No one ever goes through life thinking they are going to rehabilitate from a concussion/mTBI (mild Traumatic Brain Injury) or the potential sequelae of post-concussion syndrome. After all, the definition has the word “mild” in its name, so it can’t possibly be that bad, right?
Unfortunately, those who do experience it, live in a world with a different brain and symptoms that can last weeks, months, years, or even the rest of their lives.
Brain injuries are alterations in your body’s Air Traffic Control center that can disrupt cognitive, psychological, emotional, and physical processes. These disruptions lead to changes in your thinking, cognitive processing, autonomic nervous system, visual system, vestibular system, metabolism, and even hormonal regulation—basically everything.
The most common cognitive symptoms experienced are difficulties with working memory, concentration, attention, and fatigue (Lindeløv et al., 2023). The most known experience I can compare this to is COVID brain fog, but worse.
One can experience “cogniphobia,” or a cognitive version of learned nonuse due to fear of negative outcomes from engaging in highly cognitive activities (Silverberg et al., 2017, 2018). This is similar to having an old cell phone with a short battery life. You wake up each day with 40% of the battery (brain) life one day, maybe 60% the next day, but never 100%.
Just like a roaming call, activities that require more energy deplete your brain battery rapidly. A cognitive task takes some energy, but if it is a cognitive/physical/emotional task, then watch out because your energy is going to deplete fast, leaving you with a brain that has an incredibly difficult time tolerating stimuli. Before you know it, you need to be in a room where you can lay down and sleep to allow your brain to catch up to everything it has experienced.
Brain injuries are an ever-changing landscape of symptoms to be navigated and addressed while working with subpar capacity. In the effort to get better, living has natural consequences. For example, going to a visually busy grocery store provokes symptoms, and you expect that to change during the next grocery run. Each time you get groceries, you hope things will get better or that you have reached a new threshold. Each time you do not discover a new threshold, it is further evidence of how far you have to go in your recovery.
Brain injuries are “strong inducers of negative self-expectancies” (Lindeløv et al., 2023). One literally has to do the same thing over and over again to test as they continually heal through time and rehabilitation, in search of the return to participating in life. This is a tough reality to face, knowing that you might not be successful. In your desperation, you look for anything that can help.
My research on hypnotherapy led me to find:
“One of the primary contributions of hypnosis to rehabilitation is its potential for facilitating change and accelerating learning. . . .An argument is made that self-hypnosis allows patients to develop an experience of ‘self’ that reflects mastery and competence” (Appel, 2003).
Jamieson (2016) also tells us hypnosis is well positioned to alter modulation of expectancies.
According to case studies, large and persistent working memory improvements were found after 4 hours and 8 hours of hypnotherapy treatments (Lindeløv et al., 2017).
Depression and anxiety decreased, and patients reported less fatigue. Effects are smaller for malingering patients (those that might benefit from additional symptoms such as in legal cases) (Lindeløv, 2019).
Another study showed a one-hour reduction in the need for daily sleep and progress on a majority of patient-reported outcome measures (Kvamme et al., in review).
Hypnosis is cost-effective when compared to other treatments, including physical exercise, pharmaceuticals, Mindfulness-Based Stress Reduction, face-to-face therapy, attention process training, strategies to increase attention, and therapist-administered exercises to improve high-level cognitive ability (Lindeløv, 2015).
Some studies have looked at specific protocols. These protocols include the positive affirmation that thinking will become effortless, reliable, and automatic after hypnosis (Lindeløv et al., 2017).
These affirmations boost the patients’ expectations that thinking is easy and automatic and decrease the interoceptive monitoring and its cognitive impacts (Teodoro et al., 2018).
Overall, I found there is limited research into hypnosis for mTBI, and current evidence is derived from case studies and small sample size trials. Further studies are warranted to discover the efficacy and nuances of hypnotherapy in mTBI and post-concussion management. Many foundational theories for hypnotherapy exist to suggest why it could work.
So, in my rehabilitation journey, why not give it a try?
My personal experience with hypnosis was largely due to curiosity after experiencing a concussion and the lingering post-concussion syndrome impact for 1.5 years. I felt like I had tried everything, and I wanted to see if this modality could help me in any way. My specific goals were to address my frustration with my current situation, grieving for a life/lifestyle in my past and future, and procrastination due to fear of bringing on symptoms, A.K.A. cogniphobia.
All of the goals I wanted to address took up significant real estate in my brain whether I wanted them to or not, which left me with even less energy to handle the urgent things that needed to be handled. (Hello rent payment.)
A year into treating my brain injury and having tried or still using: neurology, neuropsychology, pharmacological interventions, supplement interventions, dietary changes, speech therapy, physical therapy, vision therapy, assistive technology, mindfulness, meditation, prayer, energy healing, and significant other lifestyle changes to address my symptoms and functional ability, I still had not given up hope in trying different things.
My speech therapist told me that it is the ones who learn the minute triggers of symptoms and learn the cause and effect who eventually get better.
Being frustrated at a situation that you cannot control (one that changes almost every facet of your life) is not easy to accept. How could I get rid of my frustration and cogniphobia?
Grieving takes a lot of energy normally, and now I have had to grieve my lifestyle, career, hopes, and dreams. This grieving process was taking up emotional real estate the size of Texas, California, and Alaska combined in my brain. How could I shrink my grief?
Why not talk therapy with a psychologist/counselor/social worker? Well, the healthcare provider in me just didn’t want to go this route. I felt that the more I spoke about my situation, the more sad and depressed I became. Talk therapy was not going to be the answer for me this time. I knew I needed something different.
I also didn’t feel like I had the emotional energy and brain capacity to do talk therapy. I literally needed a more direct modality because brain injury is something you cannot work harder at to heal. Working harder is no longer an option in your toolbox, and now you make trades in activities all day/week long in order to live. If you broke your leg, you would put it in a cast to heal and not walk on it. That is impossible to do with a brain, so you do the next best thing, which is to limit the amount of demands placed on the brain each day. Talk therapy was not how I wanted to spend my precious energy.
So I tried hypnosis.
Each session felt like I was peeling back another layer to get to the bottom of the emotional load I was carrying. It felt direct, it was incredibly humane, I did not feel retraumatized (at all), and I felt like I was in complete control the entire time.
My results yielded a way to decouple my frustration from the somatic symptoms I had been feeling, significantly decreased my frustration, decreased my need for sleep, and helped to move the grief through and out of my body.
During my sessions, each time I retrieved a “missing piece,” my body felt the need to “put” it in my neck/throat at the end of the session.
Interestingly enough, a few weeks later, I would find out that my C1 and C2 vertebrae were out of place and were in desperate need of skilled chiropractic care, which ultimately was a missing piece in my recovery.
Hypnosis has given me significant symptom relief and more cognitive capacity in a modality that was time and cost-efficient, without retraumatization.
Hypnosis gave me a place to put, and a way to deal with, these big emotions. ❤️
Written by contributing author, Rachael Angstadt, MS, OTR/L
References
Appel, P. R. (2003). Clinical hypnosis in rehabilitation. Seminars in Integrative Medicine, 1 (2), 90–105.
Jamieson, G. A.
Jamieson, G. A. (2016). A unified theory of hypnosis and meditation states: The interoceptive predictive coding approach. In A. Raz (Ed.), Hypnosis and meditation: Towards an integrative science of conscious planes (Vol. 470, pp. 313–342). Oxford University Press (xvii).
Kvamme, T. L., Lindeløv, J. K., Thomsen, K. R., Overgaard, R., & Overgaard, M.. (in review). Effect of hypnosis versus mindfulness on self-defined treatment goals and sleep following acquired brain injury: A randomized actively controlled trial. J. Clin. Psychol. Med. Settings.
Lindeløv, J. K. (2019). Cognitive rehabilitation following mild traumatic brain injury using hypnotic suggestion. Osf.Io https://osf.io/preprints/cxqth/.
Lindeløv, J. K. (2015). Computer- and suggestion-based cognitive rehabilitation following acquired brain injury. Ph.D. thesis. Aalborg University.
Lindeløv, J. K., Dall, J. O., Kristensen, C. D., Aagesen, M. H., Olsen, S. A., Snuggerud, T. R., & Sikorska, A. (2016). Training and transfer effects of N-back training for brain-injured and healthy subjects. Neuropsychological Rehabilitation, 26 (5–6), 895–909.
Lindeløv, J. K., Kvamme, T. L., Thomsen, K. R., Overgaard, R., & Overgaard, M.. (2023). Hypnosis for acquired brain injury: Four patient cases and five testable predictions. New Ideas in Psychology, 71 (2023) 101046.
Lindeløv, J. K., Overgaard, R., & Overgaard, M. (2017). Improving working memory performance in brain-injured patients using hypnotic suggestion. Brain: Journal of Neurology, 140(4), 1100–1103.
Silverberg, N. D., Iverson, G. L., & Panenka, W. (2017). Cogniphobia in mild traumatic brain injury. Journal of Neurotrauma, 34(13), 2141–2146.
Silverberg, N. D., Panenka, W. J., & Iverson, G. L. (2018). Fear avoidance and clinical outcomes from mild traumatic brain injury. Journal of Neurotrauma, 35(16), 1864–1873. Skewes, J., Frith, C., & Overgaard, M. (2021).
Teodoro, T., Edwards, M. J., & Isaacs, J. D. (2018). A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: Systematic review. Journal of Neurology Neurosurgery and Psychiatry, 89 (12), 1308–1319.
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