This is a part of podcast series from the Model Systems Knowledge Translation Center discussing emotional challenges after a traumatic burn injury (TBI). In this segment, Dr. Backhaus describes what emotional triggers are after TBI. 

Let's say, for example, there may be a husband that's had an injury and he has this sort of underlying fatigue, and there are three kids at home and a spouse. Well, that fatigue again, may be there all day, but let's say that the fatigue worsens as the day goes on, and now it's come dinner time and the kids are actually coming home from school and they haven't seen dad all day. And so what ends up happening is that kids come home and there's noise. So there's increased noise. And now they might be running around. If they're school age kids, they might be yelling, two kids might actually, two siblings are getting into a little argument, and that's mine. No, that's mine. Take it off. You can't wear my sweater, or you can't play with my toy. And in sort of a healthier circumstance, maybe a parent might need to get in there and let the kids sort that out unless it starts to get escalated.  

And then that parent can say, alright, enough is enough. Right? The parent may end up raising their voice a little bit, and if things really get escalated, maybe discipline, but now literally within 30, well within about a minute to two minutes, I'm sorry, that as they're going, that's my sweater. That's my sweater. And it's two rooms over because there's a heightened sense of hearing. Now this person with the injury goes in there and starts yelling and screaming. So what do we do in a situation like that? Right? Because now it's become a problem. What we're doing is the immediate strategies and the long-term strategies. Immediate strategies would be things like when you start to hear that happen, if it's a nice day outside, then you go, you go. And again, we need to get their buy-in on this. And once they've bought in, then that person will leave and will kind of walk outside, maybe sit on the porch, just let them give a few minutes for them to really work that out and then come back inside.  

That person can also remind them. We will remind them about, okay, well what are the other tools in your toolbox when you start to feel yourself get agitated and you can't go outside? What are you going to do? I am actually going to use my mottoes. Kids are like this. I'll wait five minutes. I just let them be, don't interfere. Whatever motto that they choose to use, that's most appropriate, they're going to start repeating this motto to themself. Some of the other things that, like we've had this one father do, he sometimes will actually, now he's learned to express himself to his wife in the past. He would actually jump out of his chair, go in there and yell and scream at the kids who now have learned, I'm not going to go to dad for anything. And that upsets him, right? He doesn't have the relationship.  

So now what he's doing is, instead of getting up and jumping and screaming, he now says to his wife, I'm starting to get agitated. I'm starting to feel upset by this. I'm starting to feel this. And that may not sound like a big deal, but there's actually a lot of research that shows that. Just the simple act of letting it out, the simple act of expressing how you're feeling and the agitation that you're feeling, actually that labeling that it will actually help cope with that situation. And it reduces some of that. So it stops him because then his wife, not only does it reduce his own agitation, just by saying, I feel agitated, but also the wife says, okay, what do we need to do? Well, do you want to take some deep breaths? Do you want to go? Do you want to maybe, how about you relax?  

You relax for a little bit and let me take care of this one, right? Instead of you going in there, let me take care of it. Or Put your headphones on. Put your headphones on, listen to music. I got it. So that's a strategy he's been using because she can be around to see if it gets too escalated. And once it deescalates, he can take his headphones off. And now he has learned that he makes it through the noise, they've deescalated, and now he gets to go in after the noise has calmed down and manage the situation, which now builds the kids' trust back in him. Because if mom goes in there every time, they're going to learn that dad isn't involved. So now that he's calm and he can go, he couldn't manage it when their voices were up here, but when they're calm, he can go in and he can say, I need you guys to, I'm going to give you two minutes to sort this out. And if it's not sorted out, the sweater's mine, whatever he and his wife decide. So we're trying to make it an approach where they can work together as a team to figure out the immediate solution to that, and then also in the long term, get him more involved so that he can instill discipline in them and regain his role as a father in that setting. So that's great. 

Visit https://msktc.org/tbi and get the answers you need from experts who conduct innovative and high-quality research, provide patient care, and work to improve the health and overall quality of life for people with traumatic brain injury. That’s https://msktc.org/tbi.