Planners Versus Avoiders in Traumatic Brain Injury

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The outcome after a traumatic brain injury often depends a great deal on the attitude of patients, and how well they can cope. Although past research is mixed about the association with coping styles and brain injury outcome, much of that research used questionnaires rather than observing actual behaviors. More recent research has shown that, based on behavior, certain coping styles can indeed be more detrimental than others to outcome after brain injury.

An avoidant coping style is one in which a person engages in activities that are distracting-such as watching television, texting, eating, drinking, or even just staring into space. Avoidance of an essential task, whether it is specifically for rehabilitation or for everyday life, obviously limits a patient's recovery. However, most traumatic brain injury patients exhibit avoidant coping styles.

Avoidant coping style can be explained by loss of executive functioning skills, such as memory, attention, decision making, and problem solving. People with a traumatic brain injury often experience a loss of executive functioning skills-either from a direct injury to the frontal lobe (which is related to executive functions), or indirectly from injured connections to the frontal lobe.

But not all people with a traumatic brain injury rely on avoidance to cope; some are capable of planning and executing a task. A recent study that compared avoiders to planners after traumatic brain injury found that planners had better executive functioning, had higher pre-injury IQs, and performed a stressful task better than avoiders.

The patients were also given psychological tests such as depression or anxiety scales, and physiological tests such as heart rate monitoring, in order to assess their reaction to stress. Interestingly, planners also were more psychologically and physiologically reactive to stress than avoiders.

Planners are therefore more able to experience the negative feelings of stress, and can subsequently take an active approach to coping. Planners are also more likely to self-regulate their emotions and impulses because of their increased reactivity. However, because traumatic brain injury patients are more likely to have executive dysfunction and exhibit avoidant coping style, rehabilitation efforts that focus on planning skills may help improve outcome.

Krpan KP, Stuss DT, & Anderson ND. Coping behavior following traumatic brain injury: What makes a planner plan and an avoider avoid? Brain Injury. (September 2011).

Krpan KP, Stuss DT, & Anderson ND. Planful versus avoidant coping: Behavior of individuals with moderate-to-severe traumatic brain injury during a psychosocial stress test. Journal of the International Neuropsychological Society. (March 2011).