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  • Dr. Nathan Keiser

The Worst Symptom of Concussion is Fear


I know most people that are working through concussion symptoms would vote for headaches or nausea or brain fog as their worst symptom. I would agree that these are absolutely miserable, but I think fear, which we more commonly call anxiety is the worst because of the paralysis it causes on our ability to do what is needed to feel better. It is the quicksand of concussion symptoms.


“Since my concussion I feel so anxious all the time. There doesn’t even need to be a reason. It just happens.”

Oftentimes people with post-concussion syndrome notice a distinct uptick in their anxiety levels after their injury. While some may notice right away, for others there is a slow creep up the anxiety scale. In either case, having anxiety or fear is a natural part of recovering from an injury. Natural or not, we can’t deny the effects of fear and anxiety on our behaviors. Especially behaviors that help us ultimately overcome our concussion and move on with our normal life.


There is no worse place to sit on the sidelines than in your own life.

Anxiety and fear are the two most common barriers to overcoming post-concussion symptoms. In order to get the help they need, people must choose what direction to go and then move down the path of recovery. Instead people become paralyzed. They are afraid to get their hopes up only to be let down again. They are afraid of what they will do if they fail. They are afraid that the way they feel now will be permanent. I get it.

So instead we have to learn how to build our strategies and our environment in our favor so we can minimize the grip of anxiety and stay on track to full recovery after a concussion.


Anxiety and fear are built into the physiology of a concussion. With any injury we experience changes in the function of our brain that causes a natural shift toward guarding our heath. Our brains shift attention to behaviors that avoid further injury so we are able to heal. Shifting into this defensive posture is helpful in the short term, but can become problematic if we start to embody these behaviors over weeks and months.


There can be comfort in putting up walls around our abilities and saying, “I can’t play anymore because I have a brain injury or I’ll never be able to follow my dreams now because of my concussion.”


Living with the anxiety that comes with a concussion can feel like a death of 1000 cuts. We start to feel inadequate, we lose our confidence, we can lose the spark that makes us special.

We start to look at the world through the lens of our limitations rather than of our possibilities. Worst of all anxiety can start to affect our behavior. I’ve met so many strong capable people that have become paralyzed by their anxieties. Anxiety can take a strange hold on us where we are unable to clearly see a way through to a solution. Many people start to avoid their lives. They isolate themselves from family and from their friends and they stop working toward a solution. I know that when you feel this way, it is hard to put your faith in the fact that anything could actually help.


No matter where you are on your path to recovery. Even if it is flat stalled out, it is important to start accumulating small victories now. Every small victory accumulates evidence that you can heal and a vote against being stuck this way. It may not all come in a day or a week, but soon enough the small victories add up to healing.


Why do Concussions Create Anxiety?

After a concussion, the brain is primed for fear.

Modern animal studies have found that the function of the limbic system of the brain is responsible for processing the emotion we tie to the events of our lives. The part of the limbic system called the Amygdala is crucial for how fear is processed. Dysregulation in circuits of the basolateral and central amygdala are associated with increased levels of anxiety and generalized fear responses.

Human and animal studies have also shown concussion and brain injury often cause dysfunction in the circuitry of the basolateral and central amygdala.

In other words, injuries in general heighten our innate levels of fear and anxiety while brain injuries turn up the dial even more. It is like the brain recognizes there is a problem and immediately looks for any threat available.


While in some ways this can serve as validation for the fact that you feel more anxious than usual, it also is an opportunity for empowerment. Problems are easier to solve once we understand them.


In order to break this cycle, we must move away from the natural tendency to be consumed by looking for problems and reorient our behaviors toward finding solutions.


Course of Action


Understand The Problem For What It Is. No Better. No Worse.

Regardless of whether or not we have had a brain injury, we all have the tendency to let our thoughts run away from us. The trick is recognizing when they are descending into an anxiety spiral. Simply ask yourself, what is the real situation here? No need to make it seem better than it is and no reason to make it worse. On a 0-10 scale how life-altering is this problem if you are truly honest with yourself? Is there a way to avoid the problem or even turn the outcome into a positive? For example “I’m anxious because my friends want to go to a movie. I don’t want to get a headache from the movie, but if I don’t go, I’ll lose all of my friends, no one will like me and I’ll be alone forever.”

The reality of this situation is valid: If you go to the movies, you may get a headache. It is a temporary problem and it is not very likely that you will lose your friends or be alone forever.

You could also consider that the headache may or may not happen and even with a headache, you might have a good time. There is also the possibility that you could tell your friends that the movie may give you a headache and offer to do a different activity that is less likely to give you a headache like playing a quieter game with a couple people or just hanging out at home.


Create A Consistent Plan.

One of the most common times for anxiety to show up is at the moment of decision. If there is no choice, the decision is made and you can move forward. If there is a choice to be made, it opens your mind up to measuring the possible outcomes. The choice you make will depend on the state you are in at the time. If you are in an anxious state, it is far less likely that your decision will move you in a positive direction.

For high priority tasks in your day, a written plan with consistent actions can take away the options for making a decision. Building these actions into your daily habits and routines removes the opportunity to decide whether or not you will do it. Your plan should state the location, time, and specific action you will implement. For example: “After I put down my toothbrush in the morning, I will walk over to my brain exercise station and do a full set of my exercises.” By setting this intention ahead of time, you remove the anxiety about performing your exercises.


Create Measurable Success Markers.

Taking on something as big as concussion recovery can feel daunting without the right perspective. You feel like a kid in the backseat on a road trip. “Are we there yet? Are we there yet?” Without mile markers along the way, the trip feels never-ending. On the way to feeling 100% healed it is valuable to set functional markers along the way that signal progress. This is why we measure so many variables in concussion cases. We can see how the functions must improve in order to heal and we can track the improvements along the way. When we approach it this way, you can experience victories at every mile marker along the way.


Shift away from negative self talk and toward affirmation.

Have you ever noticed that you have an internal voice? It is the voice in your mind that is like your perpetual narrator. The great thing about that narrator is that you control it! When we aren’t paying attention, the narrator can turn us into the bad guy of the story. Instead don’t forget-you are the hero of your story. Make the effort to notice the times when you are being tough on yourself or casting a negative vision for your future. Use your self-talk for your benefit. If you need practice, start by listing 4 qualities about yourself that on your best day, you know to be true. “I am smart, I am strong, I am healthy and I am happy.” Repeat this statement to yourself daily for 60 seconds. Soon these words will trigger you to embody these characteristics that you know to be true.


Take Actions Of The Person You Want to Become.

If you want to be a person that has recovered from a concussion, the first step is acting like one. If you wanted to be an expert painter, the first step would be to take the actions of a professional painter. To recover from a concussion, you must embody the type of person that recovers from a concussion. What decisions would that type of person make? Sometimes it can be difficult to know how to move forward when you are uncertain. When you are stuck, imagine someone who has recovered from their own brain injury. Consider what they would do. We become the accumulation of our actions. If you act like a person that has recovered from a concussion, pretty soon, you become that person.


Be Accountable To Someone You Respect.

It is amazing what we can talk ourselves out of. Even the best-laid plans can be derailed when we are feeling tired, unsure of ourselves or unmotivated. When it comes to your concussion recovery strategy, many people often feel like they are alone in the process. This is a mistake. Anything worth doing, is worth doing well which means holding yourself accountable to your plan. This might mean having your spouse or parent do your routine with you, or it could mean using a tracker. This can be as simple as sharing a google document of your brain exercise tracking sheet so your partner can see whether you have done your exercises each day or not. There are several apps and techniques that can assist you with this. An interesting version will hold money in an escrow account for you. If you achieve your goal it will release it back to you. If you don’t, it will release the funds to a charity that you don’t like, incentivising you to reach your goal. You won’t likely need to take it that far, but accountability is highly motivating but also easy to overlook. The reality is that we are far more likely to stay the course if someone is counting on us or watching over us.


Anxiety is a common symptom when dealing with post concussion syndrome. It is not easy to deal with and can be the biggest hindrance in getting into the right kind of brain rehabilitation program, following through on the process or even getting back into the swing of your life again, Knowing that it is a natural part of the recovery process and arming yourself with strategies to overcome it can not only help you discharge your sense of anxiety, but it can help you remove it as a barrier to healing.


Please use these strategies. Do your best. Get off the sideline of your life and back to living again.

I hope this article was helpful for you. If you are interested in further reading, check out my article, The 5 Mistakes That Slow Concussion Recovery.


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