Surviving Catastrophic Reaction after Brain Injury: The Use of Self-Regulation and Self-Other Regulation

Abstract

Catastrophic reactions are usually observed after brain injury. Although Kurt Goldstein described this concept more than fifty years ago, it has not been adequately incorporated in the theoretical and clinical field of neuropsychological rehabilitation. In the following article a number of cases where patients experience catastrophic reactions are illustrated, as well as the intrapersonal and interpersonal mechanisms that facilitate the regulation and reorganization of the self. It is proposed that catastrophic reaction activates attachment mechanisms by default, mobilizing the patient to look for a significant other to regulate him/herself from outside. This article also describes how high levels of arousal, triggered by a catastrophic reaction during interpersonal conflict, impact on mentalizing, which is a self-regulatory function that generates representations of our own and other’s mental states. Finally, it is suggested that lesions to different brain areas might impair specific self-regulatory and self-other regulatory components, requiring the adaptation of psychotherapeutic technique to these particular profiles. Examples of the modification of psychotherapeutic technique with the patient and the family are provided.

Keywords:

• attachment
• brain injury
• catastrophic reaction
• mentalizing
• psychotherapy
• self-regulation