Last time, in exploring the landscape of neurotrauma research, we examined what academic literature tells us about coping mechanisms following a brain injury. This week, the focus shifts from abstract data to real-world application, analyzing how well those scholarly findings align with lived reality—specifically, my own journey navigating the aftermath of a severe neurological trauma.
The American Psychological Association defines coping broadly as “the use of cognitive and behavioral strategies to manage the demands of a situation when these are appraised as taxing or exceeding one’s resources or to reduce the negative emotions and conflict caused by stress.” As noted previously, researchers Cardile and colleagues observed that patients with acquired brain injury (ABI) who employ active, problem-oriented coping strategies face their conditions with greater resilience, a stronger sense of self-efficacy, and significantly fewer reported symptoms. Conversely, past psychological studies have divided coping strategies into functional categories, contrasting adaptive action and distraction with maladaptive responses such as trivialization, resignation, and avoidance.
However, a fundamental biological hurdle complicates this equation. By directly damaging affect, emotional control, and complex cognition, a brain injury drastically reduces an individual’s available resources and abruptly cuts off access to active coping strategies.
I faced this stark reality firsthand following my own brain injury. Yet, according to the psychological frameworks documented in literature, my underlying personality—characterized by a resilient approach to facing problems head-on, seeking to understand them rather than trivializing or avoiding them, and persistently searching for solutions—should have aligned with better psychological outcomes. The puzzle, therefore, lies in understanding why theoretical resilience sometimes crashes against the unyielding wall of a physically altered brain.
Pre-Injury Coping Strategies and the Loss of Flow
A neurorehabilitation stress management course I attended determined that my primary coping strategy prior to my brain injury was reading. Unfortunately, the trauma effectively destroyed that capability. Reading requires a delicate balance of distraction—escaping reality into another world—and active engagement, such as accumulating knowledge about one’s injury, learning what others do to cope, heal, and reintegrate into society.
Any strategy that allows an individual to enter "flow," a psychological state of deep immersion that I lost entirely after my brain injury, is intrinsically rewarding and incorporates elements of both action and distraction. But what happens when an injury eliminates automaticity, long-held skills, and foundational cognitions like memory and concentration? You can no longer enter flow. By default, you end up relying on coping strategies that require virtually no remaining cognitive skills and demand no ability to retain daily habits.
That is precisely what happened to me.
Post-Injury Maladaptive Coping and the Trap of Food
Deprived of complex intellectual outlets, I fell back on the one coping mechanism I could still physically execute: eating—specifically, consuming organic dark chocolate whenever I experienced physical or psychological pain.
Eating, however, is inherently maladaptive in this context. Unlike reading or watching television, which can provide mental distraction for hours at a time, eating offers only a momentary reprieve from distress. This fleeting relief necessitates constant repetition, which in turn steadily worsens overall physical health.
Challenges With Diet, Stress, and Weight
The consequences of this shift caught up with me when my general practitioner diagnosed me with diabetes in 2009 and prescribed a strict low-glycemic diet. Interestingly, I had actually practiced a low-glycemic lifestyle prior to my brain injury, but the trauma wiped that knowledge clean from my memory, and no one in my daily life stepped in to remind me.
An adaptive personality and a history of healthy habits do not compensate for a physical brain that requires outside assistance to fill in functional memory gaps. Yet, standardized professional responses remain largely absent when it comes to helping an isolated patient replace maladaptive coping strategies with realistic alternatives tailored to their injury-created limitations, let alone systematically reinforcing those effective habits over time.
My general practitioner eventually referred me to a physical trainer who was deeply familiar with heart issues in concussed elite athletes. This specialist modified my diet further and developed an individualized exercise regimen that ultimately eliminated my chronic water retention—a relief that meant I no longer had to sleep with my head elevated. The trainer required regular feedback and refused to sugarcoat dietary advice.
Too often, healthcare professionals provide crucial instructions only once, deliver them too gently, and fail to coordinate with the rest of a patient’s support network. They frequently operate under the assumption that because a patient appears outwardly strong, they do not need ongoing reminders or active support to translate advice into action. My trainer avoided that critical mistake.
Nevertheless, after my time with the trainer concluded, the combination of my injured brain and relentless, high-stress levels meant I continuously struggled to keep my weight under control. Being able to bake easily—even without needing Post-it notes plastered across my kitchen cabinets to remind me of each individual step—exacerbated the situation.
On one hand, baking served as a distraction and gently reinforced basic cognitions; on the other hand, I had very few people to share the results with. Hiding freshly baked cookies and brownies in the freezer simply did not keep them out of my mouth. Watching television worked somewhat better as a distraction strategy that aligned with my chronic neuro-fatigue—a reality my parents recognized when they insisted I purchase a television for my bedroom. Even so, passive television viewing was neither productive nor genuinely life-affirming.
Regaining Skills and Adaptive Strategies
Over the years, through advanced neurostimulation and neuromodulation treatments, my reading, memory, concentration, writing, and other cognitive skills gradually returned. With renewed healthcare support, I eventually regained the ability to use reading to lessen negative emotions and sympathetic nervous system overdrive. Furthermore, writing and computer work began to serve as effective distractions after next-generation treatments restored my capacity for flow, even if only for a few minutes at a time.
When my overall health improved sufficiently about three to four years into the pandemic, my general practitioner and pain specialist prescribed walking five days per week to help manage both my diabetes and my stress levels. They increased the required duration very gradually, and both doctors remain strict in ensuring I maintain the routine, with my case manager checking in periodically to monitor my progress.
Walking, writing, and reading now serve as functional, adaptive coping strategies that partially replace the old impulse to eat. This progress was made possible because I healed sufficiently through next-generation medical treatments and finally secured consistent professional support. Yet, when that support inevitably wanes during holiday periods, or when I simply grow tired of being perpetually tired, I tend to skip a walk or two and read and write less frequently.
Today, I am actively experimenting with ways to leverage reading, writing, distraction, and other life-affirming techniques to break the default habit of turning to food, reserving only a small, measured treat to reward myself for accomplishing difficult tasks. Since the year 2000, I have rarely engaged in a robust clinical conversation about systematically replacing emotional eating with an alternative coping strategy that respects my brain injury’s limitations. Instead, medical discussions have remained sporadic, focusing narrowly on weight, diet, and exercise in isolation. Discussing eating solely in the context of physical metrics is fundamentally different from discussing it as a mechanism for coping with overwhelming situations and intense emotions. In the absence of a comprehensive, empathetic approach, reaching for chocolate or cookies remains the path of least resistance.
Ultimately, standard clinical research often misses two crucial pieces of the puzzle that explain why weight gain can occur despite an individual’s innate adaptive personality traits and intellectual knowledge of active coping strategies. First, an unhealed brain injury actively drives maladaptive coping by eliminating or preventing the execution of healthy cognitive skills. Second, no independent coping strategy can ever fully substitute for a dedicated person or an inclusive community willing to step alongside you and metaphorically carry the weight when circumstances overwhelm an injured brain.