiological damage to the social consequences of brain injury.

Busy Brain

"Busy brain" is a term clinicians use to describe an anxiety state in an injured brain. Instead of oscillating at normal brainwave frequencies, neurons oscillate at much higher frequencies, the frequencies associated with anxiety.

This anxiety type manifests like a hamster wheel that never stops and the hamster running in it has drunk 10,000 caffeine-laced drinks. It’s like the neurons go bananas; you cannot stop the round-and-round thought that keeps your brain busy with it, excluding all other thoughts.

It’s not psychological. It’s neurological.

You cannot stop it on your own, and being expected to do so increases the busy brain and thus anxiety.

Brainwave frequencies associated with busy brain range from roughly 21 to 35 Hz in the beta category. The entire brain may not be producing these high-beta frequencies—they may be localized to certain areas—but the subjective feeling is the same.

Drs. Lynda and Michael Thompson wrote in 2021: “Three characteristics distinguish normal beta EEG waves from Spindling Beta [busy brain]—very high amplitude, a narrow frequency range and waves that are synchronous. They have the shape of alpha waves but are much faster frequencies than alpha.”

Diagnostics with qEEG reveal where busy brain is located and the specific brainwave frequencies that are in excess. To permanently retrain the brain not to produce these frequencies is like peeling an onion. You begin with the widest range and narrow it down over time; for example, begin reducing 21 to 35 Hz at CZ; narrow down over time to 24 to 28 Hz. As the disinhibiting brain training progresses, anxiety and related irritability drops or disappears.

In addition, the Thompsons wrote, “Theoretically, increasing SMR (13-15 Hz) amplitudes would also decrease anxiety and we do find that combining SMR neurofeedback with HRV training is extremely effective for inducing a calm yet focused state of mind.” SMR are the brainwaves of relaxed, focused attention.

Confusion

Commonly, injured neurons and neural networks affect cognitions. Damaged cognitions may include loss of concentration, distortion of perceptual abilities, loss of memory both short-term and long-term as well as working memory, loss of affect, loss of identity, and so on. In addition, brain injury slows processing down significantly.

MSKTC's FactSheet noted, “changes in their thinking abilities, such as memory, attention, speed of thinking, and reasoning…can cause [people with brain injury] to feel overwhelmed if they can’t remember things or keep up with what others are doing or saying.”

"Gravity," a Star Trek: Voyager episode, demonstrates this perceptual difference well. Tuvok, Paris, and The Doctor crash-land on a planet that exists in accelerated time. Voyager remains in normal time. To Voyager, the planet is spinning like a vortex. To the three men, time appears normal on the planet but Voyager seems very slowed down. Voyager is like the person with the brain injury; Tuvok, Paris, and The Doctor like the uninjured.

Another way to think of it: For the person with brain injury, trying to participate in a conversation or make a decision is like watching a show sped up. Voices squeak rapidly in helium-high frequencies with words running into and over each other at 200 kph. Everyone around you understands the words and follows the conversation, except you. Everyone expects you to keep up with the squeaky voices and to comprehend the rapid words in real time. You’re the only one who cannot make out the words, process them in real time, and respond. You see people laughing or nodding, and you cannot participate with them. You think: "It’s impossible! Who can make out the words?!" They think: "What’s wrong with them?" They become exasperated with you while confusion reigns within you.

Slow processing creates confusion because you can’t comprehend in real time, whether it’s conversation, traffic lights, picking out apples, someone yelling at you, working out a tip on a meal, or reading a public transit map. You see others having no difficulty, you don’t understand why it’s so hard for you, and you’re given no time to process. Confusion arises. That confusion births social anxiety about why you cannot keep up, what is happening, being left behind, not belonging anymore, and so on.

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Impaired perception also creates confusion. Why is someone laughing or smiling? You can’t perceive the humour. Damaged cognitions begin to intersect: loss of humour plus impaired perception equals greater confusion. Throw in slow processing, and anxiety ratchets up and irritability sets in. Panic may appear.

Confidence Loss

Confidence in one’s competencies lessens anxiety. The opposite is true as well: When brain injury suddenly and inexplicably yanks away your talents and skills, when you begin to fail in areas you either performed automatically or well, your confidence falters. You begin to become anxious about not knowing how to do something you used to do easily; you become confused when you inexplicably fail friends, family, colleagues, and yourself. Anxiety and resentment emerge when asked to do something you cannot. That anxiety may expand into other areas—for if you cannot read books you used to find easy, if newspaper articles become weirdly incomprehensible, and if comic strips all of a sudden make no sense, then what else will vanish from your competencies?

Two prongs of next-gen treatments could help. Neurostimulation and neuromodulation restore neurons and neural networks to their harmonious state and reset brain frequencies. The sooner the neurophysiological damage is repaired, the less likely a person will suffer confidence loss and social anxiety. Whenever neurons are treated, clinicians ought to be mindful about rebuilding confidence as competencies and processing speed return and confusion diminishes.

Copyright ©2026 Shireen Anne Jeejeebhoy