I talked to a neurologist a few days ago and she expressed some ideas that I found interesting and worth thinking about. She seemed really competent and made a strong impression on me. The following ideas are probably most useful for the anxious (and mildly depressed) types like me who did not suffer from the most severe brain injuries.

She told me that, according to some scientific evidence and to her own experience with patients, perfectionist personalities have the hardest time recovering from concussions. She thinks this is because they never really put their brain at rest, even when they think they do, because they keep thinking about their condition and worrying about their future. People who are naturally more carefree (sorry if it is not the right word) spontaneously put their brain in better conditions to heal.

When I asked her what I could do to promote the recovery, she mentioned the following:

1. Be less demanding with myself, and adapt my expectations.

2. When something unpleasant and a bit ridiculous happens (e.g., a relapse caused by a raindrop - yes, it happened to me), try to laugh about it, as a child would do.

3. Spend less time worrying about the negative things that might happen, and more time trying to find solutions to improve my life and relieve my pain. This very obvious recommendation was actually quite enlightening to me, as it made me realize that I indeed spend a lot of energy anticipating and avoiding triggers, instead of pursuing the things that provide relief (e.g., massages reduce my headaches, but for some reason that I can't explain I almost never have one).

4. Think less about my health and more about what I want to do with my life. Do things that I really like, and that bring joy. Joy is obviously a goal per se, but it is also excellent for the brain.

5. Expose myself slowly to my triggers. I was asking whether, for instance, I should avoid cobbled streets when I drive, as this sets me back every time. She confirmed that this kind of things is not dangerous at all, and insisted that I should retrain my brain to tolerate them. She also noticed that I was moving very carefully to avoid rapid head movements (for instance when standing up), and she told me to stop that and to start moving normally ASAP, even if that generates symptoms. According to her, avoiding these things might simply make me unable to drive on cobbled streets ever again, or to move normally. I found this last point interesting, and it certainly resonates with habituation therapy in other contexts. That said, the right balance between legitimate self-protection and experimentation outside the comfort zone seems hard to find.

My best wishes to all of you.

(Writing all this I realize that Mark in Idaho already made some related points. Is that possible that Mark is just a cover name and that you are actually a young, female and very charming German neurologist? Just asking :-D)

The title should obviously be "exposure" to triggers. Would a moderator be kind enough to edit that? Thanks.

I have tried to convey these concepts many times. Researchers find three issues that are related to slow recovery.

1. People who are overly focused on every possibility whether it is due to anxiety or perfectionism tend to have prolonged recoveries.

2. People who had a tendency to be anxious or struggle with depression prior to the concussion have a very high likelihood of a prolonged and miserable recovery. They find they can actually predict this long recovery when the patient has pre-existing anxiety.

3. Highly intelligent people want to understand every little nuance so they may over emphasize symptoms that they ignored prior to their current concussion. Now, since they have a concussion history, they decide every symptom is severe brain damage. They also notice very minor decreases in mental function. The need to focus to overcome distractions is seen as a major dysfunction. These thoughts release stress chemicals that make recovery slow and worse.

Many symptoms of concussion are also just symptoms of a busy and active life. When we just move forward without a negative focus on those symptom as being concussion related, life returns to something that resembles a normal life.

I have learned to laugh at many situations. It not only makes PCS more tolerable but it makes life more pleasant.

For example, I play ping pong at the Y. Those I play with get all stressed out when they muff a shot. This stress reduces their level of play. I just laugh about these muffed shots. When a slow ball is missed that should have been hit and returned, the joke is "At least you waved at the ball as it went by."

I have sayings like:

Brain farts: Wow, that stinks and I can't believe it came out of me. This is when the wrong word comes out or after similar speaking mess ups.
When I get stuck trying to speak and I mumble, I have a saying, My tongue gets caught around my eye tooth and I can see what I am saying.

By having ways to laugh and lighten the stress of various struggles, we can get on with our lives.

Knowing how to reduce the impact of cobble stone roads can also help. Even if they are not damaging, they are still annoying, even to people who have not suffered a concussion. Leaning forward away from the seat back can help.

Vania, I think that the neurologist made some excellent points which are by no means confined to people who are dealing with TBI/PCS.

Great post, thanks for sharing!