The psychology of persistent concussion symptoms
Our countdown of the top five concussion breakthroughs of the past five years continues with number four: the psychology of persistent concussion symptoms.
Over recent years, there has been a gradual but significant understanding of how various mental health and psychological factors play into concussion recovery.
Some of the same imaging findings discussed in yesterday’s blog post (fMRI, Diffusion Tensor Imaging, etc.) have found very similar patterns of brain function in concussion patients, as also found in patients with anxiety or post-traumatic stress disorder (PTSD).
A great example is that studies examining concussion recovery in military veterans vs. those with PTSD, show very similar symptom profiles. Within the research, we have also seen repeatedly that having a concussion AND PTSD provides much worse outcomes than concussion alone.
We have also found that patients with pre-existing mental health issues, like anxiety or depression, are at higher risk for suffering a prolonged recovery. It is unclear at this time why this is. One possibility is that a concussion injury worsens a pre-existing condition, or amplifies stress for someone who may already be dealing with physical and cognitive problems due to a mental illness.
One of the best treatments for concussion is prompt evaluation by a clinician with training and experience with concussion, who can provide patients with the appropriate education and reassurance. This is critical. Receiving proper concussion education, as well as guidance to ease concerns, provides a patient with the appropriate management strategies to optimize their recovery. The longer a patient waits to see a trained concussion practitioner, the increased likelihood there is that they will receive improper advice from an untrained healthcare professional or “Dr. Google”.
With the right approach, concussion is recoverable. However, sometimes the treatment requires patients to push beyond their comfort zone. Fear avoidance behaviours may prevent patients from pushing these boundaries – reducing their chances of recovery as a result.
Notably, research examining the role of mental health in concussion recovery, as well as the best evidence-based treatments for concussion, landed cognitive behavioural therapy (CBT) in the International Consensus Statement for Concussion in Sport as a recommendation for patients with persistent mood or behavioural disorders following concussion.
For the reasons listed above, the greater understanding of mental health and its implications for concussion recovery places at number four on our list of the top five concussion breakthroughs of the past five years.
To read the number three concussion breakthrough of the past five years, click here!