The document discusses techniques for modifying psychotherapy to help individuals with neurological impairments following traumatic brain injury (TBI). The key points are: 1. Link cognitive strategies to daily routines like meals to lessen the memory burden. Understand catastrophic reactions like anger and tie cognitive strategies to reducing those reactions. 2. Externalize the problem by framing it as the brain injury causing issues, not the patient. Build resilience by focusing on effective coping rather than personal bests. 3. Cognitive retraining works best when integrated with psychotherapy and involves the patient, family, and therapists working as a team against the brain injury.

1. How to Lessen the Effect of TBI in Returning Soldiers or Civilians Helping the Person with Neurological Impairment Re-invent Themselves?

31. To Get Change With a Cognitive Strategy, You Have to Have Three Parts to the Cognitive Construct 1.What is the specific problem (closely related to a basic unit of brain function) 2.What you have to do to correct the specific problem 3. Both must be learned by the Patient

34. Dependency- When the Survivor Can But Doesn’t Do Something . Think of the survivor’s brain as Swiss cheese. There is plenty of good cheese — intact circuits that were unaffected by the injury. But now there are a few “holes” where cells were injured or destroyed.

42. It takes about 3 weeks to establish a new artificial day/night cycle. It must be applied 7 days/week. After the three weeks, patients can be allowed afternoon naps, but the schedule must be maintained. If the artificial pattern is broken, it always takes about three weeks to re-establish again.

44. Many of the cognitive functions, which are automatic and reflexive for people without BI, require 2-3 times the mental effort to accomplish for people with BI. This is due to the fact that people with BI often have to think about, and do with conscious effort, what the rest of the world does automatically, without thinking.

45. • Make as many activities as possible into a routine to minimize choice. This saves mental energy. • Do not fill up the days with scheduled activities, do one important thing/day

46. How to Compensate for the Symptom of Fatigue. • Make important decisions when the person has the greatest amount of mental energy, usually in the morning. Schedule patients with BI in the morning. • Make as many activities as possible into a routine to minimize choice. This saves mental energy. • Do not fill up the your day with scheduled activities. Do one important thing/day • The use of an organizer, either written, taped or electronic is essential.

47. Problems With Sequencing: Every activity has a beginning, middle and an end. Sometimes, people with BI drop off the “end” response. They begin, do the middle, then begin something else, do the middle, then begin something else, etc. By the end of the day-they have been busy, but they completed nothing.

49. Retraining Impulsivity If you are highly impulsive, you are jumping into action before your brain can size up what to do. So, count (silently) to 4 before you answer or do anything.

54. Planning Aids for Cognitive Disorders brainaid.com Attention Control Systems

59. Verbal Compensations For Poor Memory and Anger Outbursts That’s an important idea- Give me some time to think about it and I will get back to you later.

63. Trouble Reading Other’s Emotions Because I have trouble (spatially) reading other peoples faces, I need to ask how they are feeling to read them correctly. Make like a psychologist and sprinkle your speech with “So how do you feel about that?”

65. Social Compensation’s Caretaking spouses often feel unappreciated for their extraordinary efforts. Writing a couple of phrases of appreciation “You are such a wonderful partner, I’m so lucky to have you”. Or “Have I told you I love you?” in the patient’s memory book or electronic organizer every few days, (which the patient reviews after each meal) can make a spouse feel that their efforts are noticed.