In the UK alone, nearly 350,000 people are admitted to hospital each year with an acquired brain injury, caused by anything from road traffic accidents, falls, and assaults, to vascular disorders such as strokes. And this number is growing.

As they physically recover from their injury, survivors and their families also face psychologically adjusting to a lasting impairment. Often, this includes cognitive, and communicative difficulties. But the social and emotional factors can present a greater burden, with high rates of depression among survivors. This is not only difficult to experience, but can slow down the person’s overall recovery.

But not all of those with acquired brain injuries experience depression. And contrary to what some might expect, brain injury can actually be a source of positive personal growth. Some survivors recover with a better perception of themselves, an improved philosophy of life, and stronger personal relationships. Similarly, some survivors report improved quality of life and enhanced personal satisfaction.

Positive recovery

So why the difference? Why do some brain injury survivors recover with a better frame of mind, while others struggle with depression? Trying to simply be happier doesn’t work – brain injury or not – but research suggests that appreciating the positive things in life is key.

In one study, researchers found that appreciation of life, new possibilities, and a patient’s own personal strength, greatly contributed to positive personal growth after a brain injury. It can seem like a difficult task, building internal strength after such a serious event, but there is an area of psychological research that has found it can be fairly simple to do.

In recent years, the field of positive psychology has been helping researchers and psychiatrists to better understand what causes happiness and encourages well being. This study of positive emotions, optimism, strengths, and understanding, looks at “building what’s strong” – rather than “fixing what’s wrong”.

Positive psychology can be done by using one of five simple methods. It’s something we can all benefit from. Even though the focus is on building rather than fixing, this includes people with brain injuries, too.

Professor Jonathan Evans wrote in 2011 about how positive psychology could help those with brain injuries, suggesting that it may be used alongside other rehabilitation programmes, to support them with adjusting to life after injury in a positive and hopeful way.

More recently, a trial project – the Positive PsychoTherapy in ABI Rehab (PoPsTAR) programme – put this idea into practice. The researchers incorporated therapeutic exercises based on positive psychology methods, such as setting realistic goals and focusing on positive events, with a rehabilitation programme. They found that Evans’s idea worked, and now we are working on a new project to take this method forward.

Good things

Of the five positive psychology methods, one of the most effective is “three good things”. The idea is that you write down three things that have gone well every day for a week, with a short explanation for it. This exercise has been shown to increase happiness and decrease symptoms of depression for up to six months in healthy control participants. And it has been shown to effectively improve happiness in a group of people with ABI, too.

It is thought that “three good things” helps people to focus on, and be more likely to notice, positive events and aspects of life after brain injury. For survivors with memory or attention impairment, the reflection of positive events may be more difficult. This can lead to an inaccurate sense of self, or negative perceptions of life and situations, causing some to feel that their life is lacking in positivity. But keeping a three good things diary can help them to recollect positive things in order to develop positive self-perceptions and self-esteem.

We have been running a pilot study with brain injury survivors which backs up the “three good things” research. The Brain Injury Solutions and Emotions Programme (BISEP) was developed to help survivors deal with any difficulties while they recover. But rather than doing it alone, we’re taking the three good things method one step further and asking them to share one good thing with a group of fellow survivors in a weekly meeting.

Though it’s early days, so far we have received positive anecdotes, with participants using the “things” to reformulate how they feel about their day. As group interventions have been shown to provide social support, the idea is to use the “good things” to help the participants engage with other survivors and motivate them to continue the positive method.

The two hour weekly meetings are therapeutic. Each week, we discuss a different topic and different strategies, but always start with a good things reflection. Once again, it is a simple way to build a positive psychology method into recovery but one, we hope, that will help the survivors to build a new enthusiasm for life.