Like many things in life, our perception shapes our reality. This is especially true when it comes to concussion recovery. How we view an injury can directly impact the severity and length of symptoms and how quickly or slowly we recover.
A good example of this is the placebo effect: when someone believes a treatment will help, they often experience real benefits, even if the treatment itself has no actual impact. On the other hand, the nocebo effect occurs when negative expectations worsen symptoms and hinder recovery.
In concussion care, the nocebo effect is often triggered by negative thoughts, misinformation from non-specialist providers, or fear-driven avoidance behaviors.
Understanding the power of mindset is one of the most critical factors in overcoming a concussion. In this article, we’ll explore how shifting from negative expectations to a more positive outlook can help speed up recovery.
Maintaining a positive mindset is key to recovering from a concussion. It’s natural to feel concerned and even worry about the severity of your injury, but negative expectations can actually make things worse and distort how you perceive your recovery.
A study by Whittaker et al. found that people who feared long-term problems from their concussion were more likely to develop Post-Concussion Syndrome and take longer to recover. In contrast, those who kept a positive outlook tended to recover faster. (1)
One of the best ways to remain (realistically) positive is to be evaluated by a trained concussion specialist. They’ll use evidence-based methods to give you the most accurate, up-to-date information, helping to ease your worries and set you on the path to recovery.
The words we use directly impact how others internalize and interpret information. Language shapes perception, and this holds true in concussion care as well. How medical providers describe an injury can significantly influence your recovery—positively or negatively.
A study by Weber and Edwards found that patients who were told they had a “mild traumatic brain injury” had higher expectations of negative outcomes compared to those who were told they had a “concussion,” despite both terms referring to the same condition.
This highlights the powerful role language plays in shaping recovery expectations. (2)
The “Good Ole Day Bias” happens when you start thinking everyday things are caused by your concussion.
For example, forgetting why you walked upstairs or misplacing your keys happens to everyone, but if you’re recovering from a concussion, it can lead you to mistakenly link these minor occurrences to your injury. This can increase anxiety and fear, making your recovery feel more challenging and giving you a false sense of your functional well-being. (11-12)
Social processes, like observational learning, can impact how we view our concussion recovery. Hearing about someone else’s struggles or seeing their symptoms can lead us to expect the same outcome. This is called social contagion, where negative experiences or information can spread and influence others. For example, if one person is told about the risks of headaches, others who hear this are also more likely to report headaches. (3)
In concussion care, hearing about long recoveries or negative experiences can shape your expectations. With social media, negative information (or misinformation) can spread quickly. It’s important to remember that every concussion is different, and recovery varies greatly from person to person based on various factors. So, avoid comparing your experience to others’—your healing journey is unique to you. (4)
Nocebo effects are linked to several biological processes in the brain and body. Brain scans show that when people expect pain, areas related to pain perception and emotional responses—like the prefrontal cortex, amygdala, and hippocampus—become active. One study even found that negative expectations can reduce the effectiveness of prescribed pain relief, like opioids, highlighting just how much the mind can influence our physical experience. (5-8)
The anxiety caused by nocebo effects can trigger the release of stress hormones like cortisol and substances that heighten pain, such as cholecystokinin (CCK). These effects can make pain feel stronger. Additionally, nocebo effects have been linked to lower levels of natural painkillers and dopamine, one of your brain’s feel-good chemicals. (9-10)
In one study examining online news trends, Chronic Traumatic Encephalopathy (CTE) was found to be the most frequently reported consequence of concussion. (13) However, the reality is that CTE is extremely rare, and the connection between concussions and CTE is not yet well understood.
Concussions have been portrayed as more dangerous than ever in recent years, mainly due to increased media coverage. While raising awareness about concussions is necessary, the media often focuses on rare, severe, long-term effects, which can cause unnecessary fear and confusion. Stories about athletes with multiple concussions typically highlight worst-case scenarios like long-term brain damage and memory issues.
Although CTE is a serious condition, the media often oversimplifies its link to concussions.
By focusing on extreme cases to grab attention, the media can create unwarranted concern, especially among those with a history of concussion from playing contact sports. In reality, most people don’t experience these drastic outcomes. The media also tends to overlook other factors that contribute to brain health, such as mental health issues, lifestyle factors, or substance use, which have all been shown to be linked to CTE and other degenerative neurological conditions. (14)
Fear and avoidance are common reactions to concussion recovery, often due to misinformation or past beliefs about how concussions heal. When symptoms appear, many people mistakenly associate them with pain and delayed recovery. However, the symptoms after a concussion aren’t caused by brain damage but by functional changes. The increase in symptoms doesn’t mean recovery is delayed. Research shows that gradually working through symptoms can actually help recovery. (15)
While avoiding activities might seem like a way to feel better in the short term, this avoidance approach often worsens symptoms in the long run. Studies have shown that complete rest after a concussion generally leads to worse outcomes compared to a balanced approach with some activity. More and more research now supports therapy that encourages practice and gradual movement as key treatments for recovery. (16)
An early understanding of current evidence surrounding concussion injury care can significantly decrease your concussion recovery time. Once you have solid knowledge and discuss expectations with a trained concussion specialist, you can kick start your recovery and drastically minimize any potential nocebo effects.
Addressing your fears with a concussion specialist is another way you can minimize nocebo effects. Symptoms following a concussion are often misassociated with overt structural damage and delayed recovery, while this is overwhelmingly not the case. (17) A trained concussion specialist will discuss how symptoms are simply a result of functional changes that occur after a concussion, which can be treated effectively with interventions such as manual therapy, physical therapy, and functional medicine.
Staying active early on is key to speeding up concussion recovery. In the past, doctors recommended resting until symptoms completely resolved, but recent research shows this approach can delay recovery. Studies have shown that light physical and cognitive activity, even with mild symptom increases, can improve outcomes and help you recover faster.
It’s recommended to start light physical activity, such as walking or using a stationary bike, within 24-48 hours after a concussion—if tolerated. A 2023 study by Leddy et al. found that early exercise helped reduce recovery time by an average of 4.64 days. (18)
Additionally, sub-symptom threshold exercise (i.e., exercise that doesn’t worsen your symptoms >2pts out of 10) should be introduced between 2 and 10 days after the concussion. This approach helps promote faster recovery and lowers the risk of developing long-term post-concussion syndrome.
Focusing on what you can control—like getting proper sleep, eating well, and managing stress—can greatly impact your concussion recovery. Taking charge of these aspects can create a positive momentum that helps speed up your healing process. For more tips, check out our blog post on a holistic approach to concussion recovery.
The best way to take control of your recovery is to discuss your concussion injury with a trained concussion specialist. Complete Concussions trained clinicians use the latest research and proven methods to help you recover quickly and effectively. They understand the psychological impacts of a concussion and can provide the best care based on current guidelines.
To find a certified concussion provider near you, visit Complete Concussions for a map of certified clinics or download the Concussion Tracker app.
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