Social Skills After Traumatic Brain Injury

What Are Social Skills?

Social skills are the skills people use to communicate and interact with others. Social skills include what you say, as well as your body language, eye contact, facial expressions, tone of voice, and other actions. Cognitive skills (for example: staying focused, memory) and emotions (for example: anxiety, anger, sadness) also play a part in social skills.

Examples of social skills include:

• Listening to and understanding what people say
• Communicating thoughts, needs, and feelings through words and actions
• Managing your emotions in social interactions
• Respecting social boundaries and social rules (for example: not standing too close to someone, not asking overly personal questions
• Adjusting what you say and how you say it, as well as what you do, based on the situation

Why Are Social Skills Important?

Good social skills can help you:

• Have enjoyable interactions
• Get along with others
• Keep old friendships and make new ones
• Feel confident socially
• Succeed at school, at a job, or in a volunteer position

How Can a Brain Injury Affect Social Skills?

After a traumatic brain injury (TBI), people may have problems with social skills. These problems can differ from person to person and can be harder to manage when feeling strong emotions, such as anger or excitement. Common examples are:

• Feeling out of place and uncomfortable around other people
• Interrupting conversations
• Losing focus during a conversation
• Forgetting what someone has said
• Misunderstanding the words, facial expressions, tone of voice, or actions of others
• Difficulty getting along with others
• Talking too little or too much
• Having trouble expressing thoughts and feelings
• Not showing interest in what others have to say
• Not knowing how to start or maintain a conversation

Can Social Skills Get Better After a Brain Injury?

Research shows that social skills can improve after a TBI, even many years later. Working on your social skills with a therapist can help you to improve these skills. Therapists who help with social skills after TBI include speech-language pathologists, neuropsychologists or clinical psychologists, clinical social workers, and other health care professionals. You can also practice social skills with a family member or close friend.

How Can Social Skills Get Better After a Brain Injury?

Below are some tips that may help you improve your social skills. It may be helpful to ask a family member or friend to help you with this:

1. Evaluate. The first step in improving your social skills is thinking about your social skills: What you do well? What is challenging for you? It may help to think about someone who communicates well, or observe someone who is a good communicator. What skills or behaviors make that person a good communicator? This may help you gain a better understanding of the social skills you would like to improve.

   Below is a list of some common social skills. Again, ask a supportive friend or family member for feedback on how you are doing on each of these skills:

   • Taking turns in conversation
   • Staying focused on the topic
   • Listening to others
   • Showing interest in the other person
   • Asking questions of the other person
   • Getting to the point
   • Coming across as friendly and relaxed
   • Being supportive of the other person
   • Keeping emotions in check, and using a calm tone of voice
   • Taking the time to speak as clearly as possible

2. Set Social Skills Goals.

   • Decide on one or two areas you would like to improve and write them down. For example, you could set a goal to ask more questions during conversations to keep the conversation going.
   • Post your goals in a place where you’ll see them every day (for example, on your refrigerator or on your phone).
   • Share your goals with a supportive family member or friend, who can help “coach” and practice with you.

3. Practice Social Skills and Get Feedback. Practice at home, at work, or in other social situations. Here are some specific ways to practice:

   • Visit places in the community where you have a chance to interact with other people (for example, take a walk with a friend or neighbor, visit the library or recreation center, or have coffee with a friend).
   • Think about what you’re going to say before you speak, and about how others might feel about that.
   • Show interest in the person you are talking with (smile, have eye contact, ask friendly questions).
   • Pay attention to feedback you get from the other person (did he/she smile, ask questions, keep eye contact, etc.).
   • At least once a week, ask your family member or friend to give you feedback about how you’re doing on your goals.
   • Practice social skills in front of a mirror, or have someone videotape you practicing. Watching yourself can help you notice areas to work on. It may also help you realize that you are doing better than you thought!
   • Write a short script that you can practice to say when a specific situation comes up (for example: when a conflict comes up, when you are talking to someone new).

Tips for Working on Your Social Skills in Specific Situations

1. To start a conversation, especially with someone new:

   • Talk about some of the things that are around you (such as a slogan on a hat, the weather, the person’s dog, etc.).
   • When you’re first getting to know someone, stick with neutral topics. Avoid talking about politics, religion, money, or personal information.
   • Ask open-ended questions, for example, “What did you do over the weekend?”, “What do you think about the movie?”, “What kind of hobbies do you have?”, “What did you do over the holidays?”, or “What are your plans for the weekend?”

2. To keep a conversation going:

   • Focus on topics that you think might be interesting to the other person, and ask open-ended questions related to the conversation.
   • Be aware of your body language. For example, make comfortable eye contact (looking at the person but not staring), nod your head, and smile.
   • Take turns talking and listening.
   • Watch for cues that the other person might want to end the conversation (such as looking at the clock, looking away, making comments about being in a hurry).
   • Be respectful of other people’s personal space by not standing too close.

3. When you feel like there could be conflict:

   • Let the other person finish talking and listen to what they have to say. Try to see the other person’s point of view. What is it that the person wants you to know? If you don’t know, it’s okay to ask. For example, “It sounds like you’re upset that I didn’t clean the kitchen, is that right?” If you can’t agree on something, try to meet them half way.
   • Use friendly body language and tone of voice. For example, avoid pointing your finger, yelling, or rolling your eyes. Try to stay calm and have your body and face as relaxed as possible. Remember to breathe.
   • Pay attention to your emotions. Let the person know what you are feeling and start with the word “I”: “I feel frustrated right now,” or “I’m feeling upset about that.” If you think you need time to calm your emotions, let the person know that you need to take a break.
   • Show respect to the other person by talking to them in a way that you would want someone to talk to you.

Improving your social skills takes time and effort. Social skills usually improve one step at a time. Give yourself a pat on the back when you realize that you’ve taken even a small step toward your social skills goals.

For Families and Friends

Interacting with someone who has had a brain injury may require you to adjust your own social skills or the environment. For example, give the person more time to process what is being said and give them time to respond. Limit the amount of information you communicate at a time. Pay attention to the topic being discussed and the person’s reactions: Do they affect the person’s emotions and/or cognitive function? If the person seems fatigued or overwhelmed, wrap up the conversation.

Reference

Hawley, L., Newman, J. (2015) Goal Setting in Social Competence Treatment after Brain Injury. In Rehabilitation Goal Setting: Theory, Practice and Evidence, Siegert, R., Levack, W. CRC Press, Taylor and Francis group, Boca Raton.

Hawley, L., & Newman, J. (2008). Group interactive structured treatment–GIST: For social competence (Rev. ed.) (Previously titled Social Skills and Traumatic Brain Injury: A Workbook for Group Treatment; 2006). Denver, CO: Authors. (www.braininjurysocialcompetence.com)

Hawley, L., & Newman, J. (2010). Group interactive structured treatment (GIST): A social competence intervention for individuals with brain injury. Brain Injury, 24(11), 1292–1297.

McDonald, S., Bornhofen C., Togher, L., Flanagan, S., Gertler, P. & Bowen, R. (2008). Improving first impressions: A step-by-step social skills program. Sydney, Australia: University of New South Wales.

Neumann D. (2010). Emotions alter relationships after brain injury. Retrieved from https://www.lapublishing.com/blog/2010/brain-injury-emotions-relationships/

Neumann D. (2014). Talking with your spouse or Charlie Brown’s teacher? Miscommunication in couples after brain injury. Retrieved from https://www.lapublishing.com/blog/2014/tbi-spouse-couple-neumann/

Neumann, D., Babbage, D., Zupan, B., & Willer, B. (2015). A randomized controlled trial of emotion recognition training after traumatic brain injury. Journal of Head Trauma Rehabilitation, 30(3), E12–E23.

Authorship

Social Skills After Traumatic Brain Injury was developed by Lenore A. Hawley, MSSW, LCSW; Jody K. Newman, MA, CCC-SLP; Dawn Neumann, Ph.D., Therese M. O’Neil-Pirozzi, ScD, CCC-SLP in collaboration with the Model Systems Knowledge Translation Center.

Source: The content is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Traumatic Brain Injury Model Systems (TBIMS), funded by the National Institute of Disability, Independent Living, and Rehabilitation Research, as well as experts from the Polytrauma Rehabilitation Centers (PRC), funded by the U.S. Department of Veterans Affairs.

Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. The contents of this factsheet were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DP0082). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this factsheet do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.

Copyright © 2019 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.