I worked with a middle-aged woman, named Brittany, that was experiencing chronic headaches and neck pain, as well as sensitivity to both light and sound, almost two years after receiving a concussion in a motor vehicle accident.
Details in the story that follows have been changed to protect privacy.
Brittany shared that the combination of the issues she was struggling with was debilitating. She had missed out on living a full, rich life for the better part of two years. A physiotherapist had told her there wasn’t anything more he could do for her, and her physician wasn’t able to help her move forward, either.
It didn’t help that Brittany had been packaged out from work as “disabled” during a downturn at her firm, because the net effect was that she had lost her confidence.
We tend to believe what others tell us. If your company labels you as disabled, and your physiotherapist and physician both say there’s nothing more that can be done for you, you tend to believe them.
This is called the Nocebo Effect. It happens when you lower your expectations to what others tell us they should be – especially if they are experts. The Nocebo Effect is the opposite of the Placebo Effect, where you reach for what others say you can achieve.
Fortunately, I have had successes working with people with chronic headaches and neck pain, so Brittany and I were able to address these issues immediately. Within four months, with the help of a knowledgeable physiotherapist and personal fitness trainer, as well as meeting regularly with me, Brittany was able to report that her chronic headaches and neck pain were 90 percent better, and continuing to improve.
I wrote a blog post about the work I did with another client that had similar issues, so I won’t write much more on these topics in this blog post. If you’d like to read that post, you can click on: The link between stress, muscle tension and chronic headaches.
Once Brittany was making good progress resolving her chronic headaches and neck pain, we expanded our focus to address her sensitivity to light and sound.
Overcoming a sensitivity to both light and sound involves understanding that our brains can develop a habit of over-reacting to sensory input, vis-à-vis what was previously normal. To recover, Brittany needed to slowly expose herself to increasing intensities of light and volumes of sound to reset her baseline to normal, while telling herself that the increased brightness and volume were “normal,” and “okay,” and that she could relax and feel safe. Over the course of six months, with constant self-reminders of what was normal, Brittany was able to overcome both sensitivities.
Brittany’s sensitivities had started as typical, acute reactions following a concussion. She had become fearful because these sensitivities triggered headaches, and she wanted to avoid the pain of the headaches at all costs. To this end, she had started to wear sunglasses and earplugs on a full-time basis.
The problem with this approach was that her brain reset its baseline tolerances to light and sound and developed “new normals.” Anything brighter or louder than these new normals made her brace.
Understanding that her brain had become overly sensitive, but that this sensitivity was not the result of brain damage following her concussion, was key to Brittany’s learning how to overcome her sensitivities and reset her baselines.
A neuropsychologist taught me that sensitivity to light and sound following a concussion signals that there hasn’t been significant brain damage. This fact is delightful because it meant that Brittany could fully recovery, because her brain hadn’t been seriously damaged in the motor vehicle accident.
Initially, Brittany saw an audiologist to establish that there wasn’t anything wrong with her hearing. Once damage had been ruled out, she proceeded to slowly increase the normal volume of sound that she was exposed to routinely. Gradually, she turned up the volume on the television and the radio to what others called normal. Then she slowly started putting herself in increasingly louder settings, like grocery stores and shopping malls and restaurants.
After Brittany had started to experience successes working on “the sound project,” we started to work on her sensitivity to light, too. I spoke with an eye doctor that suggested she gets her eyes checked out.
Her eye exam is scheduled to take place in a couple of weeks, but I doubt that anything will be found. Once Brittany understood what was happening with her hearing, she started to overcome her sensitivity to light, too.
How did Brittany do it? How did she retrain her brain so that her baseline sensitivities to light and sound are returning to normal? It may be the Placebo Effect. She may have simply decided, and believed, that there was nothing wrong with her vision or her hearing and risen to the occasion.
This is how I understand Brittany’s situation, in part. If I had a period where I needed to wear sunglasses because I had a real sensitivity to light, then I would wear them. If I was concerned that I might be unable to take the sunglasses off, I might keep wearing them. After a couple of years, I expect I would find it difficult to function without my sunglasses because my eyes would hurt when I took my glasses off.
The biggest thing that may have helped Brittany is that she took a trip early on in our work together to Thailand, a warm and sunny destination where she wanted to participate fully in life. So, she got out there. She went out in bright places and accidentally increased her exposure to light. It helps that she was with a husband that she trusts, so that she could take risks and know that she would be safe.
After several weeks in Thailand, her sensitivity to light had decreased. Just eight weeks after the trip, she came into my office and said we didn’t have to keep the overhead lights off anymore.
I should give a brief update about Brittany’s chronic neck pain and headaches. Working with a good physiotherapist has done a lot of good. Having the physiotherapist confidently help Brittany relax her neck muscles taught Brittany that these muscles could be relaxed.
This was a huge first step because 70 percent of headaches are tension headaches, caused by tight neck muscles. Once Brittany learned to relax her neck muscles, her headaches dissipated.
While Brittany was in Thailand, the tension in her neck “disappeared” because she was relaxed and happy. She was away, having fun, with her husband. She experienced almost ten days in a row without a headache on that trip for the first time. What did this teach her? That she didn’t have to have headaches.
After the trip to Thailand, Brittany’s recovery snowballed. Less neck pain lead to less headaches, which led to a belief that she might be able to get better. Which led to a belief that she could get better. Which led to an expectation that she would get better. Which led to the belief that she could get over her sensitivity to light and to sound. The snowball just kept gaining speed and size.
The next project Brittany faces will be to get over a fear that she can’t do math anymore. I anticipate, knowing that she doesn’t have any serious brain damage from the concussion, that she will get over this fear, too.
It might be appropriate to suggest that most of Brittany’s issues lingered because of the Nocebo Effect. I anticipate that being labelled as disabled when she was terminated from her job has led her to believe she can’t do math.
Wild, hey? Also, glorious when we discover what’s going on, because we can work to undo the Nocebo Effects and get back to baseline.
— Dr. Patricia Turner, Registered Psychologist, Calgary, Alberta