December 15, 2022
As the holiday season approaches, concussion recovery can become especially challenging. The hustle and bustle of the holidays often bring increased social expectations and overwhelming schedules that can cause additional…
When you think about concussions, you don’t necessarily think about anxiety and vice versa. However, there is a definite relationship between concussion and anxiety. And what we have found over the years at our concussion management clinics is the more our patients know about both concussion and anxiety, the faster they can recover and return to sport and normal life.
What is Anxiety?
Anxiety is our body’s natural response to fear. When we’re in a state of fear, our sympathetic nervous system is activated releasing stress hormones like adrenaline and cortisol to prime the body for action. The sympathetic nervous system is the mechanism behind our natural fight or flight reaction, intended to keep us safe from harm.
From a historical sense, human beings might have felt anxiety as a result of being chased by a tiger or in the heat of a battle. Anxiety, and our fight or flight response, kept our ancestors alive.
The fight or flight response is pretty incredible. It’s Mother Nature’s way of making us superior versions of ourselves when we are in a sticky situation. When stress hormones are released, our pupils dilate so we get more light into our eyes, our heartbeat increases, and our blood pressure rises to get more blood to our muscles so we can fight the attack or run like the wind.
So anxiety and our instinctual survival mode is a healthy and even necessary part of life. Until it gets out of hand…
Modern Threats are 24/7
Nature intended our sympathetic nervous system to be activated only occasionally. Our ancestors weren’t chased by hungry tigers or attacked by warring tribes 24 hours a day, seven days a week.
When our sympathetic nervous system (fight or flight) is too activated all the time, the other side, our parasympathetic system (rest and digest) is shut off. This imbalance in our autonomic nervous system negatively impacts our health and overall well-being.
When our nervous system is chronically kicked into high gear, our heart rate and blood pressure are elevated all the time, our hormones become imbalanced, and we have trouble digesting and even sleeping. Our cognitive processing is also not very sound, so it’s difficult to have conversations and make logical and coherent decisions.
Another important thing to understand is that, while our hunter-gatherer ancestors only experienced anxiety occasionally and in truly dangerous situations, modern man can experience anxiety from things that are only perceived by us to be dangerous but aren’t actually life-threatening.
For example, many people experience intense anxiety at the idea of public speaking. And once that anxiety kicks in, so does their sympathetic nervous system, causing stress hormones to be released, pupils to dilate, and heartbeat and blood pressure to increase. And now, thanks to a sudden alteration in cognitive processing, the person experiencing this acute anxiety can’t think clearly or remember their rehearsed presentation.
The nightmare they were imagining became a reality simply because their autonomic nervous system was trying to keep them alive!
Concussions Also Cause Nervous System Imbalance
Concussions create a similar sympathetic nervous system dominance, where the patient may experience a surge in stress hormones, dilated pupils, fluctuations in blood flow and altered cognitive processing. In addition, their digestive system takes a hit, gut permeability increases, and they may end up with diarrhea or constipation and food sensitivities that they have never experienced before.
So, concussion itself can lead to a bit of anxiety, even if the person has never experienced this in the past. The good news is, if a patient does not have a history of anxiety, their post-concussion anxiety symptoms are a bit easier to treat and their recovery is typically faster.
Where things can get a bit tricky is when a patient who has sustained concussion also has a family history of anxiety or other mental health disorders like depression. In these instances, patients can then experience more prolonged recovery outcomes.
A good clinician will take the time to understands this. In fact, we’ve had some studies recently that have shown one of the number one ways to prevent persistent concussion symptoms is by seeing a trained healthcare professional early in your recovery. This certainly has a lot to do with the fact that clinicians trained in concussion management can deliver the right kind of education to patients, helping them to understand not only the symptoms and treatment plans surrounding concussions, but also how anxiety plays a key role.
Symptoms of Anxiety
Anxiety is a great imitator and can look like a variety of different health conditions. So how might a patient or clinician pick up whether anxiety is playing a role in health outcomes?
People might often think they are having a heart attack when they are having an anxiety attack. The symptoms can be similar. They may experience chest pain, dizziness and trouble breathing.
Some people with anxiety may experience gut disruption and diarrhea, and they may start losing weight because they’re not eating. And eventually they may start to think they have IBS or even cancer, when, they are instead experiencing symptoms of chronic anxiety.
Concussion and anxiety symptoms also look very similar because both activate the sympathetic (fight or flight) nervous system. In both instances we can see an inability to process things cognitively. The patient may experience poor digestion, dizziness, blood flow impairments, and exercise intolerance. All these things can look very, very similar no matter the initiating cause.
Sometimes patients may have a specific fear or phobia that can trigger an anxiety response. For instance, a patient may have a preexisting fear of flying. Having a concussion along with this fear can cause the fear to become that much more intense.
We have seen patients develop a fear of cars after sustaining a concussion from a motor vehicle accident. After the accident, riding in cars causes them anxiety. They are worried the driver may slam on the brakes too quickly or hit a speed bump or pothole and sustain additional head trauma.
Many patients also have anxiety related to the health symptoms they are experiencing because of the concussion. They may have constant headaches or dizziness and can become convinced something is really wrong. They may experience ruminating thoughts like … Maybe I have a tumor? Maybe I have an aneurysm or something else that’s fatal that hasn’t been diagnosed yet? This triggers anxiety, causing even more symptoms, and the vicious cycle continues.
And some patients may develop a fear of aggravating their symptoms. They may be told to avoid certain things, such as loud noise, bright lights, exercise, and crowds to help calm concussion symptoms. Although sound advice in the first few days, ongoing advice to maintain avoidant behavior typically leads to something that harms rather than helps health outcomes.
Fear Avoidant Behavior
Patients are often told by healthcare providers that anything provoking symptoms is to be avoided. And oftentimes, particularly early on after concussion, light, noise, and screens can be bothersome to some people. It’s okay to avoid these things initially because we want to allow the nervous system a little time to calm down after being in an excited state, however prolonged avoidance is not advised.
When a patient works with practitioners trained in concussion management, we can help them gradually build up their activities. But patients on their own might not know how to build back up, and so they continue to avoid lights and sounds and crowds for prolonged periods of time.
We now know that this type of avoidant behavior causes your nervous system to become more sensitized over time. For instance, a patient who begins to wear sunglasses in the house after a concussion will find, over time, they have developed a heightened sensitivity to light. So now light triggers their symptoms more easily, and they try and avoid it even more. It’s a downward spiral.
The bottom line is fear avoidance after concussion is associated with higher post-concussion symptoms, higher emotional distress, and higher catastrophic beliefs about post-concussion symptoms.
Patients with concussion who have high fear avoidance in the weeks following injury are more likely to experience adverse health outcomes such as anxiety disorders and ongoing dysfunction months later.
How Anxiety Holds You Back from Recovering from Concussion
Concussion treatment generally involves finding things that provoke symptoms, and then challenging the patient to do those things more. If we witness a patient at our clinic become dizzy when they turn their head a certain way, we recognize exactly what we’re dealing with and can develop an appropriate treatment plan.
For instance, a patient starts to feel “weird” when we have them perform specific up and down and side-to-side eye movements. This suggest we may need to start grooving their motor patterns slowly. This exercise will trigger the dizziness, but this is what’s needed to strengthen neural pathways so that dizziness stops being an issue.
Healing ultimately requires a patient to challenge themselves. Fear avoidant behavior makes recovery more difficult because a patient is actually avoiding the very thing he or she needs to do in order to get better.
How Can You Get the Best Health Outcomes After Concussion?
It’s important to become educated around concussion. The more you know about concussion and related anxiety, the better equipped you will be to make the right choices on your healing journey. You’ll be able to recognize how the symptoms can overlap as well as stay calm when you experience any.
Education is about learning who the enemy is – in this case, Post-Concussion Syndrome (PCS) – and understanding everything about it. Why does PCS happen? What systems does it affect? And, what can be done to reverse those effects?
Once you know your enemy, you can conquer your enemy. If you don’t know your enemy, it’s scary. Everything is scary. And that provokes anxiety. Fear provokes anxiety. So knowledge is power.
Second, work with an experienced team of healthcare providers. This means with practitioners specifically trained in concussion management as well as mental health professionals. Both will help you to reduce avoidant behavior so you can heal as quickly as possible.
And finally, work on healing yourself from within. This means eating a diet that will help reduce inflammation in the body. Inflammation can influence stress hormone responses. This, in turn, can negatively impact your sleep. Who can sleep when they feel anxious? And if you don’t sleep, you can increase your anxiety. Another vicious cycle.
By reducing inflammation, you can reduce your stress hormone response, get proper sleep, and help to heal your body.
Balancing your nervous system may also require you to exercise, meditate, sing, laugh, hang out with friends… anything that will take you out of fight and flight mode (sympathetic) and put you into rest and digest mode (parasympathetic).
Concussion causes anxiety and anxiety can prolong concussion symptoms. The two are intricately intertwined, and it’s very difficult to separate them from one other. So in every case of concussion, anxiety and mental health should be part of the picture.
Anxiety influences and is influenced by our autonomic nervous system, which frequently becomes dysregulated in acute concussion and PCS cases. We must incorporate strategies that improve nervous system regulation. These strategies can include exercise, a healthy diet, gut hormone regulation, sleep, stress reduction, and more.
And then finally, be wary of avoidant behaviors. Recovery from concussion will require you to gradually expose yourself to stimuli that triggers your symptoms. But they will be very short-lived. When you can do this confidently, you’ll be more likely to follow your treatment plan and get back to sport and normal life as quickly and safely as possible.
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