Relationships after Traumatic Brain Injury (TBI)

Experiencing a traumatic brain injury (TBI) can significantly alter the dynamics of a couple's relationship, introducing profound and often emotional changes for both partners. This guide aims to shed light on the typical alterations couples might observe in their relationship post-TBI, providing insights and strategies to navigate these challenging transformations.
Despite the difficulties and potential discomfort these changes may bring, there are numerous strategies couples can employ to foster a renewed sense of connection and find new, meaningful ways to appreciate their bond.

The Impact of TBI on Couples

TBI can profoundly affect the fabric of a couple's relationship, with the severity of the injury playing a crucial role in the extent of these changes. Moderate to severe injuries often necessitate substantial adjustments in various aspects of life, even more minor concussions can cause short term changes impacting intimate connections in the following ways:

Every day tasks become arduous or impossible
There is a need for a redistribution of responsibilities
Evolution of relationship roles
Challenges and shifts in communication
Change in intimacy between partners

Individuals with TBI may develop different personality traits, encounter new limitations, and face unique challenges, which can surprise both them and their partners, leading some to feel as though they are in a relationship with a stranger. Their partners might also confront new anxieties and responsibilities, particularly concerning the other’s health and the incident leading to the injury, contributing to a shift in life priorities and an atmosphere of unpredictability that can heighten stress and anxiety within the household.

Changes in Responsibilities and Roles

TBI survivors often need to channel their energy into recovery and relearning skills, prompting a reassignment of duties within the household. This reorganization involves both partners learning new roles and tasks, which can increase stress due to the added responsibilities and the adjustment process.

Adjusting to New Responsibilities

Survivors might step back from certain duties, including work and household chores, to concentrate on their recovery. Conversely, their partners may find themselves taking over tasks previously handled by the survivors, such as maintaining the home, managing finances, and organizing family activities. This shift can lead to disparities in available time and energy, potentially causing mismatched expectations regarding shared moments.

Evolution of Relationship Roles

Recovery from TBI often leads to modifications in the roles traditionally held within a family, with partners possibly needing to make decisions or assume responsibilities typically undertaken by the injured individual. This role adjustment, while necessary, can challenge established dynamics, necessitating patience and flexibility as both partners navigate this new terrain.

How do responsibilities typically change?

Survivors often give up many responsibilities, including work expectations and household chores, while they focus on getting better.
Partners often must take on many responsibilities formerly managed by the survivor, such as:

Yard work and physically maintaining their home through chores and repairs
Managing household finances
Planning and organizing activities for the family

There are also new tasks for both survivors and their partners, such as managing the health care of the survivor.

Strategies for Navigating Changes in Responsibilities

Understanding and acknowledging each other's new burdens can significantly alleviate relationship strain. Regularly expressing gratitude for the partner's efforts in managing these added responsibilities and scheduling regular breaks from these duties can foster a supportive environment, encouraging growth in mutual respect and appreciation.

Giving Thanks: Make a commitment to yourself to thank your partner at least once a day for attempting to manage new responsibilities.
Plan for regular intervals of downtime from obligations. While these pauses might be brief and less frequent than preferred, dedicating time for relaxation for every adult in the household, and genuinely respecting this arrangement, can significantly enhance feelings of gratitude and respect within the relationship.
Couples therapy: Receiving guidance and support to learn new tools
Outlets for stress (for the partner): yoga, physical activity, meditation, breathwork, journal, change of environment

Navigating Role Adjustments

The more substantial and numerous the role changes, the more challenging the adjustment process can be for a couple. This adjustment can be particularly difficult for couples who had distinct and separate tasks before the injury or those who are navigating new relationship milestones, like marriage or parenting. Adapting to new roles involves a learning curve, often accompanied by uncertainty and frustration, which can lead to increased criticism and tension between partners. External pressures from friends and family who may not understand the necessity for these role changes can further complicate this dynamic.

Strategies for Adapting to Role Changes

Open communication about these role shifts is crucial.
Recognizing and being sensitive to the emotional impact of these changes
Partners can support each other by sharing insights and experiences, thus serving as mentors in adapting to new responsibilities.
Avoid criticism and practice patience

Enhancing Communication Post-TBI

Committing to improving communication is a shared responsibility that involves active listening, patience, and a willingness to understand the other's perspective.

Taking notes during conversations, preparing for discussions on sensitive topics, and practicing delivery can facilitate better communication.
Educate family and friends about the implications of TBI on communication and relationship dynamics to foster a supportive environment.

Changes in Physical Intimacy

Physical intimacy and sexual relationships often undergo changes following a TBI, influenced by factors like hormonal shifts, role changes, and alterations in self-perception and attraction. Couples facing these challenges can benefit from seeking therapy specialized in TBI and exploring support groups to navigate the complexities of their evolving relationship.

Hormone levels due to injury
Roles in the sexual relationship
Read more on sexuality after TBI Here
Appearance, self-confidence, and or attraction
Areas of sexual interest
Helpful Fact sheet

What are current options like?

Currently, pharmacotherapy, physical rehab, mental health counselling, as well as a high protein diet paired with adequate supplementation to promote brain healing is what is recommended.

Most of the prescription drugs are for symptom management to support feelings of depression and anxiety, and help with insomnia. This being said, research has long shown that these drug therapies long term are not ideal and often times dont provide adequate support. There are many studies underway to find more adequate solutions.

To address the hormonal imbalances that can ensue post-TBI, hormone replacement therapy is the current standard of care.

Some resources and information to explore:
Bioidentical hormones for TBI

5 best ways to feed you concussion by Dr Silverman

Concussion supplements

New Research

There are, however, studies underway investigating psychedelic therapies to promote both physical healing and emotional healing from the head injury. To note that these are not yet approved by the FDA and you should seek advice from your physician if you would like to find out more. These Psychedelic therapies are also likely to be for individuals who are past the acute phase of their injury.

It is also important to note that effective therapy for TBI must integrate mental health support, addressing not only the physical aftermath, but also the emotional trauma that often accompanies the injury. Whether in the context of psychedelic medicine paired with integration therapy , or with traditional medicine, the guidance of a therapist is primordial.

Here’s a quick look at what is currently being studied in the realm of psychedelic medicine:

Mg-Ibogaine therapy (study from Stanford Jan 2024) Investigating safety and efficacy for Special Operations Veterans (SOVs) with Traumatic Brain Injury (TBI) and repeated blast/combat exposures.

Psilocybin: Flanagan and Nichols suggests that certain psychedelics can diminish the inflammatory response elicited by serotonin by interacting with the 5-H2TA receptor and have been shown to elicit potent anti-inflammatory effects in animal models of inflammatory disorders.

In animal models, Attila Szabo and colleagues found that DMT’s action at sigma-1 receptors has been shown to modulate inflammation by reducing the levels of inflammation-inducing molecules including TNF-α, IL-1β and IL-6 while simultaneously increasing the secretion of the anti-inflammatory IL-10.

Summary of Tips

For couples navigating the recovery process and the associated role changes can be particularly challenging.

Embracing a flexible and open-minded approach to roles and responsibilities
Specialized counseling/therapy
Building supportive networks
Educating family and friends
Practicing patience
Strong communication
Varying the relationship environment: dates, activities, and date nights
Engaging in bonding activities that favor intimacy: meditation, breathwork, touch
Sharing feelings, fantasies and desires

The journey through recovery and adaptation following a traumatic brain injury is both complex and deeply transformative for couples. The sudden shift in relationship dynamics, roles, and communication necessitates a reevaluation of the foundational pillars that once defined their partnership. However, within these challenges lies the opportunity for growth, resilience, and a deeper understanding between partners. By embracing open communication, fostering a supportive environment, and navigating changes with patience and empathy, couples can forge a new path that honors both the individual and collective journey through recovery. It is through this collaborative and compassionate approach that relationships can not only endure but also thrive in the face of adversity, emerging stronger and more connected than ever before.

In essence, breaking the silence around sexual health post-TBI is essential. These conversations are crucial to humanizing and advancing care in this field. I encourage anyone affected to seek support from healthcare providers and open up to loved ones. My dedication to supporting the TBI community fuels my optimism for future breakthroughs in research and education, promising a more informed and compassionate approach to recovery and well-being.

MDMA is different than Psilocybin, but how?

Mg-Ibogaine for Traumatic Brain Injury: A Summary

Stephanie Karzon Abrams