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Pepping N, Weinborn M, Pestell CF, Preece DA, Malkani M, Moore S, Gross JJ, Becerra R. Improving emotion regulation ability after brain injury: A systematic review of targeted interventions. Neuropsychol Rehabil 2024:1-41. [PMID: 39230344 DOI: 10.1080/09602011.2024.2398029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/25/2024] [Indexed: 09/05/2024]
Abstract
Emotion dysregulation is a common sequela after a brain injury, and it can have serious negative consequences for individuals, families, and the community. A systematic review of the literature was conducted to identify and evaluate interventions designed to improve emotion regulation ability in adults with acquired brain injury. Studies were identified on ProQuest, PsycInfo, ScienceDirect, Scopus, and Web of Science; last searched on 3 August 2023. A review protocol was prospectively registered on PROSPERO (CRD42020218175). Risk of bias was assessed using the Cochrane Risk-of-Bias tool (version 2). Sixteen studies were included in the review comprising one case series, five pilot studies, four pre-post studies, and six RCTs. There was a total of 652 participants across studies. Fourteen of the sixteen studies reported statistically significant improvements in at least one emotional functioning variable. Ten studies reported medium-large effect sizes. Limitations included inconsistency in the measurement, reporting of intervention outcomes and processes. Future directions are discussed.
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Affiliation(s)
- Natalie Pepping
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Michael Weinborn
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Carmela F Pestell
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - David A Preece
- School of Psychological Science, The University of Western Australia, Perth, Australia
- School of Population Health, Curtin University, Perth, Australia
- Psychological Sciences Research Institute, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Maya Malkani
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Sammy Moore
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Rodrigo Becerra
- School of Psychological Science, The University of Western Australia, Perth, Australia
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2
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Fletcher K, Wydera S, Thorpe N, Radford K, das Nair R, Booth V. A rapid realist review of clinical neuropsychology rehabilitation programmes to improve psychological wellbeing and quality of life for people with acquired brain injuries. Neuropsychol Rehabil 2024; 34:1035-1070. [PMID: 37975854 PMCID: PMC11332407 DOI: 10.1080/09602011.2023.2273580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 10/03/2023] [Indexed: 11/19/2023]
Abstract
Approximately 20% of acquired brain injury (ABI) survivors experience reduced psychological wellbeing (PWB). Neuropsychological rehabilitation (NPR) is one approach supporting people with ABI to participate meaningfully in activities despite challenges. Although literature supports NPR effectiveness, little is known about change mechanisms. This systematic realist review identifies what NPR programmes have been designed, delivered, and evaluated for people with ABI to improve PWB and/or quality of life (QOL), as well as providing a context-relevant understanding of what NPR includes and how NPR might lead to positive outcomes. A rapid realist review was conducted in three phases: (1) structured retrieval and evidence extraction; (2) stakeholder consultation; (3) analysis and synthesis. Searches were completed, and findings from 35 publications and one stakeholder consultation were synthesized into a refined logic model. Six context-mechanism-outcome chains (CMOCs) were identified. Participants' relationships to internal experiences, and feelings of self-worth, mastery, and connection appeared to be mechanisms that led to improved PWB and QOL. Adaptation and individualized programmes were also key mechanisms to explain successful NPR. Embedding CMOCs into NPR could improve PWB and/or QOL for people with ABI. The logic model will inform ongoing development of a new online, group-based, NPR programme.
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Affiliation(s)
- K. Fletcher
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - S. Wydera
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - N. Thorpe
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - K. Radford
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - R. das Nair
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- SINTEF, Trondheim, Norway
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - V. Booth
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
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3
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Rowlands L, Salas C, Coetzer R, Buckland S, Turnbull OH. "We can all relate": patient experience of an emotion-oriented group intervention after Acquired Brain Injury. Front Psychol 2024; 15:1384080. [PMID: 38993336 PMCID: PMC11238635 DOI: 10.3389/fpsyg.2024.1384080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/24/2024] [Indexed: 07/13/2024] Open
Abstract
Introduction Group interventions are carried out routinely across neuropsychological rehabilitation services, to improve understanding of brain injury and aspects of impairment. Treatment provided in a group modality can bring additional perceived benefits, such as co-operative learning. However, there are very few studies which explore patient perceptions and experiences of such interventions. In the present study we investigated the experience of attending a group-based educational intervention for the consequences of acquired brain injury (ABI), which had a strong focus on emotion and emotion regulation. Methods Using qualitative semi-structured interviews (approximately 20 minutes), the study explores the lived experience of participating in the seven-session programme, the better to identify the perceived efficacy, salience and value of individual elements. Twenty participants with ABI took part in individual interviews, after completion of the group programme (the Brain Injury Solutions and Emotions Programme, BISEP). The study adopted a descriptive phenomenological philosophy, which focuses on lived experience to explore a phenomenon (i.e. the experience of BISEP). As regards methods, the study employed thematic analysis to cluster experiences into themes of meaning. Results Five themes were identified: (1) 'Long term consequences and psychological needs', which related to the persistent nature of direct consequences of injury and adjustment, and how these result in a need for interventions such as BISEP. (2) 'Positive experiences of participating in the programme', referred to participants' overall experience of the programme and valued elements within it. The remaining themes referred to the programme as (3) a social milieu; (4) a place to learn; and (5) a place to promote positive emotional experiences. Discussion Similar to previous studies, many people reported high acceptability and perceived value of the group programme, and its role in facilitating adjustment and understanding of injury. Of particular importance was the opportunity to socialise with people who "can all relate", in line with a growing emphasis on social rehabilitation. The findings especially highlight the relevance of emotion-focused group programmes for ABI, promoting emotion regulation, and practical tools that are delivered optimistically. Further implications for practice and future research include to focus on long term rehabilitation, a social milieu, and strategies to support adjustment.
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Affiliation(s)
- Leanne Rowlands
- School of Psychology, Arden University, Coventry, United Kingdom
- Department of Psychology, Bangor University, Bangor, United Kingdom
| | - Christian Salas
- Clinical Neuropsychology Unit, Centre for Human Neuroscience and Neuropsychology, Faculty of Psychology, Diego Portales University, Santiago, Chile
| | - Rudi Coetzer
- Department of Psychology, Bangor University, Bangor, United Kingdom
- Brainkind, Sussex, United Kingdom
- Medicine, Health & Life Science Faculty, Swansea University, Swansea, United Kingdom
- North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, United Kingdom
| | - Sharon Buckland
- School of Psychology, Arden University, Coventry, United Kingdom
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4
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Conklin JP, Wallace T, McCauley KL, Breitenstein J, Gore RK. Level of Evidence of Telehealth Rehabilitation and Behavioral Health Services for Traumatic Brain Injury: A Scoping Review. J Clin Psychol Med Settings 2024; 31:379-402. [PMID: 37903966 DOI: 10.1007/s10880-023-09981-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/01/2023]
Abstract
Traumatic brain injury (TBI) can result in significant impairments in functioning associated with partial or permanent disabilities. Examining the evidence for domain-specific telehealth interventions is necessary to guide the development of effective clinical and research programs for this population. The present scoping review characterizes the level of evidence across a range of TBI-related disabilities and impairments. A literature search was performed across comprehensive databases using search terms related to TBI, rehabilitation, telehealth, and outcome. A total of 19 publications from 17 studies met inclusion criteria. Articles focused on telehealth interventions to improve global, cognitive, emotional, and physical functioning post-TBI. Levels of evidence ranged from 1 to 4 across domains, with predominantly experimental designs (level 1). Outcomes demonstrating improvement or benefit from telehealth treatments were reported across all functional domains (50-80% of studies). Results highlight the potential of telehealth interventions across the span of comprehensive interdisciplinary rehabilitation care. Expanded research is needed on remote treatment options for physical symptoms, for subgroups within TBI populations (i.e., mild TBI, military populations), as well as on remote and hybrid comprehensive rehabilitation programs.
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Affiliation(s)
- Jessica P Conklin
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Tracey Wallace
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA.
| | - Katherine L McCauley
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Jackie Breitenstein
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Russell K Gore
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
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5
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Boulos ME, Colella B, Meusel LA, Sharma B, Peter MK, Worthington T, Green REA. Feasibility of group telerehabilitation for individuals with chronic acquired brain injury: integrating clinical care and research. Disabil Rehabil 2024; 46:750-762. [PMID: 36855274 DOI: 10.1080/09638288.2023.2177357] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 02/02/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Acquired brain injury (ABI) is a leading cause of lifelong disability, but access to treatment in the chronic stages has significant barriers. Group-based, remotely delivered neurorehabilitation reduces costs, travel barriers, and infection risk; however, its feasibility for patients with ABI is not well-established. OBJECTIVES To investigate the feasibility of remotely group-based cognitive and mood therapies for persons with chronic ABI. METHODS Three hundred and eighty-eight adults with chronic ABI participated in group tele-neurorehabilitation modules comprising Cognitive Behavioral Therapy, Goal Management Training®, Relaxation and Mindfulness Skills Training, and/or a novel Concussion Education & Symptom Management program. Assessments comprised quantitative metrics, surveys, as well as qualitative semi-structured interviews in a subset of participants. RESULTS High retention, adherence, and satisfaction were observed. Facilitators of treatment included accessibility, cost-effectiveness, and convenience. Adoption of technology was high, but other people's technological interruptions were a barrier. Self-reported benefits specific to group-based format included improved mood, stress management, coping, interpersonal relationships, cognitive functioning, and present-mindedness. CONCLUSIONS The present study examined chronic ABI patients' perceptions of telerehabilitation. Patients found remotely delivered, group-based mood, and cognitive interventions feasible with easy technology adoption. Group format was considered a benefit. Recommendations are provided to inform design of remotely delivered ABI programs.
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Affiliation(s)
- Mary E Boulos
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Brenda Colella
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Liesel-Ann Meusel
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Bhanu Sharma
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Medical Sciences, McMaster University, Hamilton, Canada
| | - Marika K Peter
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Thomas Worthington
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Robin E A Green
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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6
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Dunne S, Williams GP, Bradbury C, Keyes T, Lane AR, Yang K, Ellison A. Uncovering the social determinants of brain injury rehabilitation. J Health Psychol 2023; 28:956-969. [PMID: 37026570 PMCID: PMC10466963 DOI: 10.1177/13591053231166263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Social determinants of health (SDH), such as social isolation and loneliness, are often more frequently experienced in brain injury survivors. The paper explores the personal experiences of loneliness among brain injury survivors during lockdown to negate health inequalities and improve rehabilitation for this population in the future. Twenty-four brain injury survivors participated in semi-structured interviews and questionnaires relating to loneliness, resilience and wellbeing. Three themes (the experience of loneliness, loneliness during the pandemic and loneliness after the pandemic) explored survivors' experiences of loneliness generally post-brain injury, but also chronicle how these feelings developed in lockdown and survivors' feelings regarding society returning to 'normal'. Future interventions should focus on reframing survivors' beliefs regarding societal expectations and minimise the pressure they experience to keep up with their peers physically and emotionally. Additionally, we recommend creating accessible peer support options for all brain injury survivors as an important step for alleviating loneliness.
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Affiliation(s)
- Stephen Dunne
- Northumbria University, UK
- NIHR Applied Research Collaboration North-East and North Cumbria, UK
| | | | | | | | | | | | - Amanda Ellison
- NIHR Applied Research Collaboration North-East and North Cumbria, UK
- Durham University, UK
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7
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McShan EE, Juengst S, Douglas ME, Noorbakhsh D, Calhoun S, Bennett M, Suhalka A, Dubiel R, Driver S. Efficacy of a group-based education intervention for people with traumatic brain injury: supplementary results from a 12-month randomized controlled trial. Brain Inj 2023; 37:1205-1214. [PMID: 37355803 DOI: 10.1080/02699052.2023.2225874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/25/2023] [Accepted: 06/12/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Our team developed an attention control condition, called the Brain Health Group (BHG), for a randomized controlled trial (RCT; NCT03594734). The focus of the BHG was on brain health education and self-management. The objectives of this supplementary analysis are to (1) Describe compliance with the 12-month BHG; (2) Examine efficacy for improving general self-efficacy (GSE, primary) and secondary outcomes; and (3) Describe findings from the program evaluation. DESIGN English-speaking adults (18-64 years old) who were ≥6 months post a moderate-to-severe TBI were randomized to the BHG (n = 29) or active intervention (n = 28). Data were collected at baseline and 12 months, including GSE, depression, satisfaction with life (SWL), self-rated abilities for health practices (SRAHP), and alcohol use. Program evaluation was conducted at 12 months. RESULTS Attendance was 89%, and goal tracking was 63%. Within group analysis showed a significant increase in SRAHP scores (p = 0.018). Non-significant increases in GSE and SWL were observed, and participants perceived the BHG as helpful. No significant changes in depression or alcohol use were reported. CONCLUSION People with TBI can engage in and benefit from the BHG and perceive the program as helpful for improving knowledge about brain health and awareness of self-management skills.
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Affiliation(s)
- Evan Elizabeth McShan
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Shannon Juengst
- Clinical Investigator Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas b
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center; North Texas Traumatic Brain Injury Model System, Dallas, Texas
- Department of Physical Medicine and Rehabilitation, UT Health Sciences Center at Houston, Houston, Texas
| | - Megan E Douglas
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Donna Noorbakhsh
- Speech Language Pathologist Certified Brain Injury Specialist Day Neuro Program, Baylor Scott and White Institute for Rehabilitation; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Stephanie Calhoun
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Monica Bennett
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
- Biostatistics Core Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Alexandria Suhalka
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Rosemary Dubiel
- TBI Services Baylor Scott and White Institute for Rehabilitation; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Simon Driver
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
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8
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Christensen I, Power E, Togher L, Norup A. "Communication Is Not Exactly My Field, but It Is Still My Area of Work": Staff and Managers' Experiences of Communication With People With Traumatic Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:827-847. [PMID: 36455235 DOI: 10.1044/2022_ajslp-22-00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Communication between people with traumatic brain injury (TBI) and rehabilitation staff can be impacted by cognitive-communication disorders. Communication partner training (CPT) programs hold potential to improve communication between people with TBI and their communication partners. To tailor CPT programs to the rehabilitation environment, it is critical to understand the nature of communicative interactions for staff members. This study explores staff and managers' experiences of communication with people with TBI in the rehabilitation setting. METHOD Individual semistructured videoconference interviews were carried out with staff members (n = 22) and managers (n = 4) varying in terms of professions and length of work experience. Interviews were guided by a phenomenological approach to gain comprehensive knowledge of staff and managers' lived experiences of communication with people with TBI. RESULTS Four themes with nine subthemes were generated: (a) cognitive-communication disorders challenge interaction (communication is socially inappropriate, the diversity of presenting symptoms associated with TBI is demanding), (b) staff struggle in communication (there is a breakdown of communicative collaboration, communication increases staff's workload, emotional well-being of staff is at risk), (c) communication context is crucial (tasks affect communication, extending the professional roles), and (d) staff want communication knowledge and skills (needs vary according to work experience, access to tailored strategies, and feedback). CONCLUSIONS Staff and managers experienced communication with people with TBI as highly demanding. The socially inappropriate communication in people with TBI was perceived to disturb the collaborative aspects of communication and create negative emotional impacts for staff. Staff experiences varied according to discipline, work experience, rehabilitation tasks, and facility. Consequently, staff and managers expressed a need for specific communication strategies to help them overcome the communicative challenges. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21579159.
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Affiliation(s)
- Iben Christensen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Denmark
| | - Emma Power
- University of Technology Sydney, Department of Speech Pathology, Ultimo, New South Wales, Australia
| | - Leanne Togher
- Department of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Anne Norup
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Al-Kader DA, Onyechi CI, Ikedum IV, Fattah A, Zafar S, Bhat S, Malik MA, Bheesham N, Qadar LT, Sajjad Cheema M. Depression and Anxiety in Patients With a History of Traumatic Brain Injury: A Case-Control Study. Cureus 2022; 14:e27971. [PMID: 36134081 PMCID: PMC9481205 DOI: 10.7759/cureus.27971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background The burden of psychiatric illness following a head injury may have implications on the disease prognosis. The present study evaluated the association of depression and anxiety with traumatic brain injury (TBI). Methods A case-control study was conducted in Karachi, Pakistan, from 2nd July 2021 and 30th January 2022, including individuals of age 18 and above of both genders, with or without a mild head trauma history, forming the case and control groups, respectively. Individuals with previous head trauma/congenital neurological dysfunction were excluded. A mental health assessment of the participants was carried out with two scales, the Generalized Anxiety Disorder-7 (GAD-7) scale and the Public Health Questionnaire-9 (PHQ-9) scale. Other parameters like age, gender, socioeconomic status, education status, and comorbidities were also documented. Results A total of 62 participants were enrolled with 31 cases and 31 controls. The majority were males aged between 18 and 39 years. About 29% of the patients with a history of mild TBI had moderate to severe depression while only 22.6% of them did not have depression or had minimal depression. We found that about 29.3% of patients with TBI had severe anxiety as compared to the only two healthy controls. The majority of the control group participants did not have anxiety. Conclusion Traumatic head injuries and their long-term side effects can predispose patients to a myriad of psychiatric comorbidities. In this study, we found definitive evidence that both anxiety and depression had a significantly higher incidence in cohorts that suffered from mild TBI. However, we recommend large-scale and multicenter studies in the future to explore these relationships more thoroughly and comprehensively.
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10
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Puertas-Gonzalez JA, Mariño-Narvaez C, Romero-Gonzalez B, Sanchez-Perez GM, Peralta-Ramirez MI. Online cognitive behavioural therapy as a psychological vaccine against stress during the COVID-19 pandemic in pregnant women: A randomised controlled trial. J Psychiatr Res 2022; 152:397-405. [PMID: 35830754 PMCID: PMC9259661 DOI: 10.1016/j.jpsychires.2022.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 06/18/2022] [Accepted: 07/04/2022] [Indexed: 12/02/2022]
Abstract
The COVID-19 pandemic has affected the population's levels of stress and anxiety due to its contagious nature and the uncertainties generated by its novelty. One population that is especially vulnerable to these psychological consequences are pregnant women. This is why the objective of this study was to test the efficacy of an online stress management programme of a cognitive behavioural nature on pregnant women during the COVID-19 pandemic, in Spain. The trial was controlled and randomised, with a total of 207 pregnant women divided into three groups: the Online Cognitive Behavioural Therapy group (o-CBT) (N = 70); the Online Psychological Support group (o-PS) (N = 69); and the Usual Care group (UC) (N = 68). To test the therapy's efficacy, the women's resilience, perceived stress, pregnancy-specific stress and psychopathological symptoms were assessed before and after the intervention. The o-CBT and o-PS consisted of a programme of 8 group sessions (one per week). The results showed that pregnant women who participated in the o-CBT group presented lower rates of pregnancy-specific stress and perceived stress, as well as greater resilience and lower anxiety, depression and obsessions-compulsions symptoms. These data show the efficacy of the treatment programme and thus confirm the importance of implementing these types of interventions during a woman's pregnancy, especially over periods of major stress, such as during a pandemic.
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Affiliation(s)
- Jose A. Puertas-Gonzalez
- Mind, Brain and Behaviour Research Center (CIMCYC), Granada, Spain,Personality, Assessment and Psychological Treatment Department, Faculty of Psychology, University of Granada, Granada, Spain
| | | | - Borja Romero-Gonzalez
- Psychology Department, Faculty of Education, University of Valladolid, Campus Duques de Soria, Soria, Spain.
| | | | - Maria Isabel Peralta-Ramirez
- Mind, Brain and Behaviour Research Center (CIMCYC), Granada, Spain,Personality, Assessment and Psychological Treatment Department, Faculty of Psychology, University of Granada, Granada, Spain
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11
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Halder T, Michl P, Flanagin V, Schenk T. Impaired Emotion Processing and Panic Disorder After Left Anterior Temporal Lobectomy: A Case Report of Successful Psychotherapeutic Intervention. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background
Over the last decades, brain surgery became a more frequently applied treatment for temporal lobe epilepsy (TLE). Despite its success, several studies found de-novo post-operative psychiatric symptoms in TLE surgery patients. Cognitive behavioural therapy is effective to treat brain healthy psychiatric patients but might not be translatable to patients with resections in emotion regulating networks as these areas seem to be essentially involved in successful psychotherapeutic treatment.
Methods
Here we report the case of a female patient with medically refractory medial temporal lobe epilepsy resulting in left anterior temporal lobectomy at age 35. Post operation she did not show adequate fearful response but at the same time manifested symptoms of a severe panic disorder. We investigated if this patient, despite lesions in emotion-behaviour brain circuits, can benefit from cognitive behavioural therapy.
Results
The intervention, customized to the specific resources and difficulties of the patient, was effective in stopping panic attacks and improving social functioning.
Conclusions
This case shows that MTL brain surgery patients may benefit from CBT and demonstrates the important and if yet still somewhat mysterious role of the amygdala in emotion regulation processes.
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12
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Kersey J, Hammel J, Baum C, Huebert K, Malagari E, Terhorst L, McCue M, Skidmore ER. Effect of interventions on activity and participation outcomes for adults with brain injury: a scoping review. Brain Inj 2022; 36:21-31. [DOI: 10.1080/02699052.2022.2034043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Jessica Kersey
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Joy Hammel
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kelly Huebert
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Emily Malagari
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth R. Skidmore
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
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13
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Pedrotty M, Wong TS, Wilde EA, Bigler ED, Laatsch LK. Application of neuropsychology and imaging to brain injury and use of the integrative cognitive rehabilitation psychotherapy model. NeuroRehabilitation 2021; 49:307-327. [PMID: 34420990 DOI: 10.3233/nre-218028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND An early approach to cognitive rehabilitation therapy (CRT) was developed based on A. R. Luria's theory of brain function. Expanding upon this approach, the Integrative Cognitive Rehabilitation Psychotherapy model (ICRP) was advanced. OBJECTIVE To describe the ICRP approach to treatment of clients post brain injury and provide a comprehensive list of evaluation tools to determine the client's abilities and needs. Finally, to provide a link between CRT and functional imaging studies designed to improve rehabilitation efforts. METHODS History of cognitive rehabilitation and neuropsychological testing is reviewed and description of cognitive, academic, psychiatric, and substance abuse tools are provided. Cognitive and emotional treatment techniques are fully described. Additionally, a method of determining the client's stage of recovery and pertinent functional imaging studies is detailed. RESULTS Authors have been able to provide a set of tools and techniques to use in comprehensive treatment of clients with brain injury. CONCLUSIONS Inclusive treatment which is outlined in the ICRP model is optimal for the client's recovery and return to a full and satisfying life post brain injury. The model provides a framework for neuropsychologists to integrate issues that tend to co-occur in clients living with brain injury into a unified treatment plan.
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Affiliation(s)
- Mark Pedrotty
- Tingley Hospital Outpatient -UNM, Albuquerque, NM, USA
| | - Tiffanie S Wong
- Polytrauma Rehabilitation Center, Comprehensive Rehabilitation Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Stem Cognitive and Psychological Rehabilitation, Inc., Palo Alto, CA, USA
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA.,George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, UT, USA
| | - Erin D Bigler
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA.,Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Linda K Laatsch
- Department of Neurology, University of Illinois, Chicago, IL, USA
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14
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Gupta S, Kumar M, Rozatkar AR, Basera D, Purwar S, Gautam D, Jahan R. Feasibility and Effectiveness of Telecounseling on the Psychological Problems of Frontline Healthcare Workers Amidst COVID-19: A Randomized Controlled Trial from Central India. Indian J Psychol Med 2021; 43:343-350. [PMID: 34385729 PMCID: PMC8327876 DOI: 10.1177/02537176211024537] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Preliminary reports suggest that during the COVID-19 pandemic, telecounseling could be an effective model of psychological intervention for the frontline healthcare workers (fHCW) with psychological problems. Literature is sparse in this area, particularly from low- and middle-income countries, including India. We aimed to investigate the feasibility and the effectiveness of telecounseling (vs. general education) on the psychological problems of the fHCW over three time-points (baseline vs. end-of-session and at two and four weeks after the intervention). METHODS The study followed a single-blind, active arm versus general education, parallel-group randomized control design, with participant allocation in 1:1. Active healthcare workers (HCWs) with mild- to-severe or clinically concerning scores on any of the sub-scales of Depression, Anxiety and Stress Scale (DASS-21) or Impact of Event Scale-Revised (IES-R; represented by higher scores) were included, while those with known psychiatric illness were excluded. Chi-square and Mann-Whitney U test and linear-mixed effect model (group-, time, and group by time-effect) were used for analysis. RESULTS There were no baseline group differences (telecounseling group, active arm, n = 9; general education group, control arm, n = 10). A significant time-effect (P = 0.044 to <.001) was found on DASS-21 on intention-to-treat analysis. Per-protocol analysis, additionally, found a significant group effect on Impact of Event Scale-Revised (IES-R; P = 0.036). A significant random effect of the participants was also found (P <.001). CONCLUSION Telecounseling could be a feasible and scalable model of psychological interventions for the fHCW with psychological problems, albeit with some feasibility challenges.
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Affiliation(s)
- Snehil Gupta
- Dept. of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Mohit Kumar
- Dept. of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Abhijit R Rozatkar
- Dept. of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Devendra Basera
- Dept. of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Shashank Purwar
- Dept. of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Disha Gautam
- Dept. of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rahat Jahan
- Dept. of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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15
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Exner C, Doering BK, Conrad N, Künemund A, Zwick S, Kühl K, Nestler S, Rief W. Integrated neuropsychological and cognitive behavioural therapy after acquired brain injury: A pragmatic randomized clinical trial. Neuropsychol Rehabil 2021; 32:1495-1529. [PMID: 33818305 DOI: 10.1080/09602011.2021.1908902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
After acquired brain injury (ABI) many patients suffer from persistent cognitive and emotional disturbances. The aim of this study was to investigate the treatment outcome of an integrated intervention, combining neuropsychological and cognitive behavioural therapy (nCBT), against waitlist (WL) in outpatients with ABI. Individuals seeking outpatient treatment for cognitive and emotional problems after ABI were randomly allocated to nCBT (n = 27) or WL (n = 29) and completed assessments at baseline, post-treatment/WL and at six-month follow-up. The primary outcome measures were general psychopathology and functional activity in daily life. The nCBT group showed significant improvement for general psychopathology post-treatment when compared to WL. nCBT was also superior to WL regarding the secondary outcomes, i.e., the reduction of negative affect and the improvement of quality of life. No significant differences for functional activity and community integration were observed. Significant pre-post effect sizes ranged between small for functional activity and medium for quality of life. The positive effects were maintained at follow-up. The majority of patients with cognitive and emotional problems after ABI benefit from an integrated approach that offers cognitive remediation and psychotherapy. However, the heterogeneous sequelae of ABI and the moderate sample sizes in clinical trials present a methodological challenge to ABI research.
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Affiliation(s)
- Cornelia Exner
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany.,Department of Clinical Psychology and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Bettina K Doering
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany.,Department of Clinical and Biological Psychology, University of Eichstaett-Ingolstadt, Ingolstadt, Germany
| | - Nico Conrad
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Anna Künemund
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Sarah Zwick
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Kerstin Kühl
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Steffen Nestler
- Department of Statistics and Psychological Methods, University of Muenster, Muenster, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
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16
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Mitchell T, du Preez E, Theadom A. An intervention to improve coping strategies in adult male prisoners with a history of traumatic brain injury: A pilot randomised clinical trial. Clin Rehabil 2021; 35:1185-1195. [PMID: 33706573 DOI: 10.1177/0269215521998535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether a psychological intervention improves coping, post-concussion symptoms and decreases in-prison infractions in adult males with a history of traumatic brain injury. DESIGN A single centre, randomised, wait-list, pilot study. SETTING A high security prison in New Zealand. SUBJECTS Fifty-five adult male participants who had experienced at least one traumatic brain injury in their lifetime (mean age 37.29 +/-9.81 years). INTERVENTION A manualised ten session, in-person, group based combined Cognitive Behavioural Therapy /Mindfulness Based Stress Reduction intervention versus wait list control. MAIN MEASURES The Negative Affect Repair Questionnaire and Rivermead Post-concussion Symptom Questionnaire were completed at baseline, post-intervention (five weeks) and at 12 week follow up. In-prison misconduct charges and negative file notes were reviewed for the previous five weeks at each assessment time point. RESULTS There was an improvement in the use of calming and distraction strategies in the intervention group from baseline (x̄ = 17.38, SD = 3.57) to post-intervention (x̄ = 18.67, SD = 3.84) and 12-week follow up (x̄ = 18.13, SD = 2.63). Participants in the intervention group had significantly higher negative affect repair on the calming and distractive strategies subscale following completion of the intervention, compared to wait-list controls (F = 4.69, P = 0.04) with a moderate effect size (ηp2 = 0.11). Improvements in use of calming and distractive strategies was not sustained at the twelve-week follow-up (F = 0.87, P = 0.36). There was no-significant improvement on other negative affect subscales or for post-concussion symptoms or decrease in-prison infractions. CONCLUSION A manualised psychological intervention may have the potential to facilitate the development of positive coping strategies in prisoners with a history of traumatic brain injury.
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Affiliation(s)
| | - Elizabeth du Preez
- Department of Psychology, School of Clinical Sciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Department of Psychology, School of Clinical Sciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand.,TBI Network, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
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17
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Kringle EA, Terhorst L, Gibbs BB, Campbell G, McCue M, Skidmore ER. Activating Behavior to Reduce Sedentary Behavior After Stroke: A Nonrandomized Pilot Feasibility Study. Am J Occup Ther 2020; 74:7406205030p1-7406205030p10. [PMID: 33275563 PMCID: PMC7717647 DOI: 10.5014/ajot.2020.040345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Importance: Reducing poststroke sedentary behavior is important for reducing recurrent stroke risk, yet interventions to achieve this are scant. Objective: To assess the feasibility of, and estimate change in sedentary behavior over time associated with, a behavioral intervention. Design: Single-arm delayed baseline with postintervention and 8-wk follow-up assessment. Setting: Community based. Participants: Ambulatory, community-dwelling people with chronic stroke and reported ≥6 hr daily sitting time (N = 21). Intervention: Activating Behavior for Lasting Engagement (ABLE) was delivered by an occupational therapist 3×/wk for 4 wk. ABLE involves activity monitoring, activity scheduling, self-assessment, and collaborative problem solving. Outcomes and Measures: Feasibility (participant safety, adherence, satisfaction, and reliable intervention delivery) was assessed against preestablished benchmarks. Changes over time in sedentary behavior (assessed with an ActivPAL micro3 device) and participation (Stroke Impact Scale–Participation subscale) were described. Results: ABLE was safe (0 serious adverse events), adhered to (11.95 sessions/participant), and reliably delivered (90.00%–97.50% adherence). Participant satisfaction was unmet (Client Satisfaction Questionnaire–8, M = 28.75, SD = 3.84). ABLE was associated with a mean group reduction in prolonged sitting of 54.95 min (SD = 81.10) at postintervention and 14.08 (SD = 58.95) at follow-up. ABLE was associated with a negligible mean group increase over time in participation at postintervention (M = 1.48%, SD = 8.52) and follow-up (M = 1.33%, SD = 15.38). Conclusions and Relevance: The ABLE intervention is feasible and may be associated with within-group reduction in sedentary behavior over time. Further refinement is indicated. What This Article Adds: The ABLE intervention uses engagement in meaningful daily activities to reduce sedentary behavior after stroke. These findings suggest that ABLE can be delivered safely and consistently. Further research is required to enhance participant satisfaction and determine the effects of ABLE on stroke survivors’ sedentary behavior.
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Affiliation(s)
- Emily A Kringle
- Emily A. Kringle, PhD, OTR/L, is Postdoctoral Research Fellow, Division of Academic Internal Medicine and Geriatrics, College of Medicine, University of Illinois at Chicago. At the time of the study, she was Graduate Student Researcher, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA;
| | - Lauren Terhorst
- Lauren Terhorst, PhD, is Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Bethany Barone Gibbs
- Bethany Barone Gibbs, PhD, is Associate Professor, Department of Health and Human Development, School of Education, University of Pittsburgh, Pittsburgh, PA
| | - Grace Campbell
- Grace Campbell, PhD, RN, is Assistant Professor, Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Michael McCue
- Michael McCue, PhD, is Professor, Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Elizabeth R Skidmore
- Elizabeth R. Skidmore, PhD, OTR/L, is Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
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18
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Di Vita A, Procacci MA, Bellagamba M, Jacomini M, Massicci R, Ciurli MP. Psychotherapy and Art Therapy: A pilot study of group treatment for patients with traumatic brain injury. J Health Psychol 2020; 27:836-846. [PMID: 33138657 DOI: 10.1177/1359105320967099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Here we investigated the efficacy of group Psychotherapy and Art Therapy in rebuilding self-identity after traumatic brain injury (TBI), assessing their effects on psychological aspects in twelve patients with severe TBI. Overall, the results show an increased ability to adapt to the experiences of life as well as a higher level of awareness, social functioning and emotional autoregulation. Furthermore, patients exhibited a reduction in depressive symptoms and in the perception of physical problems. Results highlight the importance of treatments focusing on the patients' emotional needs, in addition to the classic rehabilitation (i.e. physiotherapy, cognitive therapy).
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Affiliation(s)
- Antonella Di Vita
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Mario Augusto Procacci
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy.,Hairam Onlus Association, Rome, Italy.,SIFP - Scuola Italiana per la Formazione in Psicoterapia, Rome, Italy
| | - Martina Bellagamba
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Maria Jacomini
- Hairam Onlus Association, Rome, Italy.,Specialization in Arts for therapy, Accademia delle Belle Arti, Rome, Italy.,SIPEA - Scuola di Specializzazione in Artiterapie, Rome, Italy
| | - Roberta Massicci
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Maria Paola Ciurli
- Neuropsychological Diagnosis and Rehabilitation Unit, IRCCS Santa Lucia Foundation, Rome, Italy
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19
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Romero-Gonzalez B, Puertas-Gonzalez JA, Strivens-Vilchez H, Gonzalez-Perez R, Peralta-Ramirez MI. Effects of cognitive-behavioural therapy for stress management on stress and hair cortisol levels in pregnant women: A randomised controlled trial. J Psychosom Res 2020; 135:110162. [PMID: 32485622 DOI: 10.1016/j.jpsychores.2020.110162] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/19/2020] [Accepted: 05/24/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To demonstrate the effectiveness of a cognitive behavioural therapy for stress management in pregnant women in the reduction of psychological stress and hair cortisol levels. METHODS The trial was controlled and randomised, with a total of 78 pregnant women: control group (n-39) and Cognitive Behavioural Therapy group (n-39). To test the therapy's efficacy, an evaluation of the primary outcome (hair cortisol levels) and secondary outcomes (psychological stress, psychopathological symptomatology and resilience) was conducted before and after the treatment. The therapy was conducted during 8 sessions (one per week) in a group setting. The study was registered as a Randomised Controlled Trial with the code NCT03404141. RESULTS The results showed a group time interaction between hair cortisol levels, psychological stress (perceived and pregnancy-specific), and in the exacerbation and severity of psychopathological symptoms. These variables presented reductions after treatment only in the Cognitive Behavioural Therapy group. CONCLUSIONS Using a novel way of assessing chronic stress (psychological and objective measures as hair cortisol levels), this is the first study that has shown a decrease in both the levels of cortisol in hair and in psychological stress. This decline could have implications for maternal and fetal health.
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Affiliation(s)
- Borja Romero-Gonzalez
- Brain, Mind and Behavior Research Center (CIMCYC), Faculty of Psychology, University of Granada, Granada, Spain; Department of Personality, Assessment and Psychological Treatment, University of Granada, Granada, Spain
| | - Jose A Puertas-Gonzalez
- Brain, Mind and Behavior Research Center (CIMCYC), Faculty of Psychology, University of Granada, Granada, Spain; Department of Personality, Assessment and Psychological Treatment, University of Granada, Granada, Spain
| | | | - Raquel Gonzalez-Perez
- Department of Pharmacology, CIBERehd, School of Pharmacy, Instituto de Investigación Biosanitariaibs.GRANADA, University of Granada, Granada, Spain.
| | - M Isabel Peralta-Ramirez
- Department of Personality, Assessment and Psychological Treatment, University of Granada, Granada, Spain
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20
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Liu Q, Li R, Qu W, Li B, Yang W, Cui R. Pharmacological and non-pharmacological interventions of depression after traumatic brain injury: A systematic review. Eur J Pharmacol 2019; 865:172775. [DOI: 10.1016/j.ejphar.2019.172775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/26/2019] [Accepted: 11/01/2019] [Indexed: 12/27/2022]
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21
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Whiting D, Deane F, McLeod H, Ciarrochi J, Simpson G. Can acceptance and commitment therapy facilitate psychological adjustment after a severe traumatic brain injury? A pilot randomized controlled trial. Neuropsychol Rehabil 2019; 30:1348-1371. [DOI: 10.1080/09602011.2019.1583582] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Diane Whiting
- Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, Australia
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Frank Deane
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Hamish McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Joseph Ciarrochi
- Institute of Positive Psychology & Education, Australian Catholic University, Strathfield, Australia
| | - Grahame Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
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22
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Clauss K, Bardeen JR. Addressing Psychometric Limitations of the Attentional Control Scale via Bifactor Modeling and Item Modification. J Pers Assess 2018; 102:415-427. [PMID: 30398371 DOI: 10.1080/00223891.2018.1521417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this three-part study was to identify and correct psychometric limitations of the Attentional Control Scale (ACS; Derryberry & Reed, 2002) via bifactor modeling and item modification. In Study 1 (N = 956), results from exploratory factor analyses (EFAs) and confirmatory factor analyses (CFAs) suggested that the multidimensionality of the ACS might be a function of a method effect (i.e., reverse coding). In Study 2 (N = 478), reverse-coded items were recoded in a straightforward manner and submitted to EFA. Results supported retention of 15 items and 2 factors. In Study 3 (N = 410), CFA was used to test the model identified in Study 2 and compare it to competing models (i.e., 1-factor, bifactor). The bifactor model exhibited the best fit to the data. However, results from bifactor analysis suggested that the structure of the ACS is more consistent with a unidimensional rather than multidimensional model. Additionally, the second domain-specific factor appears to be redundant with the general factor and both domain-specific factors are poorly defined and might be of little practical value. Taken together, results caution the use of the ACS subscales independent of the total score. Moreover, they support coding ACS items in a straightforward manner.
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23
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Benfer N, Bardeen JR, Fergus TA, Rogers TA. Factor Structure and Incremental Validity of the Original and Modified Versions of the Difficulties in Emotion Regulation Scale. J Pers Assess 2018; 101:598-608. [PMID: 30142305 DOI: 10.1080/00223891.2018.1492927] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) is a self-report measure that assesses six facets of emotion dysregulation. A modified version of the DERS (M-DERS) was developed to address psychometric limitations of the original measure (Bardeen, Fergus, Hannan, & Orcutt, 2016). Although the factor structure of the M-DERS (i.e., two models: correlated trait and second-order models) has been supported via confirmatory factor analysis (CFA), the tenability of a bifactor model of the M-DERS has yet to be examined. Preliminary research suggests that a bifactor model of the M-DERS is tenable. In this study (Ns of 993 and 578), results from a series of CFAs indicated adequate fit of the M-DERS and poor fit of the original DERS across several tested models (e.g., correlated trait, second-order, bifactor). Although a considerable amount of variance was accounted for by the general factor, statistical indexes from the bifactor model supported a multidimensional conceptualization of the M-DERS. The Nonacceptance and Goals subscales evidenced incremental utility, after accounting for the general factor, in predicting general distress (Nonacceptance only) and intolerance of uncertainty. Implications for future use of the DERS and M-DERS are discussed.
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Affiliation(s)
| | | | - Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University
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24
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Hart T, Driver S, Sander A, Pappadis M, Dams-O'Connor K, Bocage C, Hinkens E, Dahdah MN, Cai X. Traumatic brain injury education for adult patients and families: a scoping review. Brain Inj 2018; 32:1295-1306. [PMID: 30084694 DOI: 10.1080/02699052.2018.1493226] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Traumatic brain injury (TBI) is increasingly viewed as a chronic condition, bringing long-term needs for patient and caregiver knowledge pertaining to symptom and problem management over time. In light of these needs, we performed a scoping review of the literature on brain injury education provided to adult patients and/ or family members affected by TBI. Objectives were to describe the types of educational interventions that have been developed; to review the effects of these interventions; and to determine gaps that might be filled by future research efforts. Of 88 articles meeting search criteria and subjected to data extraction, 34 concerned education about mild TBI and 54, moderate to severe TBI. Most mild TBI articles focused on education in the Emergency Room, while most moderate/ severe TBI education was directed toward family members/ caregivers and was frequently combined with other treatment components, making the effects of education difficult to discern. Only 1 article incorporated elements of self-management training (SMT), a model proved effective in other chronic health conditions. We recommend further exploration of SMT principles in long-term TBI care, as well as more precise definition of treatment components in all patient and family interventions, so that the specific effects of education and other treatment elements may be more readily evaluated.
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Affiliation(s)
- Tessa Hart
- a Moss Rehabilitation Research Institute , Elkins Park , PA , USA
| | - Simon Driver
- b Department of Rehabilitation Research , Baylor Scott and White Institute for Rehabilitation , Dallas , TX , USA
| | - Angelle Sander
- c Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA.,d Brain Injury Research Center , TIRR Memorial Hermann , Houston , TX , USA
| | - Monique Pappadis
- d Brain Injury Research Center , TIRR Memorial Hermann , Houston , TX , USA.,e Division of Rehabilitation Sciences, School of Health Professions , University of Texas Medical Branch at Galveston , TX , USA
| | - Kristen Dams-O'Connor
- f Department of Rehabilitation Medicine, Department of Neurology Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Claire Bocage
- g American Institutes for Research , Washington , DC , USA
| | - Emma Hinkens
- g American Institutes for Research , Washington , DC , USA
| | - Marie N Dahdah
- b Department of Rehabilitation Research , Baylor Scott and White Institute for Rehabilitation , Dallas , TX , USA.,h Department of Medical Psychology , Baylor Scott and White Medical Center , Plano , TX , USA
| | - Xinsheng Cai
- g American Institutes for Research , Washington , DC , USA
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25
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Kreutzer JS, Marwitz JH, Sima AP, Mills A, Hsu NH, Lukow HR. Efficacy of the resilience and adjustment intervention after traumatic brain injury: a randomized controlled trial. Brain Inj 2018; 32:963-971. [DOI: 10.1080/02699052.2018.1468577] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Jeffrey S. Kreutzer
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer H. Marwitz
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Adam P. Sima
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Ana Mills
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Nancy H. Hsu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Herman R. Lukow
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
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26
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Simpson EK, Ramirez NM, Branstetter B, Reed A, Lines E. Occupational Therapy Practitioners' Perspectives of Mental Health Practices With Clients in Stroke Rehabilitation. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2018; 38:181-189. [PMID: 29495909 DOI: 10.1177/1539449218759627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Following a stroke, depression and anxiety may negatively affect recovery and decrease quality of life. Occupational therapy (OT) practitioners are distinctly qualified to address both the physical and psychosocial sequelae of a stroke, including clients' mental and emotional health. This study explored the ways in which OT practitioners address the mental health needs of clients post stroke. A sequential explanatory mixed-methods design was used to collect both survey and focus group data. In all, 754 OT practitioners across the United States completed an online survey, and 10 practitioners participated in focus groups. Practitioners considered their clients' mental health needs to be a priority (68.17%); however, only 56.64% were satisfied with the care they provided related to mental and emotional health. They identified barriers that included limited time, increased productivity standards, expectations related to physical recovery, and poor educational preparation. Practitioners are motivated to improve their provision of mental health services to clients post stroke. To address the conflict between practice realities and professional values, education programs should better integrate curricular components that focus on physical and mental health.
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Affiliation(s)
| | | | | | - Aileen Reed
- 1 Midwestern University, Downers Grove, IL, USA
| | - Evan Lines
- 1 Midwestern University, Downers Grove, IL, USA
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Mueller C, Wesenberg S, Nestmann F, Stubbs B, Bebbington P, Raymont V. Interventions to enhance coping after traumatic brain injury: A systematic review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.3.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: The aim of this study was to identify effective psychosocial interventions to enhance coping in people who have experienced a traumatic brain injury, in order to inform clinical practice and articulate future research directions. Methods: Five electronic databases (CINAHL, Medline, EMBASE, PsycINFO, and Cochrane Library) were searched. Titles and abstracts were independently screened by two of the authors and selected for inclusion. The full text of all potentially relevant studies were retrieved and assessed for eligibility, reporting and methodological quality, and risk of bias. Findings: Eight included studies were very heterogeneous in terms of study design, type of intervention, the population studied and instruments used to evaluate coping. All studies were judged to have a moderately high risk of bias. Six studies used cognitive behavioural therapy-based interventions. Two interventions (a peer-mentoring programme and cognitive behavioural therapy combined with motivational interviewing) showed significant treatment effects on maladaptive coping. Two cognitive behavioural therapy-based group programmes improved adaptive coping, but increases were either not sustained over time or no longer significant when compared to an active control. Conclusions: There is insufficient evidence to support practice recommendations strongly. Targeting specific subgroups of people who have experienced traumatic brain injury might allow the development of more effective coping interventions. Further, a more unified concept of coping in traumatic brain injury needs to be articulated allowing larger scale evaluations.
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Affiliation(s)
- Christoph Mueller
- Academic clinical lecturer, Department of Old Age Psychiatry, King's College London, London, UK
| | - Sandra Wesenberg
- Research associate, Faculty of Education, Technische Universität Dresden, Germany
| | - Frank Nestmann
- Emeritus professor of counselling and rehabilitation, Faculty of Education, Technische Universität Dresden, Germany
| | - Brendon Stubbs
- Post-doctoral research physiotherapist, King's College London and Head of Physiotherapy at South London and Maudsley NHS Foundation Trust, London, UK
| | - Paul Bebbington
- Emeritus professor of social and community psychiatry, Division of Psychiatry, University College London, London, UK
| | - Vanessa Raymont
- Senior clinical researcher, Department of Psychiatry, University of Oxford, Oxford, UK
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Verberne DPJ, Spauwen PJJ, van Heugten CM. Psychological interventions for treating neuropsychiatric consequences of acquired brain injury: A systematic review. Neuropsychol Rehabil 2018; 29:1509-1542. [DOI: 10.1080/09602011.2018.1433049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Daan P. J. Verberne
- Department of Acquired Brain Injury, GGZ Oost Brabant, Boekel, the Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Maastricht, the Netherlands
| | - Peggy J. J. Spauwen
- Department of Acquired Brain Injury, GGZ Oost Brabant, Boekel, the Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Caroline M. van Heugten
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Improving Emotion Regulation Following Web-Based Group Intervention for Individuals With Traumatic Brain Injury. J Head Trauma Rehabil 2017; 32:354-365. [DOI: 10.1097/htr.0000000000000345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Potter SDS, Brown RG, Fleminger S. Randomised, waiting list controlled trial of cognitive-behavioural therapy for persistent postconcussional symptoms after predominantly mild-moderate traumatic brain injury. J Neurol Neurosurg Psychiatry 2016; 87:1075-83. [PMID: 27496149 DOI: 10.1136/jnnp-2015-312838] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 05/31/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Persistent postconcussional symptoms (PCS) can be a source of distress and disability following traumatic brain injury (TBI). Such symptoms have been viewed as difficult to treat but may be amenable to psychological approaches such as cognitive-behavioural therapy (CBT). OBJECTIVES To evaluate the effectiveness of a 12-session individualised, formulation-based CBT programme. METHOD Two-centre randomised waiting list controlled trial with 46 adults with persistent PCS after predominantly mild-to-moderate TBI (52% with post-traumatic amnesia (PTA)≤24 hours), but including some with severe TBIs (20% with PTA>7 days). RESULTS Improvements associated with CBT were found on the primary outcome measures relating to quality of life (using the Quality of Life Assessment Schedule and the Brain Injury Community Rehabilitation Outcome Scale). Treatment effects after covarying for treatment duration were also found for PCS and several secondary outcomes, including measures of anxiety and fatigue (but not depression or post-traumatic stress disorder (PTSD)). Improvements were more apparent for those completing CBT sessions over a shorter period of time, but were unrelated to medicolegal status, injury severity or length of time since injury. CONCLUSIONS This study suggests that CBT can improve quality of life for adults with persistent PCS and potentially reduce symptoms for some, in the context of outpatient brain injury rehabilitation services. TRIAL REGISTRATION NUMBER ISRCTN49540320.
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Affiliation(s)
- Sebastian D S Potter
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, King's College, London, UK Lishman Unit, Maudsley Hospital, South London & Maudsley NHS Foundation Trust, London, UK
| | - Richard G Brown
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, King's College, London, UK Lishman Unit, Maudsley Hospital, South London & Maudsley NHS Foundation Trust, London, UK
| | - Simon Fleminger
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Lishman Unit, Maudsley Hospital, South London & Maudsley NHS Foundation Trust, London, UK
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Winegardner J, Keohane C, Prince L, Neumann D. Perspective training to treat anger problems after brain injury: Two case studies. NeuroRehabilitation 2016; 39:153-62. [DOI: 10.3233/nre-161347] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jill Winegardner
- Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, UK
| | - Clare Keohane
- Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, UK
| | - Leyla Prince
- Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, UK
| | - Dawn Neumann
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
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Wheeler S, Acord-Vira A, Davis D. Effectiveness of Interventions to Improve Occupational Performance for People With Psychosocial, Behavioral, and Emotional Impairments After Brain Injury: A Systematic Review. Am J Occup Ther 2016; 70:7003180060p1-9. [PMID: 27089290 DOI: 10.5014/ajot.115.020677] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This systematic review evaluates the effectiveness of interventions to improve occupational performance for people with psychosocial, behavioral, or emotional impairments after traumatic brain injury (TBI). METHOD Medline, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews were searched. Of the 1,512 articles initially identified, 35 met the inclusion criteria. RESULTS Six types of interventions were identified: (1) education, (2) peer mentoring, (3) goal-directed therapy, (4) physical activity, (5) skills training, and (6) cognitive-behavioral therapy (CBT). Strong evidence from well-conducted research supports the use of CBT in individual and group settings. Moderate evidence supports goal-directed interventions, aquatic exercise, and functional skills training. Limited evidence supports peer mentoring, aerobic exercise, educational interventions, and various skills training. CONCLUSION An increasing body of evidence supports specific interventions to improve occupational performance and participation for people with psychosocial, behavioral, or emotional impairments after TBI.
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Affiliation(s)
- Steven Wheeler
- Steven Wheeler, PhD, OTR/L, CBIS, is Associate Professor and Associate Chair, Division of Occupational Therapy, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown;
| | - Amanda Acord-Vira
- Amanda Acord-Vira, MOT, OTR/L, CBIS, is Assistant Professor, Division of Occupational Therapy, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown
| | - Diana Davis
- Diana Davis, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown
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Patterson F, Fleming J, Doig E. Group-based delivery of interventions in traumatic brain injury rehabilitation: a scoping review. Disabil Rehabil 2016; 38:1961-86. [DOI: 10.3109/09638288.2015.1111436] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Freyr Patterson
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Jennifer Fleming
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health District, Queensland Health, Brisbane, Australia
| | - Emmah Doig
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health District, Queensland Health, Brisbane, Australia
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Wiart L, Luauté J, Stefan A, Plantier D, Hamonet J. Non pharmacological treatments for psychological and behavioural disorders following traumatic brain injury (TBI). A systematic literature review and expert opinion leading to recommendations. Ann Phys Rehabil Med 2016; 59:31-41. [PMID: 26776320 DOI: 10.1016/j.rehab.2015.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The non pharmacological approach is an important issue in the treatment of psychological and behavioural disorders in traumatic brain injury (TBI) patients. It remains nevertheless insufficiently known and defined. The objective of this work was to develop precise recommendations for caregivers and relatives. METHOD The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement, involving a systematic, critical review of the literature and the expert opinions of the French Society of Physical Medicine and Rehabilitation (SOFMER) group. RESULTS 458 articles were identified, among which 98 were selected for their relevance to the theme of the research. None of the studies reached the highest level of evidence. Fifteen controlled studies reached a relatively high level of evidence (level 2); other studies were case series or expert opinions, and other articles again were reviews of the literature and theoretical points of view. The holistic approach structured into programmes, cognitive-behavioural therapy, and family and systemic therapy, despite the low levels of proof, are recommended in first intention at all stages in the evolution of TBI. Relational and adaptive approaches, rehabilitation and vocational approaches, and psychoanalytical therapies may be useful, provided that therapists are familiar with and trained in traumatic brain injury. CONCLUSION Despite the small number of publications and a low level of proof, a number of recommendations for the non-pharmacological approach to psychological and behavioural disorders in TBI is proposed by the consensus conference of experts. Scientific research in this domain is needed to confirm and complete these first recommendations.
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Affiliation(s)
- Laurent Wiart
- Service de MPR, CHU Pellegrin, 33076 Bordeaux Cedex, France.
| | - Jacques Luauté
- Service de MPR, Hôpital Henri-Gabrielle, 69230 Saint Genis Laval, France
| | | | - David Plantier
- Service de MPR, Hôpital René-Sabran, 83400 Giens, France
| | - Julia Hamonet
- Service de MPR, Hôpital Dupuytren, 87042 Limoges cedex, France
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Cullen B, Pownall J, Cummings J, Baylan S, Broomfield N, Haig C, Kersel D, Murray H, Evans JJ. Positive PsychoTherapy in ABI Rehab (PoPsTAR): A pilot randomised controlled trial. Neuropsychol Rehabil 2016; 28:17-33. [PMID: 26726854 DOI: 10.1080/09602011.2015.1131722] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Psychological distress is common following acquired brain injury (ABI), but the evidence base for psychotherapeutic interventions is small and equivocal. Positive psychotherapy aims to foster well-being by increasing experiences of pleasure, engagement and meaning. In this pilot trial, we investigated the feasibility and acceptability of brief positive psychotherapy in adults with ABI and emotional distress. Participants were randomised to brief positive psychotherapy plus usual treatment, or usual treatment only. Brief positive psychotherapy was delivered over eight individual out-patient sessions, by one research psychologist. A blinded assessor administered the Depression Anxiety Stress Scales (DASS-21) and the Authentic Happiness Inventory (AHI) at 5, 9 and 20 weeks post-baseline. Of 27 participants randomised (median age 57; 63% male; 82% ischaemic stroke survivors; median 5.7 months post-injury), 14 were assigned to positive psychotherapy, of whom 8 completed treatment. The intervention was feasible to deliver with excellent fidelity, and was acceptable to participants. Retention at 20 weeks was 63% overall. A full-scale trial would need to retain n = 39 per group to end-point, to detect a significant difference in change scores on the DASS-21 Depression scale of 7 points (two-tailed alpha = .05, power = .80). Trials including an active control arm would require larger sample sizes. We conclude that a full-scale trial to investigate efficacy is warranted.
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Affiliation(s)
- Breda Cullen
- a Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK
| | - Jaycee Pownall
- a Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK
| | - Joanne Cummings
- a Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK.,b School of Psychological Sciences and Health , University of Strathclyde , Glasgow , UK
| | - Satu Baylan
- a Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK
| | - Niall Broomfield
- a Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK.,c Stroke Psychology Service, NHS Greater Glasgow & Clyde , Glasgow , UK
| | - Caroline Haig
- d Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK
| | - Denyse Kersel
- e Community Treatment Centre for Brain Injury, NHS Greater Glasgow & Clyde , Glasgow , UK
| | - Heather Murray
- d Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK
| | - Jonathan J Evans
- a Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK
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Gertler P, Tate RL, Cameron ID. Non-pharmacological interventions for depression in adults and children with traumatic brain injury. Cochrane Database Syst Rev 2015; 2015:CD009871. [PMID: 26663136 PMCID: PMC8761477 DOI: 10.1002/14651858.cd009871.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Following traumatic brain injury (TBI) there is an increased prevalence of depression compared to the general population. It is unknown whether non-pharmacological interventions for depression are effective for people with TBI. OBJECTIVES To investigate the effectiveness of non-pharmacological interventions for depression in adults and children with TBI at reducing the diagnosis and severity of symptoms of depression. SEARCH METHODS We ran the most recent search on 11 February 2015. We searched the Cochrane Injuries Group Specialised Register, The Cochrane Library, MEDLINE (OvidSP), Embase (OvidSP), three other databases and clinical trials registers. Relevant conference proceedings and journals were handsearched, as were the reference lists of identified studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of non-pharmacological interventions for depression in adults and children who had a TBI. DATA COLLECTION AND ANALYSIS Two authors independently selected trials from the search results, then assessed risk of bias and extracted data from the included trials. The authors contacted trial investigators to obtain missing information. We rated the overall quality of the evidence of the primary outcomes using the GRADE approach. MAIN RESULTS Six studies met the inclusion criteria, with a total of 334 adult participants. We identified no studies that included children as participants. All studies were affected by high risk of bias due to a lack of blinding of participants and personnel; five studies were affected by high risk of bias for lack of blinding of outcome assessors. There was high or unclear risk of biases affecting some studies across all the Cochrane risk of bias measures.Three studies compared a psychological intervention (either cognitive behaviour therapy or mindfulness-based cognitive therapy) with a control intervention. Data regarding depression symptom outcome measures were combined in a meta-analysis, but did not find an effect in favour of treatment (SMD -0.14; 95% CI -0.47 to 0.19; Z = 0.83; P = 0.41). The other comparisons comprised of single studies of depression symptoms and compared; cognitive behaviour therapy versus supportive psychotherapy (SMD -0.09; 95% CI -0.65 to 0.48; Z = 0.30; P = 0.77); repetitive transcranial magnetic stimulation plus tricyclic antidepressant (rTMS + TCA) versus tricyclic antidepressant alone (SMD -0.84; 95% CI -1.36 to -0.32; Z = 3;19, P = 0.001); and a supervised exercise program versus exercise as usual (SMD -0.43; 95% CI -0.88 to 0.03; Z = 1.84; P = 0.07). There was very-low quality evidence, small effect sizes and wide variability of results, suggesting that no comparisons showed a reliable effect for any intervention.Only one study mentioned minor, transient adverse events from repetitive transcranial magnetic stimulation. AUTHORS' CONCLUSIONS The review did not find compelling evidence in favour of any intervention. Future studies should focus on participants with a diagnosed TBI and include only participants who have a diagnosis of depression, or who record scores above a clinical cutoff on a depression measure. There is a need for additional RCTs that include a comparison between an intervention and a control that replicates the effect of the attention given to participants during an active treatment.
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Affiliation(s)
- Paul Gertler
- University of SydneyJohn Walsh Centre for Rehabilitation ResearchKolling InstituteSt. LeonardsAustraliaNSW 2065
| | - Robyn L Tate
- University of SydneyJohn Walsh Centre for Rehabilitation ResearchKolling InstituteSt. LeonardsAustraliaNSW 2065
| | - Ian D Cameron
- University of SydneyJohn Walsh Centre for Rehabilitation ResearchKolling InstituteSt. LeonardsAustraliaNSW 2065
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Libin AV, Scholten J, Schladen MM, Danford E, Shara N, Penk W, Grafman J, Resnik L, Bruner D, Cichon S, Philmon M, Tsai B, Blackman M, Dromerick A. Executive functioning in TBI from rehabilitation to social reintegration: COMPASS (goal,) a randomized controlled trial (grant: 1I01RX000637-01A3 by the VA ORD RR&D, 2013-2016). Mil Med Res 2015; 2:32. [PMID: 26664736 PMCID: PMC4675019 DOI: 10.1186/s40779-015-0061-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/30/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans' ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent function. METHODS/DESIGN The COMPASS(goal) (Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community re-integration psychosocial research in veterans with mild traumatic brain injury. COMPASS(goal) integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASS(goal) will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management (intervention) and supported discharge (control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment follow-up. DISCUSSION Goal management is part of the "natural language" of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits that follow brain injury. Re-training returning veterans with brain injury in goal management, with appropriate help and support, would essentially treat deficits in executive function. A structured approach to goal self-management may foster greater independence and self-efficacy, help veterans gain insight into goals that are realistic for them at a given time, and help clinicians and veterans to work more effectively as true collaborators.
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Affiliation(s)
- Alexander V. Libin
- />Mental Health Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, DC 20422 USA
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
- />MedStar Health Research Institute, 6525 Belcrest Rd #700, Hyattsville, MD 20782 USA
| | - Joel Scholten
- />Physical Medicine and Rehabilitation Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, DC 20422 USA
| | - Manon Maitland Schladen
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
- />MedStar Health Research Institute, 6525 Belcrest Rd #700, Hyattsville, MD 20782 USA
| | - Ellen Danford
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
| | - Nawar Shara
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
- />MedStar Health Research Institute, 6525 Belcrest Rd #700, Hyattsville, MD 20782 USA
| | - Walter Penk
- />Texas A&M College of Medicine, 8447 TX-47, Bryan, TX 77807 USA
| | - Jordan Grafman
- />Rehabilitation Institute of Chicago, 345 E Superior St., Chicago, IL 60611 USA
| | - Linda Resnik
- />Research Service, Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI 02908 USA
| | - Dwan Bruner
- />Physical Medicine and Rehabilitation Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, DC 20422 USA
| | - Samantha Cichon
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
| | - Miriam Philmon
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
| | - Brenda Tsai
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
| | - Marc Blackman
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
| | - Alexander Dromerick
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
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Fann JR, Bombardier CH, Vannoy S, Dyer J, Ludman E, Dikmen S, Marshall K, Barber J, Temkin N. Telephone and in-person cognitive behavioral therapy for major depression after traumatic brain injury: a randomized controlled trial. J Neurotrauma 2015; 32:45-57. [PMID: 25072405 DOI: 10.1089/neu.2014.3423] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Major depressive disorder (MDD) is prevalent after traumatic brain injury (TBI); however, there is a lack of evidence regarding effective treatment approaches. We conducted a choice-stratified randomized controlled trial in 100 adults with MDD within 10 years of complicated mild to severe TBI to test the effectiveness of brief cognitive behavioral therapy administered over the telephone (CBT-T) (n = 40) or in-person (CBT-IP) (n = 18), compared with usual care (UC) (n = 42). Participants were recruited from clinical and community settings throughout the United States. The main outcomes were change in depression severity on the clinician-rated 17 item Hamilton Depression Rating Scale (HAMD-17) and the patient-reported Symptom Checklist-20 (SCL-20) over 16 weeks. There was no significant difference between the combined CBT and UC groups over 16 weeks on the HAMD-17 (treatment effect = 1.2, 95% CI: -1.5-4.0; p = 0.37) and a nonsignificant trend favoring CBT on the SCL-20 (treatment effect = 0.28, 95% CI: -0.03-0.59; p = 0.074). In follow-up comparisons, the CBT-T group had significantly more improvement on the SCL-20 than the UC group (treatment effect = 0.36, 95% CI: 0.01-0.70; p = 0.043) and completers of eight or more CBT sessions had significantly improved SCL-20 scores compared with the UC group (treatment effect = 0.43, 95% CI: 0.10-0.76; p = 0.011). CBT participants reported significantly more symptom improvement (p = 0.010) and greater satisfaction with depression care (p < 0.001), than did the UC group. In-person and telephone-administered CBT are acceptable and feasible in persons with TBI. Although further research is warranted, telephone CBT holds particular promise for enhancing access and adherence to effective depression treatment.
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Affiliation(s)
- Jesse R Fann
- 1 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington
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Farrell-Carnahan L, Barnett S, Lamberty G, Hammond FM, Kretzmer TS, Franke LM, Geiss M, Howe L, Nakase-Richardson R. Insomnia symptoms and behavioural health symptoms in veterans 1 year after traumatic brain injury. Brain Inj 2015; 29:1400-8. [PMID: 26287761 DOI: 10.3109/02699052.2015.1063161] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Insomnia and behavioural health symptoms 1 year after traumatic brain injury (TBI) were examined in a clinical sample representative of veterans who received inpatient treatment for TBI-related issues within the Veterans Health Administration. METHODS This was a cross-sectional sub-study (n = 112) of the Polytrauma Rehabilitation Centres' traumatic brain injury model system programme. Prevalence estimates of insomnia, depression, general anxiety, nightmares, headache and substance use, stratified by injury severity, were derived. Univariate logistic regression was used to examine unadjusted effects for each behavioural health problem and insomnia by injury severity. RESULTS Participants were primarily male, < 30 years old and high school educated. Twenty-nine per cent met study criteria for insomnia; those with mild TBI were significantly more likely to meet criteria (43%) than those with moderate/severe TBI (22%), χ(2)(1, n = 112) = 5.088, p ≤ 0.05. Univariable logistic regression analyses revealed depressive symptoms and general anxiety were significantly associated with insomnia symptoms after TBI of any severity. Headache and binge drinking were significantly inversely related to insomnia symptoms after moderate/severe TBI, but not MTBI. CONCLUSIONS Veterans with history of TBI, of any severity, and current insomnia symptoms may be at increased risk for depression and anxiety 1 year after TBI.
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Affiliation(s)
- Leah Farrell-Carnahan
- a Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA .,b Virginia Commonwealth University , Richmond , VA , USA
| | - Scott Barnett
- c James A. Haley Veterans Hospital , Tampa , FL , USA
| | - Gregory Lamberty
- d Minneapolis Veterans Affairs Health Care System , Minneapolis , MN , USA .,e University of Minnesota Medical School , Minneapolis , MN , USA
| | - Flora M Hammond
- f Indiana University School of Medicine , Indianapolis , IN , USA
| | | | - Laura M Franke
- a Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA .,b Virginia Commonwealth University , Richmond , VA , USA .,g Defense and Veterans Brain Injury Center , Richmond , VA , USA , and
| | - Meghan Geiss
- a Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA
| | - Laura Howe
- h VA Palo Alto Health Care System , Palo Alto , CA , USA
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Archer KR, Coronado RA, Haislip LR, Abraham CM, Vanston SW, Lazaro AE, Jackson JC, Ely EW, Guillamondegui OD, Obremskey WT. Telephone-based goal management training for adults with mild traumatic brain injury: study protocol for a randomized controlled trial. Trials 2015; 16:244. [PMID: 26031289 PMCID: PMC4454274 DOI: 10.1186/s13063-015-0775-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 1 million individuals experience a mild traumatic brain injury (TBI) and cost the United States nearly $17 billion each year. Many trauma survivors with mild TBI have debilitating and long-term physical, emotional, and cognitive impairments that are unrecognized at trauma centers. Early intervention studies are needed to address these impairments, especially cognitive deficits in executive functioning. Goal management training (GMT) is a structured cognitive rehabilitation program that has been found to improve executive functioning in patients with moderate to severe TBI. The current study adapted the GMT program for telephone delivery in order to improve the accessibility of rehabilitation services in a patient population with multiple barriers to care and significant yet unrecognized cognitive impairment. The primary objective of this study is to examine the efficacy of telephone-based GMT for improving executive functioning, functional status, and psychological health in trauma survivors with mild TBI. METHODS/DESIGN This study is a three-group randomized controlled trial being conducted at a Level I trauma center. Ninety trauma survivors with mild TBI and cognitive deficits in executive functioning will be randomized to receive telephone-based GMT, telephone-based education, or usual care. GMT and education programs will be delivered by a physical therapist. The first in-person session is 1 h and the remaining six telephone sessions are 30 min. A battery of well-established cognitive tests will be conducted and validated questionnaires will be collected that measure executive functioning, functional status, and depressive and posttraumatic stress disorder symptoms at 6 weeks, 4 months, and 7 months following hospital discharge. DISCUSSION This study supports a telephone-delivery approach to rehabilitation services in order to broaden the availability of evidence-based cognitive strategies. TRIAL REGISTRATION This trial was registered with Clinicaltrials.gov on 10 October 2012, registration number: NCT01714531.
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Affiliation(s)
- Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA. .,Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, 2201 Children's Way, Suite 1318, Nashville, TN, 37212, USA.
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
| | - Lori R Haislip
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
| | - Christine M Abraham
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
| | - Susan W Vanston
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
| | - Anthony E Lazaro
- School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Boulevard, Nashville, TN, 37208, USA.
| | - James C Jackson
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, Center for Health Services Research, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, North Tower, Nashville, TN, 37232, USA. .,Department of Psychiatry, Vanderbilt University School of Medicine, 1601 23rd Avenue, Nashville, TN, 37212, USA. .,Geriatric Research, Veteran's Affairs Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, 1310 24th Avenue South, Nashville, TN, 37212, USA.
| | - E Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, Center for Health Services Research, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, North Tower, Nashville, TN, 37232, USA. .,Geriatric Research, Veteran's Affairs Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, 1310 24th Avenue South, Nashville, TN, 37212, USA.
| | - Oscar D Guillamondegui
- Division of Trauma and Surgical Critical Care, Department of Medicine, Vanderbilt University School of Medicine, 1215 21st Avenue South, 404 MAB 1750, Nashville, TN, 37232, USA.
| | - William T Obremskey
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
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Ashworth F, Clarke A, Jones L, Jennings C, Longworth C. An exploration of compassion focused therapy following acquired brain injury. Psychol Psychother 2015; 88:143-62. [PMID: 25123589 DOI: 10.1111/papt.12037] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 06/09/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with acquired brain injuries (ABI) frequently experience psychological difficulties such as anxiety and depression, which may be underpinned and maintained by high self-criticism and shame alongside an inability to self-soothe. Compassionate focused therapy (CFT) was developed to address shame and self-criticism and foster the ability to self-soothe. OBJECTIVES This is a naturalistic evaluation with the aim of assessing the feasibility, safety, and potential value of CFT for ABI patients with emotional difficulties receiving neuropsychological rehabilitation. METHODS This study employed a mixed methods design combining self-report measures and qualitative interviews. Twelve patients received a combination of CFT group and individual intervention. Self-report measures of self-criticism, self-reassurance, and symptoms of anxiety and depression were collected pre and post programme and analysed using Wilcoxon signed rank test (N=12; five female, seven males). Follow-up data were analysed in the same manner (N=9). Interviews were conducted with six patients and analysed using interpretative phenomenological analysis. RESULTS CFT was associated with significant reductions in measures of self-criticism, anxiety, and depression and an increase in the ability to reassure the self. No adverse effects were reported. Three superordinate themes emerged from the interviews: psychological difficulties; developing trust and finding safeness; and a new approach. CONCLUSIONS This study suggests that CFT is well accepted in ABI survivors within the context of neuropsychological rehabilitation. Furthermore, the results indicate that further research into CFT for psychological problems after ABI is needed and that there may be key aspects, which are specific to CFT intervention, which could reduce psychological difficulties after ABI. PRACTITIONER POINTS CFT appears to be a feasible intervention for psychological problems after ABI. CFT was associated with a reduction in symptoms of anxiety and depression and associated self-criticism, as well as enhanced self-reassurance for ABI survivors. These ABI survivors reported that CFT provided them with tools to manage continued psychological difficulties.
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Affiliation(s)
- Fiona Ashworth
- Department of Psychology, Anglia Ruskin University, Cambridge, UK.,Oliver Zangwill Centre, Cambridgeshire Community Services, Cambridgeshire, UK.,Evelyn Community Head Injury Service, Cambridgeshire Community Services, Cambridgeshire, UK
| | - Alexis Clarke
- Plym Neurorehabilitation Unit, Mount Gould Hospital, Plymouth, UK
| | - Lisa Jones
- Neurorehabilitation Unit, Rookwood Hospital, Cardiff, UK
| | - Caroline Jennings
- Oxford Institute for Clinical Psychology Training, University of Oxford, UK
| | - Catherine Longworth
- Oliver Zangwill Centre, Cambridgeshire Community Services, Cambridgeshire, UK
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Gall C, Brösel D, Franke GH. Mental distress in patients with cerebral visual injury assessed with the german brief symptom inventory. Front Aging Neurosci 2015; 7:51. [PMID: 25999848 PMCID: PMC4418273 DOI: 10.3389/fnagi.2015.00051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/28/2015] [Indexed: 11/13/2022] Open
Abstract
Background While there are reports on vision-related quality of life in patients with vision impairment caused by both ophthalmic and brain diseases, little is known about mental distress. In fact, mental distress after cerebral visual injury has been widely ignored. Methods Mental health symptoms were assessed in 122 participants with visual field defects after brain damage (72 male, mean age 58.1 ± 15.6 years), who completed the German Brief Symptom Inventory (BSI) at their homes after they had been asked by phone for their participation. Results Clinically relevant mental distress was present in 25.4% of participants with cerebral visual injury. In case of multisensory impairment, an increased amount and intensity of mental distress symptoms was observed compared to the subsample with only visual impairment. Conclusion Assessment of comorbid mental health symptoms appears to be clinically meaningful in brain-damaged patients with visual sensory impairment. In case of clinically relevant mental distress, psychological supportive therapies are advisable especially in subjects with cerebral visual injury and comorbidities affecting other sensory modalities as well.
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Affiliation(s)
- Carolin Gall
- Department of Rehabilitation Psychology, AHW, Magdeburg-Stendal University of Applied Sciences , Stendal , Germany ; Department of Psychiatry, AMEOS Hospital , Haldensleben , Germany
| | - Doreen Brösel
- Department of Psychiatry, AMEOS Hospital , Haldensleben , Germany
| | - Gabriele Helga Franke
- Department of Rehabilitation Psychology, AHW, Magdeburg-Stendal University of Applied Sciences , Stendal , Germany
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Shields C, Ownsworth T, O'Donovan A, Fleming J. A transdiagnostic investigation of emotional distress after traumatic brain injury. Neuropsychol Rehabil 2015; 26:410-45. [DOI: 10.1080/09602011.2015.1037772] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schmidt J, Fleming J, Ownsworth T, Lannin NA. Maintenance of treatment effects of an occupation-based intervention with video feedback for adults with TBI. NeuroRehabilitation 2015; 36:175-86. [PMID: 25882200 DOI: 10.3233/nre-151205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Video feedback interventions have been found to improve self-awareness and occupational performance to a greater extent than other feedback interventions after traumatic brain injury (TBI). However, it is unclear whether the effects of video feedback are maintained over time. OBJECTIVE To evaluate the maintenance of gains in self-awareness achieved with a video feedback intervention in people with TBI. METHODS There were 32 participants with TBI and impaired self-awareness who had completed a randomized controlled trial with three feedback conditions (video plus verbal, verbal and experiential). Eight to ten weeks after the final feedback intervention session, a follow-up assessment was conducted. The primary outcome was maintenance of gains in online awareness measured by the number of errors made during a meal preparation task. Group outcomes were compared using an unstructured linear mixed regression model. RESULTS The video plus verbal feedback group continued to demonstrate significantly greater gains in online awareness compared to the verbal feedback group (mean difference 20.6, 95% CI 8.8 to 32.3) and the experiential feedback group (mean difference 14.4, 95% CI 3.1 to 25.6). There was no significant impact of the interventions on participants' emotional status at the 8 to 10 week follow-up. CONCLUSIONS A combination of video plus verbal feedback is an effective technique for achieving maintained gains in self-awareness in people with TBI.
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Affiliation(s)
- Julia Schmidt
- School of Allied Health, Australian Catholic University, North Sydney, NSW, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, QLD, Australia.,Royal Rehabilitation Centre Sydney, Sydney, NSW, Australia.,Centre for Functioning and Health Research, Metro South Hospital Health Service, Brisbane, QLD, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, QLD, Australia.,Centre for Functioning and Health Research, Metro South Hospital Health Service, Brisbane, QLD, Australia.,Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Griffith University, QLD, Australia
| | - Natasha A Lannin
- Occupational Therapy, La Trobe University, Melbourne, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, Australia.,John Walsh Centre for Rehabilitation Research, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Jones S, Ownsworth T, Shum DHK. Feasibility and utility of telephone-based psychological support for people with brain tumor: a single-case experimental study. Front Oncol 2015; 5:71. [PMID: 25859430 PMCID: PMC4374457 DOI: 10.3389/fonc.2015.00071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/10/2015] [Indexed: 01/21/2023] Open
Abstract
Rates of psychological distress are high following diagnosis and treatment of brain tumor. There can be multiple barriers to accessing psychological support, including physical and cognitive impairments and geographical limitations. Tele-based support could provide an effective and more flexible option for delivering psychological interventions. The present study aimed to investigate the feasibility and utility of a telephone-based psychotherapy intervention for people with brain tumor. A single-case multiple-baseline design was employed with a 4–7-week baseline phase, 10-week treatment phase, and 5-week maintenance phase including a booster session. Four participants with a benign or malignant brain tumor (three males and one female; aged 34–49 years), received 10 sessions of tele-based therapy and a booster session at 4 weeks post-treatment. Levels of depression, anxiety, and illness cognitions were monitored on a weekly basis throughout each phase whilst measures of quality of life, stress, and self-concept were administered at the start and end of each phase. Weekly measures were analyzed using a combination of both visual analysis and Tau-U statistics. Of the four participants, two of them demonstrated significant gains in mental health (depression and/or anxiety) and a significant decrease in their levels of helplessness (p < 0.05). The other two participants did not show gains in mental health or change in illness cognitions. All participants reported improvement in quality of life post-treatment. The results of the study provide preliminary support concerning the feasibility and utility of tele-based therapy for some people with brain tumor. Further research examining factors influencing the outcomes of tele-based psychological support is needed.
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Affiliation(s)
- Stephanie Jones
- School of Applied Psychology and Griffith Health Institute, Griffith University , Brisbane, QLD , Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Griffith Health Institute, Griffith University , Brisbane, QLD , Australia
| | - David H K Shum
- School of Applied Psychology and Griffith Health Institute, Griffith University , Brisbane, QLD , Australia
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Abstract
Mood disturbances, especially depressive disorders, are the most frequent neuropsychiatric complication of traumatic brain injury (TBI). These disorders have a complex clinical presentation and are highly comorbid with anxiety, substance misuse, and other behavioral alterations such as impulsivity and aggression. Furthermore, once developed, mood disorders tend to have a chronic and refractory course. Thus, the functional repercussion of these disorders is huge, affecting the rehabilitation process and the long-term outcome of TBI patients. The pathophysiology of mood disorders involves the interplay of factors that precede trauma (e.g., genetic vulnerability and previous psychiatric history), factors that pertain to the traumatic injury itself (e.g., type, extent, and location of brain damage) and factors that influence the recovery process (e.g., family and social support). It is hardly surprising that mood disorders are associated with structural and functional changes of neural circuits linking brain areas specialized in emotional processing such as the prefrontal cortex, basal ganglia, and amygdala. In turn, the onset of mood disorders may contribute to further prefrontal dysfunction among TBI patients. Finally, in spite of the prevalence and impact of these disorders, there have been relatively few rigorous studies of therapeutic options. Development of treatment strategies constitutes a priority in this field of research.
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Affiliation(s)
- Ricardo E Jorge
- Michael E DeBakey VA Medical Center, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
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Tsaousides T, D'Antonio E, Varbanova V, Spielman L. Delivering group treatment via videoconference to individuals with traumatic brain injury: a feasibility study. Neuropsychol Rehabil 2014; 24:784-803. [PMID: 24810148 DOI: 10.1080/09602011.2014.907186] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective was to assess the feasibility of delivering a group treatment to improve emotional regulation via videoconferencing to individuals with traumatic brain injury (TBI). A pre-post feasibility study was undertaken. Seven individuals with TBI were recruited at a brain injury research centre in an urban medical centre. The main measures were therapist assessment of session-by-session progress and feasibility, Difficulties in Emotion Regulation Scale (DERS), Brain Injury Rehabilitation Trust Regulation of Emotions Questionnaire (BREQ), Satisfaction with Therapy and Therapist Scale (STTS), and exit interview. Attendance across sessions and participants was over 90%. Adequate skill acquisition and ease of use of the technology were demonstrated. Self-reported satisfaction with treatment was high. Participants noted several benefits in terms of the treatment delivery modality. There was no change is self-reported emotional dysregulation. This is the first study to report the use of videoconferencing for the delivery of group treatment to individuals with TBI. The exceptional compliance and self-reported satisfaction suggest that this treatment delivery option could be a viable alternative for increasing access to healthcare in this population. The findings of the study supported the development of a large clinical trial to assess treatment effectiveness.
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Affiliation(s)
- Theodore Tsaousides
- a Department of Rehabilitation Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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Barker-Collo S, Starkey N, Theadom A. Treatment for depression following mild traumatic brain injury in adults: a meta-analysis. Brain Inj 2013; 27:1124-33. [PMID: 23895287 DOI: 10.3109/02699052.2013.801513] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE Development of depression after TBI is linked to poorer outcomes. The aim of this manuscript is to review evidence for the effectiveness of current treatments. RESEARCH DESIGN Two meta-analyses were undertaken to examine the effectiveness of both pharmacological and non-pharmacological interventions for depression after mild TBI. METHOD AND PROCEDURES PubMed, Medline, PsychInfo, Web of Science and Digital Dissertations were searched and 13 studies located. Meta Analyst Beta 3.13 was used to conduct analyses of pre- vs post-effects then to examine treatment group vs control group effects. MAIN OUTCOMES AND RESULTS Studies using a pre-post design produced an overall effect size of 1.89 (95% CI = 1.20-2.58, p < 0.001), suggesting that treatments were effective; however, the overall effect for controlled trials was 0.46 (95% CI = -0.44-1.36, p < 0.001), which favoured the control rather than treatment groups. CONCLUSIONS This study highlights the need for additional large well-controlled trials of effective treatments for depression post-TBI.
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Affiliation(s)
- Suzanne Barker-Collo
- Department of Psychology, Faculty of Sciences, University of Auckland, Auckland, New Zealand.
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