Emotional Changes and Outburst
The emotional challenges began once home and remain an ongoing trial for us. Stroke affects the brain, and the brain controls our behavior and emotions. Rick experiences feelings of irritability, forgetfulness, carelessness, and confusion. Both of us experienced depression, anxiety, or anger. If you and your loved one are also feeling this way, discuss with your physician whether anti-depressant medication would be appropriate for your loved one and you.
Rick’s personality changed from being engaged in life to an attitude of apathy. He refers to it as being disengaged, that he is an observer in his own life. Apathy is a lack of interest, enthusiasm, or concern for life, feeling empty and not knowing why. His regular response to my questions about things became, “That sounds good. No big deal.”
A stroke is the “gift” that keeps on giving. When you think you’ve figured out how to handle something, the brain throws you another curve. My brain was overflowing with questions and emotions regarding Rick’s stroke that I was desperate to share with him, but he could not process. I had no idea if or when I could expect that he would again be my emotional partner.
What emotional changes can be experienced?
Depending on what part of the brain that the stroke damaged, will make a difference on the emotional/personality changes experienced. The good news is that many changes caused by a stroke tend to improve over time. So, time is on your side.
Personality changes that may occur; Not feeling like doing anything, being irritable or aggressive, being disinhibited – saying or doing things that seem inappropriate to others, or being impulsive – acting without thinking, and doing things that are not safe or are not appropriate.
As with each brain each mood response can be different and unpredictable. Depression and Pseudo-Bulbar affect are all too common. The site below shares some great information. To learn more, log on to:
Post Stroke Mood Disorders | American Stroke Association
Studies suggest that simply having a stroke increases the risk of anxiety, depression, or both. Research indicates that PBA is more common in survivors of brainstem stroke, but it can occur with other types of strokes too. Depression affects between one- and two-thirds of stroke survivors. It's characterized by feelings of overarching sadness, lack of pleasure in old activities or changes in eating and sleeping patterns. Anxiety occurs when a survivor focuses on worries and concerns. Anxiety affects about 20 percent of survivors. PBA is characterized by a mismatch between feelings and expression, like laughing at a funeral or crying at a joke.
It's not uncommon for survivors to experience all three mood disorders. The good news is that treatment is available. For depression and anxiety, one of the best treatments is counseling or therapy with a licensed mental health practitioner. Caregivers should encourage their loved ones to get assessed. If they're reluctant to see a mental health professional, they might be willing to see a pastor, priest, or rabbi.
What therapies are available?
When your loved one starts to have problems with emotions and outbursts, the first step is to have them evaluated. This will determine the root cause of the issue. It could possibly be a reaction to medication or a temporary situation.
Solution Focused Therapy -SFT is future-focused and goal-directed, and centers on solutions instead of the problems that bring people to therapy. It’s also called Solution Focused Brief Therapy and Solution Building Practice Therapy.
Problem Solving Therapy-PST is a brief psychological intervention or “talking therapy” that’s typically four to eight sessions. Problems are identified through collaboration, and the therapist teaches the person a structured approach to solving them.
Cognitive Behavioral Therapy-CBT focuses on examining the relationships between thoughts, feelings, and behavior. By exploring thought patterns that lead to self-destructive actions and the beliefs that direct them. The therapist and individual actively work together toward recovery.
Attitude and Commitment Therapy -ACT (also known as Acceptance and Commitment Therapy) teaches people to "just notice," accept and embrace their thoughts, feelings, sensations, memories, and other private events (especially unwanted ones) instead of trying to better control them.
Interpersonal Therapy- IT focuses on interpersonal relationships by improving the way the depressed person communicates and relates. Techniques help the person identify emotions and their sources, express emotions in a healthy way and deal with emotional baggage from past relationships.
Mindfulness Therapy-MT (also called Mindfulness-Based Cognitive Therapy) helps those who suffer repeated bouts of depression and chronic unhappiness. It combines the ideas of cognitive therapy with meditative practices and attitudes based on cultivating mindfulness. The goal is to become acquainted with the mental states that often characterize mood disorders while learning to develop a new relationship with them.
Written by American Heart Association editorial staff and reviewed by science and medicine advisors.
How and what to share with family and friends?
As emotional and personality changes occur it is important to keep family and friends in the loop. Share what you are seeing and the plan for your loved one. Their support will be critical to you and your loved one’s health. Here are some tips on how they can assist you.
· Ask that they share their observations. You are with your loved one daily and so subtle changes can be missed or thought of as if that is just them.
· Activities and mental stimulation are critical to cognitive impairment. Invite the loved one out and allow them time to talk and share what they are thinking. Please be patient, it can take several minutes to form their thoughts or words to share.
· Patience with the outburst and attempt to redirect the stroke survivor.
· The primary help is for the Care Partner. Typically, they are the brunt of the outburst. Provide them with time away from the situation, allow them to vent, and provide encouragement.
Tips for the Care Partner
Each day is a new day, never knowing what to expect when I wake. I must focus on what personality remained and what had changed. It was an experiment to find the positive each day, and most days I couldn’t. After several weeks, Rick shared how much he appreciated all that I had been doing for him and said he didn’t tell me enough. That positive feedback was a life changing moment for me.
Poststroke, my identity became Rick’s Care Partner. He needs so much support from me. He becomes angry that he cannot do things for himself and at times I am the focus of the frustration. Being acknowledged by him made me feel noticed and that I was vital to the recovery. There are no simple solutions to the emotional changes, just small adaptations.
Staying positive allows me to try new approaches and to find new solutions. But staying positive, especially when they are upset or blaming you for their life change is not easy. Your feelings of worry, anger, frustration, or sadness are very valid and MUST not be discounted. Practicing cautious optimism may strike the right balance.
Ultimately, the best way to cope with the changes is to view life after the stroke as the recovery process and not as the end of life. It may feel like the end of life but it really is the beginning of a new life chapter. The key is working together with the stroke survivor. You need to provide honest and direct feedback. Allow them a sense of control and involvement over the life plan for the two of you.
What helps me…
· Share your grief with a support group. Family and friends love you both and are also dealing with the changes they see in the loved one. It is important to find a group for you. Individuals who are in the same boat and do not know your loved one.
· You feel responsible for them 100% and sharing changes falls to you. These are tough conversations. Talk to your health provider alone and then together discuss with your loved one. This softens the anger and sadness that they project onto you.
· Have a family meeting where everyone can share their observations with you, this will allow you to not feel so alone. Then together develop a plan to share with the loved one. The key is that they do not feel ganged up on. I recommend smaller conversations, with one child or friend at a time.
For more information on what worked for us, check out “Stroke and the Spouse,” available on Amazon, or follow the code below to purchase.
Stroke Caregiver Connection…Because you care!