Social Skills Treatment for People With Severe, Chronic Acquired Brain Injuries: A Multicenter Trial

Group interactive structured treatment (GIST): a social competence intervention for individuals with brain injury

BACKGROUND

Impairments in social competence are among the most prevalent sequelae of traumatic brain injury and present a major barrier to a person returning to a productive life. The recent increased incidence of TBI among military personnel and the subsequent difficulties these individuals face reintegrating into society accentuates the need for efficacious social competence treatment interventions for the TBI population.

METHOD AND RESULTS

This paper outlines the theoretical model and clinical application of Group Interactive Structured Treatment (GIST) for Social Competence. GIST- Social Competence is a structured cognitive-behavioural group therapy model addressing the underlying cognitive, communicative and emotional impairments impeding social competence after TBI. A recent randomized control trial (RCT) funded by the National Institute on Disability and Rehabilitation Research demonstrated the efficacy of this programme. GIST integrates the principles of established cognitive-behavioural therapy, group therapy and holistic neuro-rehabilitation in a manualized 13 week intervention combining a structured curriculum with a group therapy format. The structured cognitive-behavioural approach allows even those with significant underlying deficits (including self-awareness, memory, problem-solving, etc.) to benefit from this intervention.

CONCLUSION

The GIST model can be applied to other treatment areas in TBI rehabilitation. Clinical observations from application of GIST with military personnel are reviewed.

A need for improved training interventions for the remediation of impairments in social functioning following brain injury

Social functioning deficits are a prominent feature of many neurological and psychiatric conditions, and may include disruption in the acquisition or application of basic or complex social skills. Such disturbances are often resistant to treatment, and individuals with such conditions are often faced with lifelong difficulties in maintaining personal relationships, employment, and independent living. In recent years, a number of psychosocial treatments have been developed to address this growing problem. In this article, we review studies investigating the use of psychosocial training interventions in individuals with acquired brain injuries, which frequently require intervention for impairments in cognitive and social functioning. We then discuss limitations of these studies and highlight specific areas in which such treatments might be improved in the future.

Role and impact of cognitive rehabilitation

Cognitive rehabilitation interventions are theoretically based and empirically validated treatments designed to ameliorate the cognitive, behavioral, and emotional impairments commonly experienced by individuals with traumatic brain injury (TBI). Cognitive rehabilitation can play many roles in facilitating recovery after TBI, such as improving impaired cognitive functions, increasing awareness of injury-related deficits, improving mood, facilitating vocational and community involvement, and reducing the probability of secondary disability. The considerable evidence documenting the impact of cognitive rehabilitation on improving the day-to-day function of individuals with TBI is described.

Personality traits and social behaviors predict the psychological adjustment of Chinese people with epilepsy

Very little is known about the psychosocial correlates of psychological morbidity among Chinese people with epilepsy (PWE). No studies have investigated the association between social relationships and psychological morbidity, while most studies examined only the negative impact of maladaptive personalities on psychological adjustment in PWE. This study examined the association of psychological morbidity with a broad array of personality traits and social skills in a sample of 54 Chinese PWE. Respondents completed the Temperament and Character Inventory (TCI), the Social Performance Survey Schedule (SPSS), and the Hospital Anxiety and Depression Scale (HADS) via semi-structured interview. Regression analyses revealed that, independent of demographic and medical variables and perceived impact, Harm Avoidance was positively associated with anxiety and depression whereas Self-Directedness was negatively associated with anxiety and depression; that Cooperativeness was inversely associated with anxiety. Social skills were inversely associated with depression whereas negative social skills were inversely associated with anxiety. Clinical implications of adaptive personality traits and social skills functioning are discussed.

Soziales Kompetenztraining nach erworbener Hirnschädigung – Zufriedenheits- und Erfolgs- einschätzungen von Patienten, Angehörigen und Therapeuten

In dieser Studie wurden die Erfahrungen von 55 Teilnehmern mit einem speziell für hirngeschädigte Patienten entwickelten Sozialen Kompetenztraining erfasst. Auch Angehörige und Therapeuten wurden zu Verhaltensänderungen befragt. Obwohl fast die Hälfte der Patienten eine mangelnde Störungseinsicht hatte, zeigten sie eine hohe Zufriedenheit mit dem Trainingsprogramm; die Beurteilung von Verhaltensänderungen fiel etwas zurückhaltender aus. Besonders positiv wurden die Gruppenatmosphäre und die Rollenspiele mit Videoaufnahmen bewertet. Patienten schätzten die erreichten Veränderungen im Sozialverhalten positiver ein als Angehörige und diese wiederum positiver als die Therapeuten. Zwischen den Selbsteinschätzungen und den Fremdeinschätzungen ergaben sich keine signifikanten Zusammenhänge, wohl aber zwischen den Beurteilungen von Angehörigen und Therapeuten. Die Ergebnisse zeigen, dass das Soziale Kompetenztraining von den Patienten unabhängig von der Störungseinsicht sehr gut angenommen wird.