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Life Integration Cognitive Therapy
Copyright: Life Integration Cognitive Therapy and the entire contents of this website are © Patrick A. Jones, all rights reserved. Permission is hereby granted to use this for personal or institutional use under the condition that it include copyright information this web address, and references www.BrainInjuryChaplain.com.
Vision
Affordable, accessible, lay implementable long term cognitive therapy and assessment which integrates into survivor’s and caregiver’s lives and has their therapy being work on real things of their choosing.
Products (in the order it makes sense to me to develop)
Life Intigration Cognative Therapy home workbook: audience: Sally and Joe survivor and caregiver. Purpose: to guide them through the creation of their own home cognitive therapy plan.
Assessment and tracking tools: both paper and website
Speech Therapist and Neuropsych resources: various teacher manuels -- ideas for how to integrate with outpatient work, workshops, etc... Professional resources written in professional language.
Research on effectiveness of this therapy over time (long term study with findings published at various milestones) and modifications to materials to reflect latest findings.
Workbook Outline
Introduction
Who this is for
Anyone who needs cognitive therapy and is self motivated, or has a caregiver who can work with them to help with schedule and motivation, or wants to supplement the cognitive therapy they are receiving through a cognitive therapist (make friendly so cognitive therapists can use this as a supplement at home tool).
This book is recommend for use in conjunction with a cognitive therapist for people who have difficulty with motivation or extreme memory loss.
Basic Philosophy of Life Integration Cognitive Therapy
The best cognitive therapy comes from entering into life as fully as possible rather than in a simulated environment working on things that remove you from your family and have you doing “work” that does not produce anything. While working in a therapy center can be beneficial in learning new ways of coping, home and everyday living are the best environments for daily implementation of those skills. Far more than just a workbook, Life Integration Cognitive Therapy is an entirely new approach to nurturing your brain to become as functional as possible over time
Cognitive therapy should be ongoing throughout life for people with cognitive issues. This means it needs to be affordable, and easily integrate with home life so it can be part of life for years to come. It should also be low impact on a person’s brain fatigue, and encourage them to self-regulate how and when they push the envelope and when they need to give their brains a rest.
How to use this workbook
Brief descriptions of the workbook sections and what to expect from them.
Can be used in conjunction with software we are developing. (Provide info on that once developed.

Dealing with Loss of Capacity
Grief
working through stages of grief
Grief can be different timing depending on your level of responsibility and other issues. Give yourself permission to go at whatever pace you naturally go at. Your body and soul naturally progress through these stages, though sometimes they need a nudge along through the support of a loved one and/or through understanding the process of grieving, it’s stages, and what happens in each. In general, the more a person is able to face reality head on the better equipped they are to make steady progress.
As the brain injury survivor
TBI Theory of Relativity: THe whole damn world has changed and is now against me! This is the what it seems like. In reality, your brain is no longer able to deal with sensory input the way it used to, nor process your thoughts they way you are used to. So, like a passenger at a stop sign who doesn’t realize the car is slowly rolling, it seems like the whole world is moving except you. Coming to understand this is the first step toward accepting what has happened to you.
In many ways you are still the adult you know, in some ways you are like the child you were.
Learning to be your own parent
Your anger is like a child’s temper tantrum. Your mad because the world is more than you can handle right now. So remove yourself to a safe place and give yourself time to be mad, and then recover (this can take days or weeks depending on your brain injury).
Relationships
Support
Understanding what your lover is going through as they become the primary person who helps you.
Spouse/ significant other
children
Other family
Friends
Faith Community
As the caregiver, family, or friends
Support for you
Relationships
Husband and Wife
Changing expacations
Change how you communicate
New role as caregiver of the one you love
Family
Friends
Faith Community
Rearranging expectations, schedules, and environments, to help cope with deficits
Developong work around tools and strategies
notebook/calendar/pda
computer
Play with what works for you. Among the huge range of possibilities are:
Computer with PDA combination.
Because Macs are so intuitive, more reliable, and less in need of constant virus updating and protection, many people find them easier to work with. Using them taxes the memory less because they are so intuitive.
Note programs (some free) remove the clutter of paper notes and yet make everything easily findable.
Memory loss
Concentration/ overstimulation etc...
Aphasia
Other cognitive issues???
Use concept cues to help you rememer what you needs immediately. This is a combination of conceptual and situational memory.
If you think “I need to make my bed” repeat aloud to yourself “bed, bed, bed, bed, bed, bed,bed” as you walk to your bed. When you get to your bed, you’ll figure out it’s not made and will make it, even if you don’t remember why you were saying bed. With time, you may get to your bed and the word “bed”, when you stop to think about it, will open up to the specific activity you were trying to remember. Use this technique to remember what it is you want to write down as you get out your notebook or get where you need to on your computer. With time your brain will lean to mindlessly repeat whatever you are saying, then when you get to where you need to “remember” what you wanted to do you say it once more with intended action rather than mindless chanting, and the meaning often comes back.
Stages of Brain Injury
Trauma
this is where the brain is swollen due to impact. My belief is that doctors who say memory of other functioning will come back in 3-6 months or not at all are referring to this stage because in all likelihood the brain has returned to normal size after 3-6 months and any deficits due to swelling have returned (memory is common). However, there is still brain sheering which has left nerve pathways disconnected -- and this neural damage is where the long term (years, decades, a lifetime) of micro improvements take place.
Bewilderment
This is the period of time in which the brain is figuring out that its interface with the world is vastly different than it used to be -- a bit like a pilot whose instruments still give him information but it is bizarre and indecipherable and the pilot has to learn to fly all over again the plane by trial and error. Often the outputs work differently as well, so when the pilot pulls back on the yoke, the plane banks left instead of pulling up. This makes the process of figuring out how to fly much more complicated. When doctors refer to the magic year as the time when healing takes place, I believe this is the stage they are referring to because as the brain figures out how to fly the plane it appears from the outside that things have returned to normal. They haven’t -- the brain has simply adapted to the new wiring and put in patches around damaged wiring to make things work. The pilot may still be pulling back to bank left, turning left to nose down, etc. Without a very detailed scan such as a SPECT to show the damage inside, the functioning for many people appears largely normal. However for people with more severe neural damage, this stage can be an ongoing, constantly evolving stage that overlaps with the next stages -- as the brain changes with time, so does the way it processes information and we have to again relearn how to fly the plane. The more we are able to interact with the world, the more we learn about how our “new” plane functions in this new and bizarre way it understands the world.
Steady on
This is the point where our brains have figured out how to fly as best we can for now. We will keep figuring out new tips and tricks, how to avoid various exterior weather patterns most of the time and develop other work around strategies. A sense of “OK, this is the new normal” begins to settle in, and may last for years or a life time. The brain (pilot) has to land often to rest (flying a bizarre world plane is exhausting!) and fuel (the plane itself uses more fuel because it is not nearly as efficient as it was before the brain injury). The plane may be flying with a lot of deficits, many obvious to the outside world that knows how to look (via neuropsychology, for example). This is the stage where cognitive therapy can play a role of helping us to rewire around damaged areas, and over long periods of time and with diligent pushing of our capacities combined with plenty of rest, micro improvements in functioning can be seen. For many of us, this is a lifetime long stage and the steady pursuit of cognitive interaction can make a huge difference because it helps our brains know how and where we should rewire connections.
Structure Shift
This may happen of its own accord as the result of diligent engaging with life in the “Steady on” stage, or it may be because of other changes. I personally experience this shift as the result of two different therapies (and I’m often not sure which causes what or if its both). I receive Sadhana therapy, which in essence melts my body’s wrong structure and puts back its right structure. My neck is now taller and no longer has scar tissue and improper structural tension constricting motion and potentially blood flow. This improper structural function was the result of my various concussions, starting with when I landed on my head off a swing at age 12. My brain has to “catch up” with these changes and so in some ways I am back in the “Bewilderment” stage trying to refigure out how to fly my plane. As more shifts happen, the “Bewilderment” stage becomes longer, and in some ways it seems like I’m doing worse. However, I actually notice some base improvements. I am also entering into a hyperbaric chamber (it increases the oxygen in the blood). At first, I was doing 1-2 hours a day every day I could. This caused so much to shift that I could no longer function. Every day was extremely hard. I’ve since pulled back and now do 1 hour a week in the chamber. For me, this seems a good balance of hopefully continuing to see some improvement, while not being slammed all the time. I have my ordination coming up in a few months and I may even stop the chamber to allow myself to completely catch up with how my plane now functions to maximize my chances of showing up for my ordination. After, I may do occasional weeks of 1-2 hours per day, followed by periods of no chamber or 1 hour per week. Being my own guinea pig, I get to set my own tests. Grin. The hope is that I will emerge from all this scaffolding and bewilderment with a shiny new overhauled plane that, while it may not function like it is supposed to, certainly functions better than what I had before I entered these shifts.
Developing your unique Life Integration Therapy Plan
Types of memory
Detailed Memory (often called Short-term memory)
becomes medium and long term memory, but is still the memory of details, experiences. Similar to Experiental Memory
Experiential Memory
Remembering lifes experiences, like being able to repaly life like it was on a dvd.
Visual Memory
Muscle Memory
Conceptual Memory
Situational Memory
Some might argue this is not memory at all, but it is. However, rather than being stored in our brain, this memory is stored in the world around us. By learning to see the footprints of what has been, we can pick up on clues as to what the situation is without having any memory of the events themselves.
I intentionally use this to “remember” things simply because I place them in my path where I know their odd presence will remind me to do something.
Examples? Can’t think of a single one! Love this memory stuff! Argh!
I often remember things my wife has forgotten because the reality of the moment around me tells me about it. Again, I can’t think of a specific example now. However, I often unknowingly notice developmental changes in our daughters before my wife does, because I don’t remember where they are and I rediscover where they are fresh with each interaction. This was an answer to prayer  -- I’d asked St. Joseph to help me be a father to who my daughters are now, not the one 2 year old I remember.
Organic Memory
Our experiences shape us just as we shape the world and people around us. Organic memory is the reality that I am a different person now then I was five years ago. Over time, even without memory, I respond to life’s expeiences differently, in part because my brain learns new and different ways of thinking.
Types of Cognative Loss
Assessing your strengths and weaknesses
Brain Injury and Personality Theory
Personality change in TBI folks is predicted by their Myers-Brigges personality type before the TBI, including the extreemness of their personality type..
TBI forces people to live more reclusive lives due to over-stimulation, with focusing on details or memory because of decreased motor skills and memory loss. This forces people to live more like INs then they did previously, shifting them on the scale more toward the extremities of I and N. Because this shift is more dramatic for people who are E and/or S, those around them experience a personality shift and there is a greater prepensity toward anger because there is a constant inner conflict between their innate personality and the demands of their limited capacity.
Possible ways to help with the shift
Extraverts
Keep a journal
Online community - connect with email support and chat groups (give some examples)
Talk aloud to yourself. Because extraverts think aloud, they need to literally hear themselves think. Talk yourself through what you are doing.
Sensates
Strong routine (perhaps to the extremity of obsesive compulsive)
teach different types of memory (situational, organic, etc.) - like a blind person learns to see differently, teach to remember differently.
Prayer and Attitude
Living with brain injury is a long, hard, and often cruel journey. Yet there are many tremendious gifts along the way. Developing a habit of focusing on the gifts of life rather than its pain makes the road much smoother to travel and we usually find we’ve come farthr than we realize. This doesn’t mean we no longer feel the pain and challange of life, but we don’t allow it to be heavier on us then it is.
Develop or continue the habit of daily prayer and or meditation (whatever is part of your faith). Experiment with what types of prayer work for you now. After my TBI I couldn’t pray the same way I did before it -- a very hard loss. It took me lots of frustration and time to eventually figure out what my new form of prayer was.
Pray for others. Oddly enough, the best way to pick ourselves up is to reach out and help others. Keep others in your prayers and your pain and challenges dwindle back to their real size and weight.
Home Therapy Ideas
Remember you don’t remember. This is a leverage step -- which means accomplishing it open the door to many other ways of compensating. Remembering you don’t remember allows you to then ask “where do I keep my memory?” and look for you computer notes, a notebook, a calendar, whatever memory tools work for you.
Discover and Implement Compensation tools
Having ownership of our own needs, even when shared with a caregiver, promotes our dignity and self worth. Working on our own cognitive therapy at home by doing things with those we love removes the burden of therapy and promotes us entering into life more fully.
The very process of successfully discovering how we can compensate for our deficits helps us have confidence in tackling the next thing that we face. Success breeds success, so lets start by creating small successes and working forward from there
As you begin to tackle “larger” projects, give yourself permission to leave them incomplete. But before you stop, make notes and leave them where you will find them when you rediscover this project. That way you can pick up where you left off and eventually lots of your little progresses with have you completing something that seemed impossible before. (this is similar to the GTD phenomenon -- focus on one actionable step at a time, then plan the next step. (In fact, I implement GTD via the Mac program “NoteBook” by Circus Ponies. That’s literally how I accomplish what I accomplish.
Play games
kid games, card games, lawn games,
Exercise and let your mind play while you do
Reading
Children’s books (age level based on ability level). Read them aloud, to children if you have them, to a caregiver or an audience of stuffed animals or pictures if not.
Reading books one step above your comfort level
even if you can’t keep track of character or plot, read anyway. Read at what seems a regular speed to you. Feel free to look back to “remember” characters or plot, take notes about who is who and what is happening, your own thoughts in response. Describe how different aspects of this work on different types of memory and other cognitive deficits (do this through out the therapy ideas).
Mystery novels are great for this. WHatever you read, try and pick books on topics that interest you (whether they did or not before your cognitive deficits)
Pick books that were made into movies. Read the book first, then watch the movie. What differences did you notice? Which did you like better?
List of book/movie combos
Braveheart (read a biography of William Wallace)
Rob Roy (Read a biography of Rob Roy)
TV/ Movies/ Videos
If you get TV, try and follow new series as they are broadcast. The fact that many shows provide a brief summary at the begenning of an episode is very helpful now.
Check out videos and DVD’s from your library. This is free, and a great way to “veg” on days or times when your brain needs to be doing something but isn’t up to doing much.
Keep track of what you’ve watched, perhaps taking notes of your thoughts about each (computers are great for this, especially note programs.
If you have memory issues, get the same movie twice and see how much you remember about what is going to happen. This actually drives me (Patrick) nuts, because I have strong conceptual memory, so while I don’t remember exactly what will happen next, the film does not hold my attention because I conceptually know what will happen in the plot)
Plan an event
Start small, but ask yourself what you want to create. Say it’s a breakfast meeting with close friends. Who, what, where, when, why, how.
Build upon success. Do the folks involved want to do it again? Perhaps make it a book club, or discussion group or writing group, or art group, or???
Plan an overnight trip somewhere. Work with someone to help you as needed.
Plan a multi-day trip. If budget is tight, is camping an option? If not, plan it and take it virtually, printing out pictures and ideas from the internet about what you would do if you could.
Vision/ Dream/ Plan how you want to contribute to those around you
This is the seventh stage of grief (see chapter on grief)
What are you passionate about?
What would you love to see different about the world around you?
My own example:
Passionate about Scottish Enlightenment and the prospect of having passianate dialogue around concepts and issues, particularly relating to theology, economics, and politics. I had no idea where this would lead, but I started a group we call the Poker Society (because, like a fire poker we want to stoke the embers of Liberalism) and began meeting regularly with the other two guys.
Out of those conversations have come a multitude of other ideas with are in various stages of progress including:
Theology paper proposing a systemic model of Catholic Social Teaching, working with a theology professor
Foundational ideas for a Catholic company that seeks to integrate Catholic spirituality into daily living.
By daring to dream and then asking myself “How could I make this happen?” I have been able to slowly but surely progress forward in what I accomplish. Because of my deficits, I can not implement most things, and so I seek out others who are also passionate about an idea and work with them to implement it. Together we accomplish what neither of us would have on our own. (Life Integration Cognitive Therapy is another example of this).
Give yourself the down time you need
Brain fatigue is your brain’s way of telling you to slow down. You will make more progress over time if you learn to listen to this and not over tire your brain.
Create a sanctuary where you can go and have minimal stimulation around you, where you can focus on one thing without distraction of background noise, flashing lights, etc...
Remember the motto: As fast as I can, as slow as I must!
Assessment testing and tracking
Both paper and computer (internet?) options for this. Have progress chart be 5 year chart to help set long term mindset for progress.
I personally do not see the purpose of goals by a certain time here. I think establishing milestones makes sense (examples?). The motto is “As fast as we can, as slow as we must”
??? What else needs to be a part of this?