The crash was months ago — why am I still not right?
You were cleared by the ER. The CT was normal. Your doctor said give it a few weeks. But weeks turned into months, and the fog, the short fuse, the broken sleep — none of it lifted. You forget words mid-sentence. Small sounds make you flinch. You snap at your partner over nothing, then feel terrible about it. You lie in bed exhausted but your brain will not shut off.
If this is you, you are not imagining it, and you are not lazy. What you are likely living with is post-concussion syndrome — persistent symptoms after a mild traumatic brain injury that the initial medical workup missed or dismissed because the scans looked fine.
You are also not alone. A 2023 meta-analysis in the Journal of Neurotrauma found that roughly one in three people still report symptoms three to six months after a concussion using lenient criteria, and about one in six meet stricter diagnostic thresholds (Cancelliere et al., 2023). That is not a small number. And yet many people with post-concussion syndrome are told there is nothing wrong with them, or that they should be better by now.
This post explains what is actually happening in your brain, why the usual advice often falls short, and how counselling and neurofeedback training — two approaches I use together in my Vancouver practice — can help your nervous system finally recover.
What post-concussion syndrome actually is
A concussion is a functional brain injury. The brain was shaken hard enough to disrupt how neurons communicate, even though the tissue itself may look intact on imaging. In most people the disruption resolves within days or weeks. In post-concussion syndrome, it does not.
The symptoms cluster into a few domains:
Cognitive: brain fog, poor concentration, word-finding problems, slowed processing, difficulty multitasking. You were sharp before the accident; now reading a paragraph twice does not help.
Emotional: irritability, anxiety, tearfulness, low mood, emotional flatness. A 2026 study in the Journal of Head Trauma Rehabilitation confirmed that anxiety and depressive symptoms are among the most persistent consequences of concussion (van Ierssel et al., 2026). You may cry at things that never would have bothered you, or feel a simmering anger that has no clear target.
Physical: headaches, dizziness, light and noise sensitivity, fatigue that sleep does not fix.
Sleep: difficulty falling asleep, staying asleep, or both. And poor sleep makes every other symptom worse — it is the multiplier.
These are not separate problems. They are all expressions of a nervous system that was knocked off its baseline and has not found its way back.
Why “just rest” is not enough
Rest is appropriate in the first days after a concussion. But extended rest — weeks of lying in a dark room, avoiding all stimulation — can actually slow recovery. The brain needs graded re-engagement, not prolonged withdrawal.
More importantly, rest does not address the two things that keep post-concussion syndrome going once the acute phase has passed:
1. Dysregulated brainwave patterns. A concussion can shift the brain’s electrical activity — too much slow-wave activity in areas that should be faster, or connectivity patterns that are no longer efficient. The brain compensates, but the compensation is exhausting, which is why you feel mentally spent after tasks that used to be effortless.
2. Unprocessed traumatic memory. The crash itself — the moment of impact, the sounds, the confusion afterward — is often stored as a trauma memory. Your nervous system treats it as though it is still happening. That is why intersections make your chest tighten, why a sudden noise puts you on edge, why sleep will not come because your brain is scanning for the next threat.
Rest cannot retrain brainwave patterns, and rest cannot process a traumatic memory. These require specific interventions.
How counselling helps post-concussion syndrome
Counselling after a concussion is not about lying on a couch and talking about your childhood. It is targeted, practical work aimed at three things:
Processing the traumatic memory. EMDR (Eye Movement Desensitization and Reprocessing) is one of the most effective tools for this. You hold the distressing memory briefly in mind while following bilateral stimulation — eye movements, taps, or tones. This lets the brain finish processing the memory so it stops firing as though the crash is happening right now. For a single-event trauma like a car accident, EMDR often resolves the flashbacks, the driving anxiety, and the hypervigilance in a relatively small number of sessions.
Managing the emotional fallout. Irritability, anxiety, and mood changes after a concussion are not character flaws — they are symptoms. But they erode relationships, work performance, and self-worth if they are not addressed. Counselling provides concrete strategies: emotional regulation tools, communication repair with your partner or family, and a framework for understanding what is happening to you so you stop blaming yourself.
Rebuilding daily function. Sleep hygiene that actually works for a post-concussion brain. Pacing strategies so you can return to work or school without crashing. Grounding techniques for the moments when the fog or the panic hits. These are skills, and they can be taught and practised.
I want to be direct about something: counselling alone does not fix the brainwave dysregulation. It addresses the trauma, the emotions, and the daily coping — and those matter enormously — but if your brain’s electrical patterns are still off, you will keep hitting a ceiling. That is where neurofeedback comes in.
How neurofeedback training helps post-concussion syndrome
Neurofeedback training is a form of brain training. Sensors placed on the scalp read your brainwave activity in real time, and a program gives your brain feedback — usually through a game or video that responds to your brain’s activity — so it learns to produce more efficient patterns.
Think of it this way: after a concussion, your brain is running an inefficient operating system. Neurofeedback does not force a change; it shows the brain its own activity and lets it self-correct, the way a mirror helps you fix your posture.
The research supports this. A 2022 randomized controlled trial in Frontiers in Human Neuroscience found large treatment effects for neurofeedback after concussion — including a Cohen’s d of 2.74 for frontal assessment battery scores and 1.01 for phasic alertness in participants with frontal involvement (Annaheim et al., 2022). In plainer language: people got measurably sharper, more alert, and better at the executive-function tasks that post-concussion syndrome disrupts.
Neurofeedback is not a quick fix. It typically requires a course of sessions — the brain needs repetition to consolidate new patterns, the same way physical rehabilitation requires repeated exercise. But unlike medication, there is no chemical dependency, and the gains tend to hold because the brain has genuinely learned a new way of operating.
Why I use both together
In my practice, I rarely use just one approach for post-concussion syndrome. Here is why:
Neurofeedback steadies the nervous system — it calms the baseline hyperarousal, improves sleep, sharpens focus. But it does not process the memory of the crash. If that memory is still stored as live danger, the nervous system keeps getting re-triggered no matter how well-trained it is.
EMDR clears the traumatic memory — the flashbacks stop, the driving fear eases, the nightmares let go. But if the brainwave patterns are still dysregulated, the person may still struggle with fog, fatigue, and emotional reactivity that are not about the trauma at all — they are about the injury.
Used together, they cover both layers. Neurofeedback works on the injury. EMDR works on the trauma. Counselling holds the whole thing together — the daily coping, the relationship repair, the return to life.
The order depends on you. Some people need stabilisation first: grounding tools, sleep work, and several neurofeedback sessions before any trauma processing. Others are ready to start EMDR early and add neurofeedback alongside it. I decide the sequence with you, based on what your nervous system can handle, and I adjust it as we go.
ICBC coverage for post-concussion counselling in BC
If your concussion came from a motor vehicle accident in British Columbia, ICBC covers counselling on an active claim. You do not need a referral from your doctor. Under current guidelines, you can access up to twelve pre-approved counselling sessions, and additional sessions can be approved if clinically needed.
As of May 2025, ICBC reimburses Registered Clinical Counsellors at $157 per session. I bill ICBC directly — you do not pay out of pocket and then wait for reimbursement.
There is a common misconception that if your accident was months ago, it is too late. It is not. The twelve-session pre-approval window is about when you start, not about when the crash happened. If that window has technically closed, counselling is still available through an approval request. Post-concussion symptoms that persist are exactly the kind of ongoing injury that ICBC coverage is designed for.
If your injury came from a crime rather than a collision, the Crime Victim Assistance Program (CVAP) funds counselling as well.
What the first session looks like
No processing happens in the first session. I take a careful history — the accident itself, what symptoms showed up and when, what has helped and what has not, how your sleep, mood, and daily functioning are right now. I explain how EMDR and neurofeedback work, what you can expect, and what you can control.
Then we start with preparation: grounding tools, breathing techniques, the stabilisation work that makes everything that follows safe. I do not start trauma processing or neurofeedback training until you have tools that work and we both agree you are ready.
This matters because a concussed brain is already overwhelmed. Jumping into intensive treatment without preparation risks making things worse. Pacing is not caution — it is clinical skill.
Who this is for
You had a concussion — from a car accident, a fall, a sports injury, an assault — and months later you are still dealing with brain fog, irritability, sleep problems, anxiety, or emotional changes that were not there before.
You may have been told your scans are normal and there is nothing wrong. You may have tried medication and found it helped some symptoms but not others. You may have been managing on your own and hitting a wall.
Post-concussion syndrome is treatable. The brain fog can lift. The irritability can ease. Sleep can come back. But it usually requires more than time — it requires the right combination of approaches, matched to what your particular nervous system needs.
How to start
Call or WhatsApp 604-721-0604 for a free twenty-minute phone conversation — directly with me, not a receptionist, not an intake form. I will tell you honestly whether counselling and neurofeedback are the right first step for what you are experiencing, or whether something else should come first.
If you are on an ICBC claim, I can walk you through the coverage process on that call. If you are not sure whether your symptoms qualify, call anyway — that is exactly what the conversation is for.
I see clients in person at 1300–1500 West Georgia Street in downtown Vancouver and by secure video anywhere in British Columbia. Evening and weekend appointments are available.
Sessions are available in English and Farsi.
References
Cancelliere, C., et al. (2023). Systematic review of prognosis and return to play after sport concussion: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Journal of Neurotrauma, 40(13-14), 1382–1393. doi:10.1089/neu.2022.0185
Annaheim, P., et al. (2022). Neurofeedback after mild traumatic brain injury: A randomized controlled trial. Frontiers in Human Neuroscience, 16, 979723. doi:10.3389/fnhum.2022.979723
van Ierssel, J., et al. (2026). Anxiety and depressive symptoms after sport-related concussion: The TRANSCENDENT study. Journal of Head Trauma Rehabilitation. doi:10.1177/08897151261416446
British Columbia Ministry of Public Safety and Solicitor General. (2025). ICBC rate changes effective May 1, 2025. news.gov.bc.ca