Working with Concussion and Brain Injuries: A Lesson in Cognitive Flexibility through Art Therapy

A brain injury leads to rigidity. This means over-thinking and over-planning to compensate for memory loss, lack of attention to details, inability to self-regulate like before – otherwise known as cognitive failures. Meaning people feel like they are a failure because of their brain injuries.

People with a brain injury and a concussion have increased headaches, dizziness, difficulties planning and these can result in difficulties adapting to new situations and people.

What are the results? Blaming oneself for the perceived failures and inability to perform like they used to.

Blaming oneself increases stress, anxiety and can result in depression.

Using Art Therapy can help with cognitive flexibility. Even for those who have no art experience and insist they are mathematically inclined. Why does Art Therapy help? Because it works on cognitive flexibility in action.

Let’s take the example of creating a word-art collage.

1. First, the client has to find words that represent how they feel.

They are encouraged to do this by scanning a magazine for the words in their heart. I also teach the person to create new words if they can’t find the exact word they are looking for. Experiment and cut out new words. This increases creativity, which is a flexible process, by thinking outside the box!

Through this process, clients are learning to discriminate and prioritize between what is important and what is not.

Clients are learning to cut things out and throwing unnecessary words away, and surprisingly this is a very difficult task. Due to the memory loss after a brain injury, everything seems important because losing things including thoughts and ideas has become the new norm. But this is overwhelming. Learning to use cognitive factors such as the ability to discriminate and prioritize means recognizing that not everything is important. This leads to more flexible problem solving by reducing the need to hold onto everything as a way to compensate for memory and cognitive failures.

2. By throwing in the element of surprise, clients are learning to work with unpredictable circumstances.

In the Art Therapy exercise, I add an element of surprise by adding the collage paper underneath before placing the words on top. This means that once the client creates their carefully designed word collage, they have to remove it to place collage paper underneath. This shows them that plans can change. And the results can still be ok.

In life, there are many unpredictable situations. Being flexible saves psychological and emotional energy. Rigidity creates mental and physical tension. Tapping into creativity to solve problems and come up with novel and innovative ways to approach a problem leads to re-discovering one’s potential for innovation; the act of bringing something new into the world. This builds self-confidence.

3. Trusting in one’s intact abilities.

Art Therapy teaches the client the skill of learning to create a rough plan and then having the freedom to problem solve and create something new. This is the key characteristic in innovation. The inward experience after a brain injury and trauma tells a person that risks are unsafe. ‘Don’t do it!’ Learning to take safe risks again is key to breaking through the emotional barriers that keep a person stuck. Accepting there may be mistakes in creating art and that this it is OK. This builds a new foundation of safety. A key feature in healing from trauma. In life, things do not always turn out the way we plan, but sometimes we can be surprised by our abilities to adapt and create something new from difficult circumstances. It may even turn out better than we expected. Surprise!

4. What are the results?

A reduction in self-blame, acceptance of perceived failures, acceptance of one’s current abilities, decrease anxiety and depression. And most of all, learning to have confidence in one’s abilities again. To feel that there is still happiness and joy after trauma.

Forget! But how?

What feelings arise when you look at this image? Do you feel a struggle, a fight? Do you see the words ‘No Warning’? Do you see a ghost car and faceless people? Can you feel the darkness? Do you see an event that forever changed a person’s life?

When you have seen a traumatic event, how do you express yourself? James Pennebaker, a social psychologist who writes about traumatic experiences, says that people who have lived through a traumatic event often keep replaying it in their mind in a futile attempt to make sense of their suffering. Pennebaker said that continual thoughts about emotional upheavals can disturb a person’s sleep, job, and relationships.

I’ve seen this sequence. Intrusive thoughts about trauma can cause suppression. Suppression leads to depression, a depression that makes it difficult to connect with people or feel satisfaction and pleasure. The intrusive thoughts can also make it impossible to focus on daily activities where people need pharmaceutical intervention. The medication decreases the intrusive thoughts but it also takes away the joy in life.

Often people feel stuck in their painful emotions after trauma. Trauma doesn’t make sense. It is difficult to watch and feel someone else’s pain. Especially if that someone is your partner, wife, the person you cherish most. This is the story of C Hogan, one of my clients. He saw a traumatic car accident where his wife fought for her life. She suffered multiple orthopedic and nerve injuries as well as a brain injury. Her life changed: So has his.

I offer occupational therapy services to the victims of a car accident. But it is rare that the partner and caregiver receive services as well. This accident changed this couples’ lives in ways that are unimaginable for me. Mr. Hogan wasn’t the victim of the car accident; nonetheless, the effects of the accident rippled through his life just as much as hers. As service providers, we must not forget that trauma affects the victim’s spouse, caregivers and families.

I am providing mindful biofeedback and expressive art therapy services for Mr. Hogan. We talked about using art to heal and improve wellbeing. He asked me if we could create a collage. He believes that creating a collage is healing, but he didn’t know where to start. Furthermore, depression has a way of cutting off inspirational energy; the joy in life.

There are no warnings. Brene Brown says you cannot prepare for that moment when you get that phone call. His wife survived, but the realities after a car accident are shattering. He wants to forget. But he can’t. The memories don’t go away by themselves or with time. They are persistent. They are Intrusive. They leave a deep imprint on the body, mind, and heart.

On the outside, unbeknownst to the world, a person may look ok. On the inside, everything has changed. This is why meditation and expressive art therapy is so important. Meditation combined with biofeedback helps calm the fears and anxiety and soothes the depression. Meditation combined with art therapy is relaxing, providing stress relief.

Meditation does not permanently take away the symptoms, but it can soothe and settle the mind enough to create some energy for creativity. Creating art allows a person to communicate and express painful feelings, without needing to rely on words. Words are threatening: Speaking about trauma is heavy, for the traumatized person as well as the listener.

Trauma reduces a person’s quality of life. A low quality of life can trigger depression. Depression can black out self-expression. Creating art offers a way to break this cycle by opening another avenue to re-engage with oneself. Creating art encourages self-expression and facilitates emotional growth.

C Hogan finished this artwork. I helped him by facilitating the expressive art process.  The result expressed a very traumatic moment. When he saw his wife’s trauma, what he saw on her face, is an image that he cannot forget. He saw that she was afraid of losing her life. He saw her battle for survival.

During the art process, my client was given the freedom to make decisions, test out ideas and experiment. This creative process builds insight. It allows self-reflection. Finishing an art piece builds confidence.

With depression, it is very difficult to start anything. So things stay unfinished. Everything is stagnant. Seeing your finished artwork is validating. It validates potential because trauma takes away future potential. It shatters confidence and replaces self-esteem with doubt and fear. Recognizing your potential is the opposite of doubt. It is the start of believing in yourself. Believing in your potential. Realizing that there is still potential to materialized is a critical factor in healing. Healing through meditation and art is possible. It is possible if you believe in yourself.


A series by Neil.

All photographs were taken by Fiona. The narrative was written by Neil with the help of Carrie M. who recommended Neil for the group and provides weekly encouragement and support, to help Neil through his week.

Life by Neil

This print shows the connection between family and life. The four corners represent each member of my family (me, mom, dad and brother) and shows how we are all connected to each other.

Life by Neil

 I called this print life because you cannot isolate yourself from anything. Living with an injury, you must live as normal a life as possible You have to stay connected to all things and fit in with the group.

Life 4

Life means love. Loving everything that is possible and not being scared of trying things and fitting in. Caring for the place you are living in.

LIfe by Neil

 We are all connected to each other within nature and our environment.   If you are connected with your family, you can understand their moods and what is needed to help them with their day and showing that you love them.

Life 2

This print came to mind because of the relationship with my brother and how my parents have to interfere as opposed to us all being happy together as a family. This interrelationship within my family impacts my life. When my family is connected and happy, I am happy. –Neil






Mindful Art Collage

This post comes from Chris – a mentor for the Mindful Art Workshop. Thank you Chris for sharing your beautiful photograph. It definitely made me day!

In this moment, in the middle of the busy daily experiences, I am reminded to pause to breathe and be mindful. To notice the beauty in our everyday experiences. To reflect on both individual and shared experiences. To remember, how precious life is and how one life touches another in the cycle of continuous inspiration.

And…to smile!

Mindful Art Collage by Chris
Mindful Art Collage by Chris