Understanding Emotional Outcomes

  • Introduction
  • Causes
  • Outcomes
  • Things that Help


Many of the emotional difficulties people struggle with after brain injury are so complex, and cause such deeply felt emotions, that we have dealt with many of the issues on separate pages.

People can feel very overwhelmed by the impact of many unsolved emotions and it helps to break them down in order to be able to address them and understand what is happening.

Damage to the frontal lobes affects the way the executive systems are able to function and this impacts how you are able to control, regulate or respond to your emotions.

Following a brain injury, emotions can have either a conscious or an unconscious cause. Sometimes we are aware that the detail in our thinking patterns is creating a negative response on our feelings, and yet it seems impossible to break the patterns down. 

A neuropsychologist will be able to help you work through activities to help you gather information about what is causing your emotional responses and heightened or decreased feelings.

People need very gentle handling following a brain injuryThey need understanding, empathy, and support. We can usually sense and ‘see’ how people feel through their reactions. Behavioural responses, mood, and language all send subliminal or unconscious messages to us. A brain injury may mean we need to make adjustments to our habits and understanding.

Our emotions are a method that the brain uses to communicate with the thinking mind. This method acts as a safety mechanism because really the only other way that the brain can demonstrate that there are gaps in our data, or let us know that data is incomplete, is to pause or interrupt our thinking mind, which could be a nuisance or danger if it happened too much, and occurred at inappropriate times.

Negative emotions can create a myriad of symptoms, outcomes, and behavioural changes, and it can be challenging to know what is causing what. Individuals can feel as though they are swimming against an out-going tide, and can get to a point where they can no longer put a brave face on things.

Getting help at the earlier stages can help to prevent mental health issues, and it is vital to seek medical advice rather than thinking that things will pass or clear up on their own.

There is often a cross-over between causes, and thus categorisation can be complicated.


Emotional difficulties often arise following a brain injury because of the changes and trauma involved.

Very often there are a lot of complex issues to deal with, and feelings about these can occur at any time, and in any order and any intensity – there are no set rules – every individual and every injury is unique.

It is imperative not to jump to the conclusion that change events cause all emotional changes. 

Difficulties in understanding can also arise from both the physical, neurological changes, and the bio-chemical cascade that follows an injury. It is important to address these causes and not to overlook them.

For example, research tells us that the bio-chemical cascade disrupts the balance of the gut-microbiome, which in turn, if not addressed, can impact mood, anxiety, depression and even cause headaches, and migraine.

Further studies have shown that up to 50% of vitamin D reserves can be lost in the first 24 hours post-trauma and, as this is related to getting good quality restorative sleep, these depletions can also affect fatigue levels and mood.




Apathy can often be misconstrued as laziness, or as someone having an attitude problem.

Very often, these signs have a deeper cause. Apathy is the result of damage to frontal lobe structures and therefore mainly affect motivation and the ability to forward plan.

Apathy is not only the result of possible emotional changes – but executive skills impairment can also produce apathetic responses.

Structure and routine can make a massive difference to people who are struggling with apathy. It is essential to recognise that people may no longer understand what is necessary or be able to process information. For example, they may be able to see a pile of washing up in the sink, but this information may not be processed further than recognising the picture they see.

Apathy can be mistaken for depression and vice versa. It can be essential to notice the difference, as left untreated, depression can become a severe long-term problem. It is best to nip this in the bud and structure can help you notice the difference.

Use to-do lists, planners and whiteboards. However, you need to take into account that someone may have difficulty understanding why or how to do a task. Even those chores which we generally consider to be simple and straightforward can be confusing for people living with brain injury outcomes and symptoms.


Frustration and Anger

Mood swings

Mood swings are often termed ’emotional lability’ and cover a range of emotional states that are more extreme than usual. Minor events can trigger a variety of emotional responses, such as laughing, crying, or anger.

The pendulum swings beyond the normal ranges and yet, responses may feel as though they were appropriate. Constantly correcting someone can make them feel inappropriately criticised, as internally, their responses ‘feel’ as natural as they always have. Some people are more aware than others, and it is vital to give people room to work things out for themselves if you can.

So, instead of telling someone that their reaction was inappropriate, start by asking them if it felt appropriate to them. People may need a lot of support, especially if their awareness allows them to feel embarrassment or shame.

These responses, when recognised, can add further emotional distress. Everyone must remember that these effects result from brain injury and are not a reflection of someone’s personality.

While challenging to live with, it is essential to be patient and to remain calm. These symptoms do usually correct themselves in time as people relearn appropriate behaviours and social skills. This relearning starts by using reflective techniques that encourage personal feedback and understanding.

Sense of Loss


Things that help

  • Improving the brain environment can help with decreasing emotional responses. 
  • Feedback to help you notice changes in mood.
  • Enlist the help of a neuropsychologist. Ask your doctor for a referral.

Managing behavioural changes starts with awareness. Identifying triggers can help you to steer clear of situations that produce heightened responses. It is important to remember that the brain is reacting – not the person – so it isn’t as easy as being aware of when you may need to be more controlled or learning to pause before responding.

Often the ‘control’ mechanisms have ‘gone’ so managing control and improvements is rather like trying to drive in a nail without a hammer. Often relearning has to start from scratch. Keep faith that this learning process is always happening even if the changes appear to be slow in coming.