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Rebuilding Social skills (Social skills deficits)

Social skills are a complex system of behaviours that determine how well we communicate with others.  Our ability to do this is just one of the many life skills that can be affected by brain disorders such as traumatic brain injury (TBI).  

Social skills are the foundation for getting along with others. When they are lacking, it becomes difficult to maintain friendships and make new ones. It is also harder to relate to others in the workplace, learning environments and the wider community. People with an acquired brain injury need help in identifying and rebuilding lost social skills. 

Those who have sustained frontal lobe damage can lose self-awareness and insight. At the same time, orbitofrontal damage (injury to the very front of the brain) can disrupt an individual’s ability to inhibit unwanted responses such as inappropriate anger or sexual expression.  

Social skill deficits may be related to the following: 

  • impulsivity, both verbal and motor 
  • poor visual perception of facial and body language cues 
  • poor auditory perception of vocal cues 
  • invasion of the personal space of others 
  • inappropriate touching 
  • disorganisation or untidiness 

Social skills are something we learn and develop with social reinforcement from the people around us. It is important that those with brain injury have feedback from others in order to relearn the skills they have lost. Bear in mind that the learning process can be a challenge when a person is also experiencing mood swings, depression or overreaction as a result of an acquired brain injury. 

Social skills training (SST)

Social skills training is a form of behavior therapy used to help people who have difficulty relating to other people.  A social skills program will start with an evaluation of the strengths and weakness of a person’s ability to function socially. Intervention strategies will then be selected and put in place to address areas of need. 

It is important that the physical and social environment is adjusted to create positive interaction. For example, family, friends and work colleagues are likely to be more accepting once they are educated on the effects of ABI on social skills.  

Using effective ways to teach skill development will also improve a person’s chance of rebuilding lost skills. Finally, a person’s ability should be assessed and interventions modified continually throughout the program. 

Here are some tips if you are unable to access a social skills trainer: 

Self-confidence and brain injury

It is natural for people to lose self-confidence following an acquired brain injury (ABI). The injury itself can lead to depression and fatigue, which have a major impact on self-esteem. 

A group of brain injury survivors once met to discuss and find strategies for issues such as self-confidence. 

They agreed that confidence arose from: 

  •   having a purpose to life 
  •   feeling loved 
  •   doing well in a chosen role 
  •   having hope for the future 
  •   being content with who you are 

Brain disorders such as traumatic brain injury (TBI) were seen as having an impact in all these areas, therefore self-esteem was likely to be affected.

Factors influencing self-confidence

The group found that the degree of understanding shown by people close to them and the reaction of the general public made a big difference to how they felt about themselves. Families who understood the effects of the brain injury and were supportive instead of critical played a major part in the brain injury survivor feeling more confident. This issue was a difficult one when there were no outward visible signs of a brain injury, such as a wheelchair or facial scarring. In these cases families were more likely to be critical of the survivor’s cognitive problems. 

Those who constantly compared their current situation with their situation before the acquired brain injury (ABI) had more trouble with self-confidence, as did those who could not cope with negative comments from others.

Being assertive about your needs

The group found that being assertive about their needs helped build confidence. By contrast, being either too passive or too aggressive had negative consequences. 

A passive approach led to feelings of being ‘pushed around’ and meant agreeing with others despite personal feelings. This often led to resentment and levels of distress building up over time. 

The aggressive approach was viewed as people ‘getting their own way’ by arguing, making demands, threatening and generally stepping on others. This behaviour was thought to lead to social isolation. 

The group found that being assertive in a positive way involved two-way communication where problems were solved and the message put across in a way that allowed people to feel good about themselves. Survivors knew that they needed to work on communication skills so that they could see the other person’s viewpoint and know how to approach topics appropriately. 

The group agreed that body language was an important part of being assertive, including: maintaining eye contact, straight body posture and calm speech. Sometimes it helped to practice what they had to say to someone else.

Communication skills for self-confidence

Survivors often feel that they needed to relearn social skills lost after their brain injury. Regaining these skills can be vital to maintaining existing friendships and making new ones. They include:

Personal strategies for self-confidence

People who have survived a traumatic brain injury or similar brain disorder have suggested the following personal strategies for feeling better about themselves: 

  • spend time with positive people and avoid negative people 
  • become more self-aware and lose negative, unhealthy, unproductive thoughts 
  • take up hobbies you will enjoy 
  • set realistic goals and recognise small gains and achievements 
  • learn problem-solving skills to handle the bad times 
  • help someone else 
  • practise relaxation 
  • write a poem or verse that has personal meaning for you 
  • work on meeting new people and improving existing relationships 
  • make a plan for keeping in contact with others, and do something social every week 
  • be assertive and communicate your needs to others – not aggressive or passive 
  • persist despite setbacks 
  • join a support group for survivors 
  • look after your health by eating well, exercising and getting sufficient sleep 
  • use humour and see the funny side of things 
  • accept personal limitations while aiming towards self-improvement 
  • look for inspiring stories in books and films, e.g. Shaw shank Redemption 
  • grasp opportunities, experience life and make the most of it! 


Some survivors have found mantras useful. These are personal statements or affirmations that can help you get through a tough time. Some examples are: 

  • if I change my thoughts I can change my world 
  • if it is to be, it’s up to me 
  • always stop and think before you act 
  • learning is an active process and I will learn by doing 
  • actions speak louder than words. 

Many take comfort in the centuries-old prayer: “Grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”