Instrmental music playing A
I'm Carrie, a stroke survivor and a member of BIND.
And I'm Kezia, stroke survivor and member of BIND as well. Today, we're going to be welcoming Willa Vo again for our second episode. As you may have heard last episode, she works at UT Southwestern and is focused on neurorehabilitation with people like Karina. Not only with strokes, but also with any type of brain injury, all of people that have either acquired brain injury, or traumatic brain injury, or strokes, but people like us in this population. So, we're going to welcome her again.
Welcome, Willa, to spend some time with us. It's great to be back.
Welcome to BINDWAVES, the official podcast of the Brain Injury Network of Dallas. I'm Brian White, BIND's Executive Director. On each episode, we'll be providing insight into the brain injury community. We'll be talking to members and professionals regarding their stories and the important role of BIND's Clubhouse. We work as a team to inspire hope, community, and a sense of purpose to survivors, caregivers, and the public. Thank you for tuning into BINDWAVES.
BINDWAVES Let's get on with the show.
On this episode, last episode actually, we talked about, um, communicating with people after having a brain injury. On this episode, we actually wanted to talk about emotions and having a way to cope after, like, survivors after having this brain injury and also with caregivers. So, Willa, can you explain to us, like, how Like what causes these emotions to change after a brain injury?
Yeah, so I'm gonna try not to get overly scientific. Stop me if it gets a little too, uh, too much there. But so when we think about the brain and how it does everything for us, right? And so it manages our movements, our speech, our personalities, our behaviors. There are different areas of the brain that we associate with with certain functions. Um, now of course, you know, you can think more about your brain and connections more so as kind of like a, like a freeway system.
Um, so it's not just like one system is the only thing that does that thing, right? Um, a lot of it is also how different brain areas communicate with one another. Um, and so with emotions, a lot of that regulation of our emotions, really we associate with our frontal lobes. Our frontal lobes, kind of in the front here, There's also a lot of different components to that, right?
So you actually might see different types of, uh, emotional dysregulation or emotional issues, depending on specifically where the brain injury was affecting. Um, and so with that, you know, for those who, uh, may be prone to having more, Uh, orbital frontal, um, uh, disruption. And so you kind of think about the brain that's kind of right here. If you think about the bone structure over your nose and here, there's a lot of bony areas.
And so that's where it's really highly vulnerable to having injury. And so for example, for traumatic brain injuries, oftentimes you have, you know, you, you might hit your head on the back, right? So you have a uh, head injury behind you. But then we also have kind of this, uh, what we call a coup contre coup. So you kind of hit forward as well. And so that's where you might have some of the injury here too.
Um, and so with some of that, you might have, um, higher emotions or more difficulties with, um, having the right emotion, but it's at a higher volume than what would be typical, right? So something that is typically sad, you'll have sad emotions about. But it might be even higher than what might be typical for you in the past, increased emotionality. Um, and so really it can depend on areas of the brain that was particularly affected.
And then again, knowing that, um, if there's different, uh, disruptions in the freeway, right? So if there's an accident on the freeway and you're backed up, and so you can't get from point A to point B, and so even though communication is happening from from the previous point, you can't really get to your end point, right? Um, and so that's where that impact on our emotions can happen, where again, it's really a brain function.
We don't think about it as a cognitive or brain function, um, but it is a part of how we react to things and how we can communicate and express our emotions.
Okay, and as you're saying that, I'm thinking about it. Um, so, based on maybe where your brain injury was, can that, can those emotions, like, kind of change your personality? Because, or just maybe, I mean, not change your personality, because I know people like, you see them doing certain things, and you're like, that, did they do that before? Because that just seems way over the top.
So, maybe it is something they always did before, but because that emotion, because that freeway's been disrupted now, it's. Just yeah, it's over the top and they don't know how to control that
Yeah, so, you know, it's interesting because you can have a complete change in personality or behavior So something that someone never did before they're now doing more often, right? so maybe someone who used to be such a social butterfly and would just Um, really engage a room is now very, very quiet and withdrawn, right? So you can have definitely a change in that.
You can also have what we would consider like an exacerbation of previously, um, uh, our prior behaviors that already existed, right? So you have someone who's generally kind of, you know, kind of like class clown, jocular, kind of funny, and maybe now it's amped up to like, times 10. Um, and so, so yeah, you can definitely have some of those different things as well.
This is where, you know, for me as a provider, I, I like to ask, this is where it's, it's helpful to ask other people who know you to see what has actually changed and what is actually how you were before. We all have our own individual personalities that makes us unique as people. Um, and so we want to really kind of tap in, well, what was actually changed by the stroke, um, if anything.
Yeah, and I think that, um, you know, again, we, we're here at BIND and we, a lot of the questions come from our members who are also listening and also have just curiosity and like questions overall. Um, a lot of people that we talk to and we experience, a lot of them it's like a more, Like, I don't want to say negative, but I can't find a better word for it. Uh, just more sad or more like depression or just these situations that are not positive experiences.
So, um, that's why we wanted to talk about it today. And we're probably gonna say a lot of coping and coping mechanisms and tools and we hear these words, but a lot of times we don't know what this is. So, um, just to. have this ready for the listeners. Can you explain that to us? Like, what is it? Like, what is coping mechanisms?
Yeah. Yeah. So, you know, it's interesting because I think oftentimes we do think about like, what's a good coping mechanism? How is someone adjusting well to something? Right. Um, and we put these evaluative terms on that and it's, It's kind of unfair, right? Because everyone copes with things differently. And so now there might be something that might be more, um, active coping or adaptive coping.
And then there might be other coping mechanisms that are more about succumbing to what your injuries or disabilities make of you, right? Um, and that can have different consequences, right? They all serve a purpose. So I think that's really what's important is coping, regardless of if they are more active or more passive, they do serve a purpose, right? If they're more passive or succumbing, it's kind of that, it is what it is, I had it, you know, you know, I haven't, that's it, right.
It can often be mistaken for acceptance. Acceptance is more active. Acceptance is, I had this, And I'm going to keep doing this, right? As opposed to it is what it is. It happened, it happened, right? Um, and so when we think about active coping mechanisms, it's really being able to gain what you can have control over still. You can't have control over the fact that you had a brain injury. It already happened, right? But what things can you control, right?
You can control how much you engage in your therapies, how much you, you know, what kind of, um, effort you want to put into speech therapy or into cognitive testing to kind of figure out what's next for you, right? Um, so those are some things that still can be within your control. Keep in mind, regardless of brain injury or not, you can't always control your immediate emotions and thoughts.
If you could, no one would ever have a negative thought, no one would ever have a negative emotion, right? So it's not so much about controlling that initial emotional reaction or thought, it's really about what do I want to do with that, right? So something happens, you're frustrated, what do you want to do with that frustration?
Do you want to lead, you know, make that lead to you, um, not doing anything for the rest of the day because you're so frustrated, or do you want to give yourself a break and then go back to whatever it is that you were doing that was frustrating to you, right?
Um, and so that's where being able to cope is really thinking about, um, what are the things that I can still control in my environment, knowing that there's a lot that you can't control, knowing the difference between the two, and kind of figuring out from there that process of what you want to do next.
Okay, and I like the way you said that, and I always try to bring this back around also. So, like, as we talk about these different coping mechanisms and the things we need to do, there's really not anything different that we as brain injured survivors need to do. These are things that everyone does. I mean, people want to say, you know, well, you're not, you've got a brain injury, you're not normal, I don't need to do that. But really, We're all still human.
We're all still the same kind of people. These are beneficial. Brain injury or no brain injury. And I think that's a lot of where our frustration come in. Is people don't get that we are still a hundred percent normal. We just maybe are a little different. But so are they. So, I don't know. But yeah.
But with that, I mean, you know, what are like, what's the most basic, I guess, you know, like, just other than Like you said it in the last episode and I am, I'm bad about it, but um, I don't like Stopping and breathing. I like to go.
Yeah, yeah.
Don't tell me that's the easiest. That's what I'm saying. I'm just kidding.
So now, it is the easiest. It's the easiest to employ, but it's not the only. Um, and so, something to think about is, so I'd mentioned last time about relaxation strategies. Um, another form of coping is just, Um, and so for example, there's actually a really helpful acronym that is a problem solving approach to any sort of issue or something that might come up. Um, it's ABCDE. So it stands A is for Analyze, B is for Brainstorm, uh, C is for Take a breath. Sorry.
Um, so C is Consider the Consequences. Um, D is do one of those actions that you kind of figured out, um, in, in brainstorming and then E is evaluate it. So kind of figure out what, um, how did it go? What was changed? What was, what needs to be changed for the future?
Um, so when you think about any sort of problem or interaction that you might have that you're kind of going through problem solving, that active kind of approach to problem solving, whatever it is, can also be a form of active coping.
Okay, I do want to take a quick break. I think that was a great answer. I'm going to remember that. I want to take a quick break and let our listeners and remind everyone to just continue following us on Thursdays and press all those buttons, uh, to get notifications so you know exactly when our new episodes come out. So I, I love that answer because I never heard of that, but I think, I think that's like my kind of way of coping things.
I always feel, I'm like, uh, Like, uh, I like figuring it out, like I'm a problem solver, and it is very effective, I think, for me. Um, sometimes I do get overwhelmed, so I try to put a pause, myself on pause, and take a two hour nap. Like, I don't know if that's Sometimes it's needed. Yeah, sometimes it's needed, that's me. Um, but I think that, like, a lot of the times, um, and especially when we get into conversations with others, it's just Trying to figuring out like, is this my sadness?
Am I very nervous or am I just excited? And just trying to find out all of the, all of your feelings and how What is it? Like, what is it right now? Or am I just extremely overwhelmed? Like, what is it? And then, do you have like, like, how can we identify, like, let's talk about I want to say symptoms, but really it's just the feelings that we're currently having. Like, is that like the first step that you need to do is identify the feelings? Or like, or how, how can we deal with that?
Oftentimes, yeah, you know, I think that we So it's really common for us, again, whether brain injury or not, to have mixed emotions. Um, and it's, it's kind of one of those things that makes us unique as, as humans, right? Um, in that we can have two almost seemingly competing emotions. at the same time, right? You can, kind of that bittersweet, like, I'm excited, but I'm also nervous about this, right?
Um, and so when you can kind of make sense of those things and recognize that it's not just that you have one emotion at a time, um, I think it can really be helpful in kind of allowing yourself that self compassion of, hey, I'm, I'm human, I have emotions. I also, you know, kind of like that you mentioned too, that, you know, am I excited or am I sad or am I, what are these things?
I think it's also important to know that when we talk about Being stimulated by your emotions, um, or being exhausted by your emotions or things that are happening, that can happen from positive things too, right? You can be super, super happy enjoying like a day out with your friends and going to lunch and whatnot, and at the end of the day you are exhausted, right? That's normal.
You can also have that same level of exhaustion if you had a really rough day, if you had a hard time with, if you had a, you know, maybe an argument with somebody and it's kind of lingering with you and you're still exhausted, right? Um, and so I think it's It's being able to know what are, what's happening, right? What's happening in me. Now, initially after a brain injury, you might need help with that, right? You might not be able to identify those emotions.
Um, and so that's where working with other people, your therapist, your family members, having that awareness. that can be helpful too, where they can kind of label it for you, right? They're not trying to put words in your mouth, but you know, if you act in a certain way, you know, it's helpful, and you don't know why that's happening. It can be helpful for someone else to say, I wonder if you're feeling this, do you want to go take a break? Right?
Um, and so I think that's also another way that is, is really, you know, being able to help identify and separate what are those emotions, being okay with it, and also knowing, okay, what do I want to do about it? Okay,
I'm thinking about that. So I guess it's kind of once you can get to that place where you can identify that emotion on your own, then that's where you can start to figure out what coping strategy is going to work best for you in that way. Because, yeah, when you said excited and nervous all at the same time, that was me game seven of Dallas Stars. Oh no, I'm so excited, but I'm so nervous. So that I totally get. Yep. And I just went in and had fun. And it worked out.
But you know, but I mean, I guess, are there certain Is there somewhere we could go or look for to find different coping strategies? Because I know, I mean, I know there's not one coping strategy for anybody, any one person. Everyone's a little different.
Yeah, I mean, there's so many resources out there, um, you know, I think there's been a lot of focus on really, again, really improving and, and promoting, you know, independence in life, um, even after an injury. Um, and so, I know of some local resources here in the DFW area, and so I, um, obviously at UT Southwestern, um, we obviously have a, um, A clinic, a rehabilitation clinic where we have that as our focus.
There's also the O'Donnell Brain Institute where we have a lot of research that comes out about individuals with various brain injuries. I'm connected with Hope After Brain Injury as well. And we actually host a, or I, I help put on an annual conference that we have. So our conference was in March, and we have another one coming up in March 2025. Um, so that's another place for resources and connection as well.
Um, other, you know, kind of more national resources, uh, the Stroke Association, American Stroke Association, great resource for both survivors and, uh, care partners. Um, There's various traumatic brain injury support groups as well. Facebook has a lot of them. BIND is obviously one of them too, right?
Um, and then of course if for anyone who wants more individualized treatment, counseling is definitely an option, um, with a rehab counselor or a rehabilitation psychologist, um, who really kind of understands what you may be going through as someone with a brain injury, um, and then modifying some of those different strategies for coping, that best fit you in your life.
I love that you, uh, just shared all of these resources because a lot of the resources can be accessed, um, either virtually or for the people that are here in DFW to be coming in person and we would love to meet. So thank you for that. Um, I also, I think I know the answer, but I think it's really good to be sharing these answers with, uh, with our listeners. Uh, how can, like, how, what is a good way to be able to, uh, Figure out or, like, identify what is giving us these, these feelings.
Um, because, like I said earlier, we might not figure out whether it's nervous or excited. But, like, what is making me feel like this? And sometimes, like, I remember, like, before B, like, the first couple of Weeks slash months of my recovery. I couldn't figure out why I was crying all the time. Like I just didn't I couldn't Because I couldn't even understand what happened to me, right? So I was like, I don't get it.
Like I just don't get it Um, but what are some ways that we can receive that help because maybe in our own thoughts, we can't figure it out. Um, How do we figuring out what's triggering us?
Yeah, you know so something to think about too is that So sometimes because of a brain injury, the emotion that you're expressing outwardly is not actually what you're feeling inside, right? And so I've had a lot of people who, um, just start crying and I'll ask them, are you feeling sad? Like, do you feel like, they're like, no, I'm actually really happy, but I'm crying and it looks like I'm sad. Um, and, and so being able to recognize that there can be.
Differences in expression in, uh, in how we're actually feeling. And so a lot of times it's actually asking yourself, how am I feeling right now? Do I feel like I'm at the sad level where I'm crying or is there another emotion that could be leading to this? Um, Again, I think initially on it can be really helpful to have other people help you kind of work through that process, right? Um, so they might be asking you, are you feeling this? This happened today, I wonder if you're feeling this?
Or it's common that most people feel this. And over time, as you have that feedback from other people, starting to ask your questions. I'm kind of going through that list of questions for those who have found writing or journaling as a good outlet and something that they can engage in. Um, that's also another avenue to some, there's something different about actually getting something in. out of your head and tangibly on something else, um, that helps you process different things.
Um, and so that can be helpful too. Um, there's been some mechanisms too of record yourself having different emotions and then review them, right? Kind of looking like, okay, this is what it looks like when I'm sad. And this is what it looks like when I'm happy. And this is what it looks like when I'm angry. Um, that can also help you. with that self recognition and then also recognition of others emotions, right, that can also be affected in terms of how do I know how someone else is feeling.
Being able to recognize those things can also be really helpful, um, so that you know how to respond to someone else.
Yeah. I know, I think my most common emotion that I have more regularly, I hate to admit, is hangry. And I totally know when I'm hangry, I start jumping, I'm like short, I And I'm short in general, before anyone makes that joke, I know, haha. Um, but you know, I know I'm like, I bite someone's head off and then I'm like, Ooh, I need to probably eat. But there's that. But speaking of that, like, does eating can, like, exercise sleep?
I mean, what are all the, like, common things that really do help us with those emotions to keep them more regulated?
Yeah, definitely. Well, first let me say too, hangry is a great example. Sometimes you don't know what emotion you're having. Go through your basic needs. Am I thirsty? When's the last time I had a drink of water? Am I hungry? Did I sleep enough? Um, you know, go through kind of your basic needs too. And if, if something you're like, Oh, I'm missing something there that can also help kind of figure out, Oh, that's why I was acting it this way. This was a great point, Carrie.
Um, So, you know, when it comes to, oh, I love talking about exercise and sleep, it's one of my favorite things. Um, um, I could, we could do a whole episode on this. Um,
Well, we might have to Carrie back.
Um, so, exercise is, um, a great tool. Um, now, of course, something to keep in mind is that you want to be mindful and be, you know, have a recognition for your own abilities, right? So, um, That's something to talk to your doctors about or if you have a physical therapist kind of understand what are your limitations. We don't want anyone to over stress on exercise, right?
So with exercise, um, you can think of, so if you think about a brain injury, our brain requires a lot of nutrient rich, oxygenated, glucose rich blood to flow through our brains, right? You can think about anything that's healthy for the heart is healthy for the brain. Um, and so when we think about exercise as a BIND is a form of helping your cardiac function in terms of pumping blood throughout the body, throughout all the systems, and including all the little tiny crevices of your brain.
Um, that's where it can be really helpful, right? Um, and so there's been a lot of studies to show that exercise can actually have very similar effects.
Similar benefits to those who are in therapy and also who take medications for emotion regulation for like anti depressants and whatnot Again, there is a sweet spot right there can be Over exercise to where you actually stress your body out more And so again, this is where you kind of know yourself and also ask your medical team about what might be most appropriate for you Exercise is, is great. Um, sleep, so, so important. Um, we take advantage of it. You know, we take it for granted.
It's just, we just think that it's, you know, we're just unconscious for a little bit and we, we sleep. Um, but there's a lot happening. Um, and so sleep is really, really, really important for our general health. Um, The, you know, the key would be to hit that deep sleep level, um, that sleep level three, um, where it's really restorative and really considering how it's, um, aiding in repairing our muscles and our tissues and cells and whatnot.
Um, and so being able to optimize sleep is really, really key as well, um, to be able to help us function throughout the rest of the day.
Okay, so take sleep very seriously.
Yes, and you know, it's easier said than done also, and so there are, so, you know, there's different methods if you're feeling like you're having trouble sleeping. One of the most effective methods is actually in evidence based practice. It's called Cognitive Behavioral Therapy for insomnia. It's has been found to be one of the most effective, uh, methods to, uh, improve sleep for, uh, due to insomnia.
Um, there can also be medications, too, that you would talk to your doctor about if they, if they feel that adding something could be helpful in at least getting you to fall asleep and stay asleep.
I love that information. I think just, like, one more question. We could talk forever, and I'm loving it. Um, but, this, um, like, these Like methods that we're learn we're talking about, not only does it go for brain injury survivors, but it also is the other side of support. Uh, do you have a tip for like how we can, how we can avoid, not avoid, but like control these, uh, negative, um, reactions for both sides, our support and the survivors?
Yeah, you know, I think, um, something that is really important to consider also is care partners and their own well being, right?
Um, and so I think that a lot of times, at least from what I encounter, Encounter survivors and their care partners Who are trying to be brave for one another, you know The survivor is trying to be brave for the care partners I don't want them to feel like they have to help me with everything and they're so burdened But then the care partner is trying to be brave for the survivor and saying well, I don't want them to think that You know, I'm having to take over everything and that you know, now
they just can't help at all, right? Honesty, Communication; so important. How are you feeling today? I'm feeling stressed because xyz. I'm feeling stressed too. How do we work it out, right? Do we both need to separate a little bit? Do I need to go to BIND to hang out for a little bit so you can have your own time, right? Exactly. Um, so being able to recognize that, you know, as survivors you are definitely going through this adjustment time. Your care partners are too.
They're trying to kind of figure out what life is going to be like for them as well. Um, and so that That recognition for, um, knowing that it's okay to have space apart. It's okay to also, um, kind of work things out and try to communicate what is actually going on. Um, you know, care partner support and stress is also really as just as important as making sure that you are supported as a survivor too.
Um, for, for, for both sides, you know, you can't really care for another person if yourself is not fully cared for. Um, and so having that recognition that, you know, it's, it's an adjustment for everybody and, you know, be able to communicate what those emotions are and feelings are to be able to, to have open conversations about it. That way you can actually say, hey, okay, you know, this might mean that, I need to do this for a little bit. You need to do this for a little bit.
We'll come back together and we'll be able to have a little bit of a little break from each other. And that can also be helpful too.
Yeah, I love that because we try to tell people and so many people don't get it. Just because one person had the brain injury, it actually the whole family has now had a brain injury. It's not.
It's not just the survivor, it is, and Kezia and I have witnessed this very well, we are both very blessed and lucky to have the parents we have that are completely supportive, but I had to learn, and I don't know how I remembered this word after my brain injury, but I did, but I had to sit down and have a very lengthy boundary conversation with my parents, basically just saying everything you just said, so that we knew, and I think that, again, like you said, you have to advocate for yourself.
As survivors, we need to be able to go forward. Hold on, let's take a break. I need to get away from you. You need to get away from me. I just need to go to my room and be alone. So thank you for reinforcing what I think I already knew.
Yeah, absolutely. Boundary setting is hard for everybody. Um, and so I think that, but it's so empowering, right? And I think once we recognize that boundaries are actually meant to fortify our relationships, not, you know, destroy them. I think that's also something that's really helpful um, as we move forward as human beings.
Well, thank you so much for this conversation, for hanging out with us a little bit more. Uh, we loved it and maybe we'll see each other soon again.
Yeah, absolutely. Love to come back.
Thank you so much, Willa. Not only do we appreciate your presence here, I hope that all of our listeners also have learned about our conversations and have learned different methods.
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