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Traumatic Brain Injury and Social Skills: What You Need to Know as a Caregiver

As a caregiver for someone with a traumatic brain injury (TBI), you have probably noticed not only cognitive changes in the person you are caring for, such as problems with attention, concentration, and memory, but also changes in social skills. Social skills include conversational skills, recognition of social cues, and management of emotions. The person with a TBI may:

  • Have difficulty understanding your tone of voice, especially sarcasm or jokes,
  • Not understand body language or facial expressions,
  • Display an inability to understand someone else’s perspective (i.e. a lack of empathy),
  • Express extreme and/or inappropriate emotional responses.

One of the major social skills affected after a TBI is conversational skills. The frustration and misunderstandings that result from interpersonal conversational problems, such as not reading facial expressions correctly or misinterpreting one’s tone of voice, are some of the reasons many people with TBIs suffer from broken friendships, strained intimate relationships, family conflicts, social isolation, and have trouble maintaining or gaining employment. It is difficult to have a meaningful social interaction with someone who cannot communicate their needs effectively, nor accurately interpret what you are saying/asking. This may impact your ability (or perceived ability) to properly care for this individual. However, it is important to emphasize that this is no one’s fault—it is the result of the trauma the brain experienced during and after the injury.

Another common type of social skill affected in a person with a TBI is the unawareness of social signals they themselves are giving off. This person may unknowingly put out strong social signals for others to “stay away”, which leads to trouble building or keeping friendships, as well as difficulties with coworkers, family members, and caregivers. In a social situation, a person with TBI may be feeling overwhelmed with keeping up with the conversation, and not realize that their facial expression and body language are giving off signals that they are angry. This misinterpretation and unawareness of their own social signals may lead to them being excluded and avoided by people that they know and meet.

Finally, a social skill commonly affected by a TBI is trouble regulating emotions, meaning the person may have emotional reactions that are inappropriate to a given situation, or may detach from emotion completely and display few emotional reactions. Both the inability to control one’s emotional response and lack of any emotion display in someone with a TBI can lead to inabilities to accurately read and interact in social situations, creating an especially heavy caregiver burden.

While these social skill problems have real and serious consequences in the lives of the person with a TBI and those around them, the good news is that many hospitals and rehabilitation centers are now offering social skills rehabilitation groups. In the same way that therapists can work with someone with a TBI to improve cognitive skills like memory or attention, social skills can also be taught, most effectively in a group setting. Treatment groups are usually led by psychotherapists and speech therapists trained in social communication, and the groups are comprised of only people with TBI who have problems with social skills.

Learning social skills takes practice and repetition. Homework and real-world exercises are essential for social skill improvement. Caregivers are necessary in this process, to work on social skills with the individual and help them overcome their isolation (often brought on post-TBI because of social interaction difficulties). Being in a group with others who have TBIs and suffer similar social skill problems can be validating and help them feel less alone and like they have a community where they belong. The goal of such social skills rehabilitation groups is to decrease isolation and increase quality of life through implementing the social skills learned in the group out in the real world. If the person you care for is exhibiting social skill problems like those discussed in this article, ask about a social skills rehabilitation group at your next doctor’s appointment.

Caregiving, especially for someone with a TBI, can be very draining, so while looking for a social skills group for the person you care for, also see if the same hospital/rehabilitation center offers support groups for caregivers. It is important for caregivers to find support too, especially since you are the primary person dealing with the impact of post-TBI social skill problems.


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