In this blog series, we delve into the epidemic of loneliness, specifically examining its unique impact on individuals who have endured a brain injury or stroke. Of particular significance is our exploration of the study conducted by Lowe et al. (2021), which focuses on the internal experience of loneliness and identifies five themes that encapsulate the various facets of loneliness in survivors of brain injury:

  1. “Shattered to pieces”: loneliness in trauma, identity confusion, grief, and anger.
  2. “Left behind”: loneliness in the world continuing without you.
  3. “Wishing for an open wound”: loneliness in invisibility.
  4. “Papering over the cracks”: loneliness in concealment
  5. “Rejecting parts of self”: loneliness in internalized stigma and rejection of part of self.

We will now explore themes of HEALING through the process of psychotherapy, where participants were able to tap into their ability for integration and connection to self, self-compassion, and a degree of acceptance. I stress a degree of acceptance, as it is normal and healthy to be mad at the injury and the changes that took place. However, a degree of acceptance allows for movement to healing without resignation in wanting to continue to build a new self. The two themes of healing that emerged are:

1: Healing The Cracks: Being able to move forward with a positive transformation and to recognize that healing is taking place, albeit differently, was a common theme. Participants outlined the most common therapeutic factors that allowed “healing with cracks” to occur. These included processing of emotions, psychoeducation, being held in mind by the therapist, development of dialectical thinking, and mindfulness.

A. Processing of emotions: Every person who sustains a brain injury has been through a traumatic event. Trauma breeds multiple emotional experiences (e.g., anger, sadness, loss, and hopelessness), and those unprocessed emotions lead to disconnection from self and others.

Barry (male, 40 years, 8 years post-injury from an assault, wheelchair user) “Speaking with my therapist has really helped me. It’s helped me to digest the magnitude of what has happened. If you don’t deal with something mentally, eventually it’s going to catch up on you.”

B. Psychoeducation: Gaining knowledge of their injury, both in terms of neurological and emotional impacts, is important and beneficial.

Ian (male, 45 years, 5 years post-injury, car accident) “The power of knowing that it’s not that there is a demon inside you, that you’re a bad person knowing it’s literally because your frontal lobe isn’t; getting a chance to buffer the limbic system, it’s about knowing the physicality of it. It makes me feel better to know what is going on.”

C. The pre-and post-injury self being held in mind as acceptable by the therapist: the broken, shattered, fragmented, and confused sense of self can begin to be healed through the process of being held in mind by the therapist. The therapist is in a unique position to have access to the person’s invisible injuries and to hold those in mind with the positive attributes of the person. This allows for the whole person to be acceptable in the mind of the therapist, both the visible and invisible injuries.

Cian (male, 52 years, 2.5 post-injury, stroke) “The therapist has seen me, the new injured me that I try to hide, and that helps, letting someone else see and talking about the changes together.”

D. Mindfulness: The development of mindful thinking (non-judgmental, compassionate, and gentle) can aid in the integration of and connection to self. Mindfulness can aid in developing patience, self-compassion, and the ability to cope with the pain and loss of their situation.

Marian (female, 50 years old, 5 years brain cyst) “Meditation and mindfulness taught me to sit with the fear and not fight against what’s there. It really struck a chord with me; it helped me with what I was going through at the time.”

E. Developing dialectical thinking: With therapy, a brain injury survivor can get to the point where they can hold two opposing truths: loss, pain, unfairness, and anger for sustaining the injury, but also acceptance and hope for the present and future. The acknowledgment and validation do help brain injury survivors to make progress forward and help with the connection to their post-injury self. The ability for dialectical thinking helps in holding the two selves (pre- and post-injury), which leads to the integration of self. This ability to accept and integrate pre and post-injury selves allows connection with self and with other people, which in turn eases loneliness.

Liam (male, 34 years old, 8 years post-injury, bike accident) “Yes, of course, I wish it had never happened; my life would be totally different right now. But this is the road I am traveling now, and I have got to travel this road. I live with my brain injury; it’s part of me… maybe always, but it won’t define me, it won’t keep me down.”

Please join me for the next blog, where we discuss the final theme of recovery: “Visible with cracks,” and we continue to examine the importance of therapy with a counselor who understands the unique properties of brain injury. At Colorado Brain Injury Therapy, we are committed to providing specialized mental health therapy for individuals navigating life after brain injury.