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Strategies to Improve Communication After a Brain Injury

Updated on 30 January, 2019
Medically Reviewed by

Dr. Alina Fong

Strategies to Improve Communication After a Brain Injury

After a traumatic brain injury or concussion, relationships can become strained. Communication can be difficult. Let’s be honest, thinking can be difficult. Sorting out your feelings and sharing them in a healthy way may feel impossible. After a TBI, the areas of your brain that affect processing, language, and word retrieval, can be affected. It takes extra energy and effort to communicate after a TBI. It may feel overwhelming or exhausting.

The good news is it is possible to have healthy communication after a brain injury. It may take more effort and practice, but it is a real possibility.

My memory struggles didn’t make communicating more difficult, but it did require me to come up with some simple tools to remember how to communicate effectively. 

When I felt overwhelmed by a situation, which can be a common occurrence after a TBI, I relied on an acronym I developed. This acronym helped me remember effective communication skills. I call it my Communication R.U.L.E., which stands for:
R: Recognize Feelings
U: Use “I feel…” Statements
L: Listen Attentively
E: Engage in Conversation & Problem Solving

Let me give you a more in depth explanation of my helpful acronym.

Recognize Feelings

It can be easy for you to forget you have feelings when you don’t pay a lot of conscious attention to them. I hate to break it to you, but your feelings rule your world. And that’s great. If you’re not feeling...you’re dead. Be grateful for your feelings whatever they are!

Pay attention to what you are actually feeling and why you’re feeling it. If you’re feeling angry, that’s fine. Anger is a healthy emotion, but what you do with it usually isn’t. Dealing with the aftermath of something you said in anger is important but, for now, let’s focus on identifying emotions to help prevent angry, hurtful words.

Anger is often there, but anger is a secondary emotion. What that means is it cannot exist without other feelings fueling it. Anger is protecting you from other feelings you don’t want to experience. This is all very unconscious and can happen in an instant. Additional secondary emotions include: irritation, frustration, and annoyance. Think of anger as the tip of the iceberg; there are many other feelings hidden below the surface of which you’re not aware. (For more information regarding anger, see our other post “Anger After Brain Injury”.)

Secondary emotions do not motivate people to change. Underlying emotions--the real, primary emotions--do.   This is why it is important to look at the emotions deeper than the anger. At this point, you’d take some deep breaths, or calm yourself in your own way, to recognize other feelings the anger may be protecting you from. You don’t want to focus on the anger; you want to work your way through it.

My favorite activities to calm down:

  • Throw rocks: It doesn’t get me in trouble. I don’t break anything, and it gives me time to think.
  • Sing: I prefer “Janie’s Got a Gun” by Aerosmith or “Without You” by Mariah Carey. Both are equally embarrassing and do the trick.
  • Skip: Children skip, and children are not stressed out and angry. I think that’s a pretty significant correlation.
  • Write or draw: Get those feelings out on paper.
  • Run: Any form of exercise could work.
  • Call a friend: Process and work through feelings. Don’t just rant.
  • Take a cold shower: Shock yourself out of it.

There are many other ways to calm down. Find what works for you!

Give yourself roughly 30 minutes to calm down then put words and names to your emotions and feelings. Some possibilities that may be covered by secondary emotions include: sadness, hurt, fear, embarrassment, exhaustion,, loneliness,  confusion, jealousy,, or anxiety,

Communication doesn’t always have to be negative; although, difficult topics tend to be the focus in communication skills training. Some positive feelings include: happiness, confidence, surprise, excitement, hope, love, joy, fulfillment, courage, calmness, relief, satisfaction, or comfort.

Now try to figure out what caused this feeling. Something someone said or did or something that happened. The more specific you can be, the better.

Use “I Feel…” Statements

How people communicate is frequently the focus of communication skills training. There’s a reason. Most people are not very good at sharing their feelings with others in a healthy, non-attacking way. This can be especially true after a brain injury.

When using “I feel…” statements, you want to share your feelings in a way that can be heard by the other person. You say “I feel ______ (insert a feeling word, preferably not a secondary emotion) when you ______ (do this) or when _______ (this) happens.”

You can share your feelings regarding an event or another person’s choice or behavior, but be careful not to attack the other person. Be aware adding the words “like” or “that” after “I feel…” sets you up for failure.

An example of a healthy “I feel…” statement: “I feel hurt when you lie to me.”

An example of an unhealthy “I feel…” statement: “I feel like you’re a liar,” or, “I feel hurt because you’re such a liar,” or simply, “You’re such a liar!”

Be aware of your tone and body language in addition to your words. A significant amount of communication is done non-verbally. It can be an eye roll, turning away from the person while he or she is  talking to you, or slamming a door.

Listen Attentively

In my opinion, listening is the most difficult and most important part of communication. It is an opportunity to understand, validate, and see the other person’s perspective. Listening includes being a team player. You’re not the coach; you’re not a cheerleader; you are a teammate working to accomplish the same goal. You both have different perspectives, but that doesn’t make either one of you wrong.

Dr. John Gottman said, “There are always two perfectly correct subjective realities.” Let that sink in.

After a brain injury, you can get so caught up in preparing how you’re going to respond or what you  should say back, causing you to miss the entire message. Listening attentively means you are completely focused on what the person is saying and how he or she is saying it. It means you put away other distractions and truly focus.

3 Ways to Improve Your Listening:

  • Be aware of the words as well as the non-verbal communication.
  • Be patient with yourself and with others you’re listening to.
  • Be authentic in your communication, even if it is challenging.

Once you’ve heard the message and are seeking to understand it, without putting up defensive walls or explaining your perspective, you’re ready to share what you heard. Reflect, repeat, restate, rephrase, or summarize what you heard them say.

Understanding their perspective and repeating it does not mean you  agree with them or that you are accepting fault or blame. It’s simply validating his or her  experience and feelings. Reflecting back on what you heard can be difficult because it requires vulnerability and humility.

Here’s an example. Your teenager says, “You’re the worst Mom in the world, and I hate you!” Reflecting back on that, it might sound something like (without anger or sarcasm) “Wow. You feel like I’m the worst mother in the world. And you hate me.” If you’re truly feeling that, seeking understanding, you might be near tears.

Guess what. Other people don’t like to make you cry. They may think upsetting you  is entertaining, but actually hurting you ...it makes them feel uncomfortable. You’re likely to hear something along the lines of “Agh. I didn’t mean that, but I hate it when you___________.”. They just gave you a behavior you could choose to change if you want too. It’s now your choice. It’s not an all encompassing “you’re the worst,” but more of a “please don’t do this specific thing.”

Please don’t immediately apologize. You have to understand what the other person is saying before you can apologize for it. Reflect first. Then if you feel an apology is appropriate or authentic, feel free to apologize.

Engage in Conversation and Problem Solving

Communication is required in everything you do. It’s the core of relationships at home, at work, and at school. This fact can be frustrating and discouraging if you’ve suffered a TBI or concussion. But you don’t have to let a TBI hinder your communication or relationships. Practice the Communication R.U.L.E. in your everyday interactions.

When an emotionally charged situation comes up, you’ll have the skills to have a healthy discussion. Your relationships will benefit from this skill, as will your confidence and ability to communicate your needs without stepping on toes or hurting feelings.

Assertive, honest, healthy communication has been proven to be effective. If you are willing to share your feelings in an open, honest, non-attacking way, and are willing to LISTEN to what others are communicating, the outcome can be life changing.

Having this Communication R.U.L.E. in place will also help you to have positive communication and helpful communication. Sometimes our communication can also be an indicator of our self-talk and how we are speaking and treating ourselves.  Find 7 ways to unleash the power of positive thinking, and how positive thinking changes our experience during recovery. Communication is the voice to our thoughts and looking at our thoughts can also help us improve our communication after a brain injury. 

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