Coping After Brain Injury

Source: Pedro Figueras/Pixabay

In 2001, during my outpatient neurorehab at the Toronto Rehabilitation Institute (TRI), I enrolled in a 10-week stress management course as part of TRI’s clinical research. TRI tested our stress levels and had us rate our primary coping strategies. At that point, I was still grappling with my closed head injury diagnosis, understood I had a brain injury, and falsely believed that I’d be better soon, for I had not grasped that the medical system didn’t provide healing treatments and their strategies wouldn’t restore neurons and neural networks. As a result, I understood the test results but not the ramifications on my life or my familiar coping methods.

My top coping strategy prior to my brain injury was reading, and years later, brain biofeedback proved its physiological relaxation effect.

Prior to my brain injury, I read every day. I read newspapers in the morning; novels over lunch and during afternoon breaks; materials for my work throughout the day; literary tomes as a challenging habit; and emails and e-newsletters. I visited the library weekly and restricted myself to three mystery mass paperbacks per week. I could’ve read five. That was my biggest regret after brain injury: listening to complaints about my prodigious reading and cutting back, even though I read when they weren’t around or while keeping them company during TV watching.

About three months before I enrolled in the stress management course, my rehab team had informed me I couldn’t read anymore. The stress management assessment showed me reading as my top coping strategy; eating ice cream and chocolate as second. Guess which one became the top one by default?

Worse, my Life Change Index showed an 80 percent likelihood of experiencing illness in the near future. I had the worst combination: the highest stress levels, the loss of my top coping mechanism, and the elevation of an unhealthy coping strategy, which, along with changes to my hunger and appetite signals, created a new habit of eating when not hungry. My hair fell out.

Eighteen years later, I regained my top strategy, but I continue to struggle with incorporating reading in my stress management and with not using eating as stress management.

In 2001, TRI taught us post-injury coping strategies, but brain injury makes a mockery of retention, which the course and subsequent healthcare didn’t consider. As a result, coping for me became a stop-start series of learning, forgetting, experimenting, and some functional methods that reflected my drive to get better.

Research by Lazarus in 1993 contrasted two theories of coping: a personality trait versus an adaptive skill. Sasse et al in 2014 discussed two types of strategies: adaptive action/distraction versus maladaptive trivialization/resignation. A 2000 study by Bryant et al concluded “that reduction of PTSD and management of severe TBI may be facilitated by teaching patients more adaptive coping strategies.” They identified avoidant as maladaptive.

A 2024 overview study noted, “Coping strategies are essential for clinical recovery and for dealing with the stressful events that a clinical condition brings with it.” Of the 2,593 studies selected for review, Cardile et al analyzed 16 that met their inclusion criteria. “Research has shown that patients with ABI who use active coping strategies and are problem-oriented face the disease with greater resilience and a sense of self-efficacy and report fewer symptoms.”

Although I take issue with characterizing an injury as a disease, this conclusion dovetails with my experience as a person who identifies a problem, works to understand it, and seeks to resolve it. So is coping a combination of personality and acquired skills?

In 2014, Australian researchers studied pre-injury versus post-injury coping changes. They categorized coping styles as productive and non-productive. Significantly, they concluded both styles decreased after brain injury. I’d posit that this decrease reflects reduced cognition from brain injury, which combined leads to a loss of self-worth.

Cardile et al wrote, “Dealing with ABI pathologies is often viewed as a stressful situation that presents many challenges. As a result, individuals may struggle to maintain control over their lives. Coping resources play a crucial role in preserving feelings of self-worth and managing the demands of the disease.”

As I relied on food as my central coping strategy, my self-worth nosedived. As the researchers noted, brain injury leads to a continual struggle to regain control over one’s life. One’s brain no longer works or responds to one’s intentions, while people react in unpredictable ways, blaming and abandoning. One cannot control others’ reactions nor what insurance (public and private) will cover; one can only fight for support and healthcare; but then brain injury fatigue, loss of stamina, and loss of multiple functions work against persisting. Eating is about the only thing one has control over; yet as a coping strategy it is, in effect, in control of you, not you of it.

Traumatic Brain Injury Essential Reads

The Future of Football

Opioid Overdose Is Not Sleep. It Can Be a Brain Injury Event

In 2019, The Lancet published a call to change neurorehabilitation: “Acquired brain injury leaves survivors with a considerable burden of physical, cognitive, and psychosocial sequelae, and can also increase the risk of late neurodegenerative disease.”

This burden reduces coping capacity when most needed.

No matter where we live on the planet, people with brain injury need adaptive, productive coping capacities so that we can endure and heal from this devastating injury. Recognizing stress levels and assessing and teaching post-injury coping strategies isn’t enough; neurorehabilitation also needs to assess pre-injury coping styles and use effective treatments to rebuild former productive styles, support the use of active styles that include healthy distractions until they become automatic over the years, and reinforce taught productive styles. Since people with untreated brain injury struggle to retain habits and lessons, community care must continue to support existing styles and to innovate styles that adapt to changing brains, changing circumstances, and a changing world.

In order to recover from brain injury, coping strategies help weather daily challenges and emotional upheavals or lack of affect, so that one can hunt down, endure, and benefit from objective diagnoses and effective treatments and reclaim one’s potential.

Copyright ©2026 Shireen Anne Jeejeebhoy