Helping families and marriages impacted by TBI

Traumatic Brain Injury Caregivers Guide Caring for service members and veterans impacted by traumatic brain injury has become an increasingly urgent national priority. A new publication from the Defense and Brain Injury Center and innovative programs offered through VA Hospitals in collaboration with PAIRS Foundation help caregivers and families address the impact of TBI, promote healing, and strengthen marital resilience.

“Traumatic brain injury (TBI) is a major public health problem in the United States. In 2006, the Centers for Disease Control and Prevention reported that TBI is more prevalent than cases of multiple sclerosis, HIV/AIDS, and breast cancer combined. Due to the present conflicts in Iraq and Afghanistan, members of the United States Armed Forces are one of the largest populations at risk for TBI. Of the service members medically evacuated for battle-related injuries from Iraq and Afghanistan to Walter Reed Army Medical Center, 33 percent had traumatic brain injury (as of March 2009). “

Col Michael S. Jaffee, MD
National Director
Defense and Veterans Brain Injury Center

Traumatic Brain Injury (TBI) is the leading injury among U.S. forces serving in Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]).  As a result of the frequent use of improvised explosive devices (IEDs) in these wars, service members have been exposed to blasts and other injuries that led to an increasing number of TBI injuries among those returning from deployment.

According to a recent publication of the Defense and Veterans Brain Injury Center, among service members evacuated from OEF/OIF to Walter Reed Army Medical Center in 2003-2007 because of injuries, 30 percent had a TBI. The Army reported that 88 percent of TBIs among soldiers were mild. Six percent were moderate and another six percent were severe.

No two brain injuries are exactly alike. Some people who have a TBI recover quickly, others take much longer. Some will have very few longterm effects. Others will face lifelong challenges. The effects vary from person to person. Recovery from a TBI may be measured in weeks, months, or years. Strong interpersonal relationships and the consistent support of spouses, family members and significant others are vital to adjusting to the “new normal” that can result from TBI and promote long-term healing.

While the impact varies from person to person, TBI often includes physical, cognitive, communication, behavioral and emotional symptoms.

Physical effects

  • sleep
  • fatigue
  • dizziness
  • balance
  • sensory changes

Cognitive effects

  • confusion
  • slowed speed of processing
  • attention problems
  • difficulty with memory
  • planning and organization problems
  • difficulty with decision making and problem solving
  • confabulation

Communication skills

  • does not speak clearly
  • problems starting a conversation
  • word finding problems
  • problems following a conversation
  • reading comprehension problems

Behavioral and emotional

  • frustration, increased anger/aggressiveness
  • impulsivity or difficulties in self-control
  • poor judgment
  • reduced or lack of initiation
  • repetitive behaviors (perseveration)
  • less effective social skills
  • changes in sexual behaviors
  • lack of self-awareness
  • depression
  • increased anxiety
  • mood swings
  • changes in self-esteem

In 2009, PAIRS Foundation began actively collaborating with the Charlie Norwood VA Medical Center to help couples impacted by visible and invisible wounds resulting from a service member’s combat deployment, including Post Traumatic Stress Disorder and Traumatic Brain Injury. The collaboration was recognized by the Veterans Administration as “Best Practice in Marriage Enrichment.” Weekend retreats are designed to measurably strengthen attachment, bonding, communication, emotional understanding and expression, and improve conflict resolution skills.

“PAIRS is changing the lives of returning combat veterans and their spouses.”

Ron Craddock
Chief of Chaplain Services
Charlie Norwood VA Medical Center

“PAIRS systematically works toward developing participants’ emotional iteracy, including the capacity for vulnerability and empathy that is often impaired after combat deployment. We have seen remarkable results through tears and testimony from the veterans and spouses who participate.”

Mitchell S. Tepper, Ph.D., M.P.H.
The Center of Excellence for Sexual Health
The Satcher Health Leadership Institute
Morehouse School of Medicine, Atlanta, Georgia

Weekend retreats conducted by PAIRS National Faculty, VA Chaplains, counselors and others trained and certified by PAIRS Foundation add layers of resilience to couples, marriages and families during the often lengthy healing for injuries suffered in combat deployment. Enhancing interpersonal relationships is critical to addressing the impact of TBI on behavioral/emotional issues, communication, and improving the impact of related interventions throughout the treatment process.

The Defense and Veterans Brain Injury Center has published a Guide for Caregivers of Service Members and Veterans which is available for download. For more information on PAIRS Professional Training and services for couples impacted by visible and invisible wounds, visit sacredtrust.pairs.com, e-mail sacredtrust@pairs.com, or call (877) PAIRS-4U (724 7748).

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PAIRS Foundation, a 501(c)(3) nonprofit, is one of the nation’s oldest and leading providers of relationship skills training. In 2006, PAIRS was awarded a multi-year, multi-million dollar grant from the U.S. Department of Health and Human Services, Administration for Children and Families, to provide marriage education classes and relationship skills training to couples, singles and high school youth in South Florida. To date, over 5,000 people have participated. Extensive research on the program, as well as research conducted in collaboration with Charlie Norwood VA Medical Center, has shown consistent, positive results for couples in all stages of relationship. Weekend programs and multi-week classes, as well as online classes, are open to active-duty, guard and veterans. A calendar of upcoming events is available online.

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What is PAIRS?

Intimacy is critical to the process of developing and sustaining close relationships, now a major concern in our culture. Modernization has shifted the primary function of marriage from providing security, stability, and raising children to developing a lifetime of love and intimacy. In previous generations successful marriages depended upon duty and role competence. Modern marriages require greater interpersonal competence as well as equality between partners. Relationships are sought that not only create stable families but also provide partners with a lifetime of love and companionship.

The PAIRS (Practical Application of Intimate Relationship Skills) programs, developed by Lori H. Gordon, Ph.D., provide a comprehensive system to enhance self-knowledge and to develop the ability to sustain pleasurable intimate relationships. Gordon's approach integrates a wide range of theories and methods from psychology, education and psychotherapy and presents them in an educational format. PAIRS acts to bridge therapy, marital enrichment, and marriage and family development.

Programs: Courses and Workshops

PAIRS offers programs to the public led by PAIRS Trained Professionals (licensed health care professionals), and PAIRS Instructors (certified clergy and educators), trained under the auspices and supervision of Gordon and the PAIRS Foundation, the organization that officially oversees PAIRS programs, products and licensing worldwide. There are PTPs and facilitators around the world. Check “Finding an Educator” to find one near you or near one you love who may need PAIRS.

PAIRS is effective in all populations for which it has been adapted. PAIRS has relationship skills training programs for children and youth, PAIRS for PEERS, that are taught in schools, churches and agencies. PAIRS has programs for the Military, for use by chaplains and family service workers. PAIRS has faith-based programs for the Jewish, Catholic, and Christian church communities. PAIRS is currently developing programs and program delivery systems for disadvantaged youth, unmarried families, single parents, domestic violence, prison parolees, and related groups who can benefit from relationship skills training. PAIRS provides a vital ingredient to build stable marriages and healthy families with more hopeful futures for children. These programs for special groups will be taught by local agency workers and by specially trained community teachers and mentors. Research on PAIRS has demonstrated that PAIRS works for all groups under all circumstances evaluated. PAIRS is a modern technology adapted to our rapidly changing society in behalf of creating a saner, safer more loving world.

What you will learn in PAIRS

Sustaining a pleasurable intimate relationship does not work by magic. It depends upon a set of skills and understanding that can be learned. We learned most of what we know about intimate relationships through our early experiences in our families. Our personal history has a great deal of influence on what happens in our current relationships - on our behavior, our feelings, our expectations. We can change these influences if we become aware of them and wish to. It is well worthwhile to sort through what we inherited, keeping what fits for today and changing what does not.

PAIRS Competencies are specific skills that you will learn from PAIRS. These competencies focus in three areas: 1) emotional literacy; 2) conjoint partner skills for building and maintaining intimacy; and 3) practical knowledge, strategies and attitudes for sustaining positive marriage and family life. You may click on the above links to see a listing of the skills taught in PAIRS.

The Goal of PAIRS is a relationship that both partners can live with joyfully. For this to happen, each partner must become able to identify his or her own feelings and needs, and learn to communicate them in such a way that they can get met. This means communicating one's needs and desires without making the other partner feel resentful, smothered, burdened, manipulated, or inadequate. Easily and fully meeting each others' needs is the foundation of intimacy, fulfillment, and happiness.

PAIRS teaches specific easily learnable tools for successful communication such as confiding, complaining, and clarifying and for effective problems solving such as managing anger, expressing anger safely, fighting fairly for change and eliminating dirty fighting. PAIRS also guides the vast deepening of self-knowledge and develops emotional literacy. PAIRS addresses pleasure and satisfaction by teaching skills to enhance bonding, sensuality and sexuality in marriage. PAIRS teaches a profound but simple model, the Relationship Roadmap, to understand relationship success and to understand relationship mishaps and know what to do about them. PAIRS teaches over 60 skills that, after PAIRS, become the participants' PAIRS Tool Box for ongoing relationship maintenance.