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Faulkner JW, Whiting D, Theadom A, Snell DL, Roche M, Barker-Collo S. Valued living after mild traumatic brain injury: Characteristics and relationship with outcomes. Neuropsychol Rehabil 2024:1-17. [PMID: 38497571 DOI: 10.1080/09602011.2024.2328876] [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: 09/06/2023] [Accepted: 02/29/2024] [Indexed: 03/19/2024]
Abstract
Psychological factors are strong predictors of mild traumatic brain injury (mTBI) recovery, consequently, psychological interventions can form part of an individual's rehabilitation. This may include enhancing valued living (VL), an approach that is effective in severe and mixed acquired brain injury samples. This study aimed to characterize VL in mTBI and explore its relationship with mTBI and mental health outcomes. 56 participants with a mTBI completed self-report measures before engaging in a psychological intervention. Pre-injury mental health and other demographic and injury-related variables, VL, post-concussion symptoms (PCS), functional disability, and stress, anxiety and depression were measured. A pre-injury mental health condition was significantly associated with VL. VL was uniquely associated with depression after mTBI (β = -0.08, p = .05), however, there was no relationship with PCS, functional disability, stress or anxiety (p > .05). Following mTBI individuals with a pre-injury mental health condition or who experience heightened depressive symptoms may benefit from a values-based intervention as part of their rehabilitation. Future research, however, is needed to examine the role of VL in mTBI recovery.
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Affiliation(s)
- Josh W Faulkner
- Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Diane Whiting
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, Australia
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Alice Theadom
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Maree Roche
- School of Management, Fellow NZ Psychological Society, Auckland University, Auckland, New Zealand
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Harris G, Jones S, Pinkham MB, Lion KM, Ownsworth T. Reliability and validity of the telephone-based version of the Montgomery-Asberg depression rating scale for assessing depression in individuals with primary brain tumour. Disabil Rehabil 2024; 46:1158-1166. [PMID: 37021336 DOI: 10.1080/09638288.2023.2191015] [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: 09/05/2022] [Accepted: 03/09/2023] [Indexed: 04/07/2023]
Abstract
This study aimed to examine interrater reliability and construct validity of the Montgomery-Asberg Depression Rating Scale (MADRS) semi-structured interview for assessing depression in adults with a primary brain tumour. Fifty adults with a primary brain tumour (mean age = 45.86, SD = 12.48) reporting at least mild distress (Distress Thermometer [DT] ≥ 4) were recruited from a multidisciplinary brain tumour clinic and administered a telephone-based cognitive screener, MADRS, Depression Anxiety Stress Scales (DASS) depression subscale and Generalised Anxiety Disorder-7 (GAD-7). Audiotaped interviews were transcribed and then scored by two independent raters. Interrater reliability for the MADRS total score was excellent (ICC = 0.98) and ranged from good to excellent (ICC = 0.83-0.96) for MADRS items. The MADRS total score was significantly associated with the DT, DASS depression, and GAD-7 (r = 0.50-0.76, p < 0.001), thus providing evidence of construct validity. Individuals with poorer cognitive function reported higher levels of depression. The findings provide psychometric support for the MADRS as a semi-structured interview for assessing depression after brain tumour. Further research investigating the sensitivity and specificity of the MADRS is recommended.
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Affiliation(s)
- Georgia Harris
- School of Applied Psychology, Griffith University, Queensland, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Stephanie Jones
- School of Applied Psychology, Griffith University, Queensland, Australia
| | - Mark B Pinkham
- School of Medicine, University of Queensland, Queensland, Australia
- Department of Radiation Oncology, Princess Alexandra Hospital, Queensland, Australia
| | - Katarzyna M Lion
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Griffith University, Queensland, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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Faulkner JW, Snell DL, Theadom A, Mahon S, Barker-Collo S. The influence of psychological flexibility on persistent post concussion symptoms and functional status after mild traumatic brain injury. Disabil Rehabil 2023; 45:1192-1201. [PMID: 35382660 DOI: 10.1080/09638288.2022.2055167] [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: 11/03/2022]
Abstract
PURPOSE This study investigated the predictive role of psychological flexibility on long-term mTBI outcomes. METHOD Adults with mTBI (N = 147) completed a context specific measure of psychological flexibility, (AAQ-ABI), psychological distress, and mTBI outcomes at less than three months post injury (M = 6.02 weeks after injury) and 6 months later (N = 102). Structural equation modelling examined the mediating effects of psychological flexibility on psychological distress and mTBI outcomes at six months. The direct effect of psychological flexibility at less than three months on mTBI outcomes at six months was entered into the model, plus pre-injury and injury risk factors. RESULTS The theoretically derived model had good overall fit (χ2 = 1.42; p = 0.09; NFI = 0.95; TLI = 0.95; CFI = 0.98 and RMSEA = 0.06). Psychological flexibility at less than 3 months was directly significantly related to psychological distress and post-concussion symptoms at six months. Psychological flexibility at 6 months significantly mediated the relationship between psychological distress and functional disability but not post-concussion symptoms at six months post injury. CONCLUSION The exploratory findings suggest that a context specific measure of psychological flexibility assessed acutely and in the chronic phase of recovery may predict longer-term mTBI outcomes.Implications for RehabilitationPersistent post-concussion symptoms (PPCS) after mild traumatic brain injury (mTBI) can have a significant impact on wellbeing, functional status, and quality of life.In this study, psychological flexibility early in recovery, was associated with higher levels of psychological distress and more severe post-concussion symptoms six months later.Psychological flexibility at six months post-injury also mediated the relationship between psychological distress and functional disability.A context specific measure of psychological flexibility may predict poorer long-term outcomes following mTBI.
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Affiliation(s)
| | - Deborah L Snell
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Northcote, Auckland, New Zealand
| | - Susan Mahon
- TBI Network, Auckland University of Technology, Northcote, Auckland, New Zealand
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Snell DL, Faulkner JW, Williman JA, Silverberg ND, Theadom A, Surgenor LJ, Hackney J, Siegert RJ. Fear avoidance and return to work after mild traumatic brain injury. Brain Inj 2023; 37:541-550. [PMID: 36856140 DOI: 10.1080/02699052.2023.2180663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES Fear avoidance is associated with symptom persistence after mild traumatic brain injury (mTBI). In this study, we investigated whether fear avoidance was associated with other outcomes such as return to work-related activity (RTW). MATERIALS AND METHODS We analyzed associations between fear avoidance and RTW 6-9 months after mTBI, in two merged prospective mTBI cohorts. Adult participants aged 16 or over (n=175), presenting to outpatient services in New Zealand within 3 months of their injury, who were engaged in work-related activity at the time of injury, were included. Participants completed the Fear Avoidance Behavior after Traumatic Brain Injury (FAB-TBI) questionnaire at enrollment and 6 months later. Associations between FAB-TBI scores and RTW outcome were analyzed using multivariate approaches. RESULTS Overall, 53% of participants had RTW by 6-9 months after mTBI. While early fear avoidance was weakly associated with RTW, persistent high fear avoidance between study assessments or increasing avoidance with time were associated with greater odds of still being off work 6-9 months after injury. CONCLUSIONS Pervasive and increasing avoidance of symptom triggers after mTBI were associated with lower rates of RTW 6-9 months after mTBI. Further research is needed to better understand transition points along the recovery trajectory where fear avoidance behaviors fade or increase after mTBI.
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Affiliation(s)
- Deborah L Snell
- Department of Orthopedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Josh W Faulkner
- School of Psychology, Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | | | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Alice Theadom
- TBI Network, Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Lois J Surgenor
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | | - Richard J Siegert
- TBI Network, Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Wadams A, Suting L, Lindsey A, Mozeiko J. Metacognitive Treatment in Acquired Brain Injury and Its Applicability to Aphasia: A Systematic Review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:813416. [PMID: 36188940 PMCID: PMC9397955 DOI: 10.3389/fresc.2022.813416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this systematic review is to identify the utility of metacognitive therapeutic intervention for persons with acquired brain injury (ABI), with a focus on persons with aphasia. Methods A search of six databases resulted in two hundred and sixty-six unique manuscripts relating to the explicit use of metacognitive treatment for people with ABI. Two independent reviewers rated abstracts for inclusion or exclusion of the study given predetermined criteria. Twenty-nine articles, five of which included people with aphasia, were selected for inclusion in this systematic review. SCED+ and PEDro+ rating scales were used to rate the methodological quality of each study. Results Methodological quality of the 29 studies that met inclusion criteria ranged from weak to high quality studies. Three -hundred and sixty-nine individuals with ABI took part in the 29 studies. Varying treatment methods were employed. Outcome measures were inconsistent. Metacognitive treatment has been applied to people with aphasia with positive results, but efficacy of the treatment cannot yet be determined. Conclusions Metacognitive therapeutic intervention tends to be effective for persons with acquired brain injury (ABI) despite variability between intervention designs and treatment outcomes across studies. Due to so few studies with participants with aphasia, we were unable to draw conclusions regarding the efficacy of metacognitive treatment for people with aphasia. Further research on the efficacy of metacognitive treatment for this population is warranted.
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Affiliation(s)
- Amanda Wadams
- Department of Speech, Language and Hearing Science, University of Connecticut, Mansfield, MA, United States
- *Correspondence: Amanda Wadams
| | - Louisa Suting
- Department of Speech, Language and Hearing Science, University of Connecticut, Mansfield, MA, United States
| | - André Lindsey
- School of Education, Speech Pathology, Nevada State College, Henderson, NV, United States
| | - Jennifer Mozeiko
- Department of Speech, Language and Hearing Science, University of Connecticut, Mansfield, MA, United States
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Faulkner JW, Snell DL, Shepherd D, Theadom A. Turning away from sound: The role of fear avoidance in noise sensitivity following mild traumatic brain injury. J Psychosom Res 2021; 151:110664. [PMID: 34749069 DOI: 10.1016/j.jpsychores.2021.110664] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Noise sensitivity (NS) following mild traumatic brain injury (mTBI) is common impacts functioning and outcomes. Recent research suggests psychological factors may have a significant role in the development of NS after mTBI. Psychological interventions have been advocated for to reduce this experience. To be effective, these interventions must aim to target the psychological processes that contribute to this relationship. Fear avoidance holds promise in this regard. The current study aimed to explore the role of fear avoidance in NS and examine its role in mediating the relationship between psychological distress and NS. METHOD Adults (n = 234) diagnosed with mTBI were recruited from outpatient mTBI clinics throughout New Zealand. Participants completed self-report measures of pre-injury mental health status, as well as current post-concussion symptoms, psychological distress (anxiety, stress, depression, fear avoidance and post-traumatic stress symptoms) and functional status upon entry to an mTBI outpatient clinic (M = 8.9, SD = 9.2, post injury). RESULTS A pre-injury mental health diagnosis was associated with NS after mTBI, as were symptoms of anxiety, stress, depression, and post-traumatic stress. Regression analyses revealed that fear avoidance (β = 0.45, p = .01), as well as stress (β = 0.07, p = .01) and PTSD symptoms (β = 0.02, p = .01), made a significant and unique contribution to NS. A series of mediation analyses found that fear avoidance had a significant indirect effect on the relationships between psychological distress and NS. CONCLUSIONS Fear avoidance is related to NS following mTBI. Targeting fear avoidance behaviours and beliefs may represent a treatment target for reducing NS after mTBI.
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Affiliation(s)
- Josh W Faulkner
- Massey University, PO Box 756, Wellington 6140, New Zealand.
| | - Deborah L Snell
- University of Otago Christchurch, 2 Riccarton Ave, Christchurch 8011, New Zealand
| | - Daniel Shepherd
- TBI Network, Auckland University of Technology, University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand
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Faulkner JW, Snell DL, Theadom A, Mahon S, Barker-Collo S, Skirrow P. Psychological flexibility in mild traumatic brain injury: an evaluation of measures. Brain Inj 2021; 35:1103-1111. [PMID: 34334064 DOI: 10.1080/02699052.2021.1959062] [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: 10/20/2022]
Abstract
PRIMARY OBJECTIVE In this study, we examined the psychometric properties of measures of psychological flexibility in a mild traumatic brain injury (mTBI) sample. METHOD AND PROCEDURES Adults who sustained a mTBI (n = 112) completed the Acceptance and Action Questionnaire - Acquired Brain Injury reactive avoidance subscale (AAQ-ABI (RA). Exploratory factor analysis and Rasch analysis were conducted to evaluate the facture structure, dimensionality, and differential item functioning. Construct validity was determined by correlating the AAQ-ABI (RA) with the Acceptance and Action Questionnaire-Revised (AAQ-II) and Fear Avoidance after Traumatic Brain Injury (FAB-TBI). MAIN OUTCOME AND RESULTS The AAQ-ABI (RA) was found to have strong internal consistency (Cronbach's α = 0.87). Consistent with previous findings, the AAQ-ABI (RA) had one distinct factor. Fit to the unidimensional Rasch model was adequate (χ2 (18) = 22.5, p = .21) with no evidence of differential item functioning across person factors examined. The AAQ-ABI (RA) also had expected relationships with theoretically relevant constructs. CONCLUSIONS The AAQ-ABI (RA) appears to be a psychometrically sound measure of psychological flexibility in mTBI.
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Affiliation(s)
- Josh W Faulkner
- School of Psychology, Massey University, Wellington, New Zealand
| | - Deborah L Snell
- University of Otago Christchurch, University of Otago, Christchurch
| | - Alice Theadom
- TBI Network, Auckland University of Technology, TBI Network, Auckland University of Technology, University of Technology, Northcote, Auckland
| | - Susan Mahon
- TBI Network, Auckland University of Technology, TBI Network, Auckland University of Technology, University of Technology, Northcote, Auckland
| | | | - Paul Skirrow
- University of Otago Wellington, University of Otago, Newtown, Wellington
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Boroda E, Armstrong M, Gilmore CS, Gentz C, Fenske A, Fiecas M, Hendrickson T, Roediger D, Mueller B, Kardon R, Lim K. Network topology changes in chronic mild traumatic brain injury (mTBI). Neuroimage Clin 2021; 31:102691. [PMID: 34023667 PMCID: PMC8163989 DOI: 10.1016/j.nicl.2021.102691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/14/2021] [Accepted: 05/01/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND In mild traumatic brain injury (mTBI), diffuse axonal injury results in disruption of functional networks in the brain and is thought to be a major contributor to cognitive dysfunction even years after trauma. OBJECTIVE Few studies have assessed longitudinal changes in network topology in chronic mTBI. We utilized a graph theoretical approach to investigate alterations in global network topology based on resting-state functional connectivity in veterans with chronic mTBI. METHODS 50 veterans with chronic mTBI (mean of 20.7 yrs. from trauma) and 40 age-matched controls underwent two functional magnetic resonance imaging scans 18 months apart. Graph theory analysis was used to quantify network topology measures (density, clustering coefficient, global efficiency, and modularity). Hierarchical linear mixed models were used to examine longitudinal change in network topology. RESULTS With all network measures, we found a significant group × time interaction. At baseline, brain networks of individuals with mTBI were less clustered (p = 0.03) and more modular (p = 0.02) than those of HC. Over time, the mTBI networks became more densely connected (p = 0.002), with increased clustering (p = 0.001) and reduced modularity (p < 0.001). Network topology did not change across time in HC. CONCLUSION These findings demonstrate that brain networks of individuals with mTBI remain plastic decades after injury and undergo significant changes in network topology even at the later phase of the disease.
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Affiliation(s)
- Elias Boroda
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
| | | | | | - Carrie Gentz
- Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Alicia Fenske
- Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Mark Fiecas
- Center for the Prevention and Treatment of Visual Loss, Iowa City VA Healthcare System, Iowa City, IA, USA
| | - Tim Hendrickson
- University of Minnesota Informatics Institute, University of Minnesota, Minneapolis, MN, USA
| | - Donovan Roediger
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Bryon Mueller
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Randy Kardon
- University of Minnesota Informatics Institute, University of Minnesota, Minneapolis, MN, USA; Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Kelvin Lim
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA; Minneapolis VA Health Care System, Minneapolis, MN, USA; School of Public Health, Department of Biostatistics, University of Minnesota, Minneapolis, MN, USA
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The relationship between post-traumatic stress disorder and acquired brain injury among civilian patients. Clin Neurol Neurosurg 2020; 196:105981. [PMID: 32599423 DOI: 10.1016/j.clineuro.2020.105981] [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] [Received: 01/24/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Patients with acquired brain injury are a vulnerable group in Pakistan with limited psychosocial services available to them. The current study sought to determine the incidence of post-traumatic stress disorder (PTSD) in ABI patients with traumatic and non-traumatic injury. PATIENTS AND METHODS A cross-sectional research design was used. The assessment of PTSD was carried out by using the Clinician Administered PTSD Scale (CAPS-5). In the study, there were 132 adults older than 18 years who have ABI-either traumatic or non-traumatic. The study was conducted in a public hospital in Islamabad, Pakistan, and the data was collected one-month post brain injury. RESULTS The results showed that traumatic brain injury (TBI) patients have more PTSD symptoms as compared to non-TBI patients (p = 0.00). Intrusive (p = 0.00) and hyper arousal symptoms (p = 0.04) of PTSD were higher in TBI than in non-TBI patients. There was statically non-significant mean difference in symptoms of PTSD among male and female patients (p = 0.34). The moderately brain injury patients have high PTSD symptoms as compared to mild brain injury patients (p = 0.04). Further, the frequency of severe and extreme PTSD symptoms was high in TBI patient as compared to non TBI patients (p = .05) CONCLUSION: PTSD severity and PTSD symptoms such as intrusive and avoidance symptoms were higher in TBI patients than in non-TBI patients. This study contributed to the literature by assessing the onset of PTSD in patients with acquired brain injury. This study also provided knowledge to plan psychosocial interventions for patients with acquired brain injury having PTSD symptoms.
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Gertler P, Tate RL. Are single item mood scales (SIMS) valid for people with traumatic brain injury? Brain Inj 2020; 34:653-664. [DOI: 10.1080/02699052.2020.1733087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Paul Gertler
- John Walsh Centre for Rehabilitation Research, University of Sydney, St. Leonards, Australia
| | - Robyn L. Tate
- John Walsh Centre for Rehabilitation Research, University of Sydney, St. Leonards, Australia
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Gertler P, Tate RL. Behavioural activation therapy to improve participation in adults with depression following brain injury: A single-case experimental design study. Neuropsychol Rehabil 2019; 31:369-391. [PMID: 31793383 DOI: 10.1080/09602011.2019.1696212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Following brain injury, the risk of depression increases. There are few studies of non-pharmacological interventions for this problem. Behavioural Activation (BA) could help because it has been demonstrated to be as effective as cognitive-behaviour therapy but is less cognitively demanding and more suitable for people with brain impairment. The current study evaluated BA using a multiple-baseline design across behaviours with replication. Three male participants with clinically significant depressive symptoms (two with traumatic brain injury aged 26 and 46, one who experienced strokes in infancy, aged 26) engaged in a 10-14-week trial of BA focusing on three activity domains: physical, social and functional activities. Participants completed an online form three times a day which recorded activity participation and responses to a single-item mood scale. There was little evidence in support of BA for increasing participation. There was also a lack of change in average mood, but some positive effects were found on measures of depression symptoms and quality of life in these participants. Various factors affected participation which might have been mitigated by extended treatment contact, greater use of prompts or electronic aids or the addition of other therapy modes.
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Affiliation(s)
- Paul Gertler
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Robyn L Tate
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Subjective cognitive functioning and associations with psychological distress in adult brain tumour survivors. J Cancer Surviv 2019; 13:653-662. [PMID: 31313128 DOI: 10.1007/s11764-019-00784-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/01/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The impact of brain tumour on subjective cognitive function (SCF) has received little attention despite the implications of these perceptions for quality of life. SCF consists of two related yet distinct components, perceived cognitive impairment (PCI) and perceived cognitive abilities (PCA). This study compared the SCF of adult brain tumour survivors and healthy controls and examined demographic, illness-related, and psychological factors associated with SCF. METHOD Sixty-five adult survivors with primary brain tumour (age, 22-75 years), and 65 age- and sex-matched controls were recruited. Participants with brain tumour completed the Brief Test of Adult Cognition by Telephone, Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), ratings of physical symptoms, Depression Scale of the Depression Anxiety Stress Scales-21 (DASS-Depression), and Generalized Anxiety Disorder-7 (GAD-7) scale. Controls completed the FACT-Cog, DASS-Depression, and GAD-7. RESULTS Adult brain tumour survivors reported significantly greater PCI and lower PCA than controls, after accounting for anxiety. Higher PCI was significantly related to fatigue, pain, treatment-related side-effects, anxiety, and depression. Lower PCA was significantly associated with fatigue, pain, poorer objective cognitive function, lower education, anxiety, and depression. Anxiety uniquely accounted for 9-14% of variance in SCF. CONCLUSIONS Adult brain tumour survivors were found to experience poorer SCF than healthy controls after accounting for anxiety. SCF was related to multiple factors after brain tumour; however, an independent association with anxiety was identified. IMPLICATIONS FOR CANCER SURVIVORS These findings highlight the potential value of psychological interventions targeting anxiety and cognitive effects to improve quality of survivorship after brain tumour.
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Zelencich L, Kazantzis N, Wong D, McKenzie D, Downing M, Ponsford J. Predictors of working alliance in cognitive behaviour therapy adapted for traumatic brain injury. Neuropsychol Rehabil 2019; 30:1682-1700. [PMID: 30990370 DOI: 10.1080/09602011.2019.1600554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cognitive Behaviour Therapy (CBT) has the strongest preliminary support for treatment of depression and anxiety following traumatic brain injury (TBI). TBI associated cognitive impairments may pose an obstacle to development of a strong working alliance, on which therapeutic gains depend. The current study examined the association of demographic (i.e., gender, age at study entry, years of education and premorbid IQ) and injury-related (i.e., years since injury, post-trauma amnesia duration, memory and executive functioning test performance) variables with alliance in CBT adapted for TBI (CBT-ABI). The audio-recordings of 177 CBT-ABI sessions from 31 participants were assessed with an observer version of the Working Alliance Inventory at nine time-points. Multi-level mixed model regressions showed that participants and therapists maintained a relatively strong alliance across all sessions. Pre-intervention symptom severity was considered as a confounder variable and was found to have no statistically significant influence on the models. None of the demographic variables were significantly associated with alliance scores. More years since injury was associated with a stronger alliance. These findings demonstrate that TBI associated cognitive impairments do not necessarily pose an obstacle to development and maintenance of a strong working alliance, which is more likely to develop with more time post-brain injury.
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Affiliation(s)
- Leah Zelencich
- School of Psychological Sciences, Cognitive Behaviour Therapy Research Unit, Monash University, Clayton, Australia
| | - Nikolaos Kazantzis
- School of Psychological Sciences, Cognitive Behaviour Therapy Research Unit, Monash University, Clayton, Australia
| | - Dana Wong
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Dean McKenzie
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
| | - Marina Downing
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
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Lee J, Lee EH, Moon SH. Systematic review of the measurement properties of the Depression Anxiety Stress Scales-21 by applying updated COSMIN methodology. Qual Life Res 2019; 28:2325-2339. [PMID: 30937732 DOI: 10.1007/s11136-019-02177-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE The Depression Anxiety Stress Scales (DASS)-21 measures emotional symptoms of depression, anxiety, and stress, is relatively short, and is freely available in the public domain, which has resulted in it being applied to various clinical and non-clinical populations in many countries. The aim of this study was to systematically review the measurement properties of the DASS-21. METHODS The MEDLINE, Embase, and CINAHL databases were searched. The methodological quality of each identified study was assessed using the updated COSMIN Risk of Bias checklist. The quality of the measurement properties of the studies was rated using the updated criteria for good measurement properties. The quality of evidence was rated using a modified version of the GRADE approach. RESULTS This study included 48 studies in its review. The content validity of the DASS-21 demonstrated sufficient moderate-quality evidence. The instrument exhibited sufficient high-quality evidence for bifactor structural validity and internal consistency. The instrument also showed sufficient high-quality evidence for hypothesis testing of construct validity. Regarding criterion validity, only the DASS-21 Depression subscale demonstrated sufficient high-quality evidence. The measurement invariance across gender demonstrated inconsistent moderate-quality evidence. There was insufficient low-quality evidence for the reliability of each subscale. For responsiveness there was sufficient low-quality evidence for depression and stress subscales, and insufficient very-low-quality evidence for anxiety subscale. CONCLUSIONS The DASS-21 demonstrated sufficient high-quality evidence for bifactor structural validity, internal consistency (bifactor), criterion validity (Depression subscale), and hypothesis testing for construct validity. Further studies are required to assess the other measurement properties of the DASS-21.
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Affiliation(s)
- Jiyeon Lee
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Eun-Hyun Lee
- Graduate School of Public Health, Ajou University, 164 World cup-ro, Yeongtong-Gu, Suwon, 16499, Republic of Korea.
| | - Seung Hei Moon
- Department of Nursing, Graduate School, Inha University, Incheon, Republic of Korea
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Beadle EJ, Ownsworth T, Fleming J, Shum DHK. The nature of occupational gaps and relationship with mood, psychosocial functioning and self-discrepancy after severe traumatic brain injury. Disabil Rehabil 2019; 42:1414-1422. [PMID: 30668152 DOI: 10.1080/09638288.2018.1527954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To examine the nature of occupational gaps and desired re-engagement following severe traumatic brain injury (TBI), and the relationship to mood, self-discrepancy, and psychosocial functioning.Materials and methods: Fifty-nine adults with severe TBI (73% male, M age = 36.50, SD = 12.54) were administered measures of past, current, and desired occupations (Occupational Gaps Questionnaire), mood (Depression Stress and Anxiety Scale - 21), and self-discrepancy (Head Injury Semantic Differential Scale - version 3). Psychosocial functioning was rated by relatives on the Sydney Psychosocial Reintegration Questionnaire.Results: Participants reported that they engaged in significantly fewer occupations than prior to their injury (p < 0.001). Further, they participated in fewer occupations than they desired (p < 0.001). Desired re-engagement was identified for 18 of the 30 occupations (e.g., working, sports, managing personal finances, and supporting others). A higher number of these re-engagement gaps was significantly related to greater anxiety (r = 0.30, p < 0.05) and lower psychosocial functioning (r = -0.29, p < 0.05). A mediation analysis revealed that re-engagement gaps were indirectly related to self-discrepancy through an association with anxiety.Conclusions: Occupational gaps are commonly experienced after severe traumatic brain injury. Lack of engagement in desired occupations is associated with greater anxiety and poorer psychosocial functioning. Anxiety regarding these gaps may contribute to negative comparisons between one's pre-injury and post-injury self. Identification of occupational gaps and their psychological impact may guide the focus of client-centred rehabilitation approaches.Implications for RehabilitationGaps between current activity engagement (i.e., post injury) and desired activity engagement are commonly experienced after severe traumatic brain injury.Greater desired re-engagement gaps (i.e., when individuals report they are not completing activities that they would like to do) are associated with greater anxiety and poorer psychosocial functioning.Individuals who are unable to re-engage in desired activities are more likely to experience anxiety, which in turn may contribute to negative self-discrepancy.It may be beneficial to explore the personal meaning of changes in occupation after traumatic brain injury.
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Affiliation(s)
- Elizabeth Jane Beadle
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - David H K Shum
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Australia.,Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Hurst FG, Ownsworth T, Beadle E, Shum DHK, Fleming J. Domain-specific deficits in self-awareness and relationship to psychosocial outcomes after severe traumatic brain injury. Disabil Rehabil 2018; 42:651-659. [DOI: 10.1080/09638288.2018.1504993] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Felicity G. Hurst
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Elizabeth Beadle
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - David H. K. Shum
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Neuropsychology and Applied Cognitive Neuroscience Laboratory CAS Key Laboratory of Mental Health, Institute of Psychology Chinese Academy of Sciences, Griffith University, Beijing, China
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
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Chin EG, Buchanan EM, Ebesutani C, Young J. Depression, Anxiety, and Stress: How Should Clinicians Interpret the Total and Subscale Scores of the 21-Item Depression, Anxiety, and Stress Scales? Psychol Rep 2018; 122:1550-1575. [PMID: 29932351 DOI: 10.1177/0033294118783508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The 21-item Depression, Anxiety, and Stress Scales (DASS-21) is a self-report measure that is easy to administer, quick to score, and is freely available. Widely used in diverse settings and populations, confirmatory factor analytic evidence has accumulated for a bifactor model underlying this multidimensional measure. Studies employing an exploratory bifactor approach to more closely examine its underlying structure and inter-relations of factors, however, have been scarce. This is unfortunate because confirmatory techniques often employ indirect ways of handling model misspecification, whereas exploratory methods enable more direct approaches. Moreover, more precise approaches to modeling an exploratory bifactor structure have not been examined with the DASS-21. Based on several large samples of undergraduate students in the United States, the first two parts of the paper (Studies 1 and 2) utilized both exploratory (M = 19.7 years of age) and confirmatory factor analytic methods (M = 19.7 years of age) following those presented by contemporary multidimensional modeling theorists. Building upon these results, the third part of the paper (Study 3; M = 20.0 years of age) examined sensitivity-/specificity-related indices to provide cut-off score recommendations for a revised DASS-21 instrument based on a newly identified and supported bifactor structure. Implications of these results are discussed in terms of taxonomy, challenges inherent in multidimensional modeling, and potential use of the revised DASS-21 measure as a component of an actuarial decision-making strategy to inform clinical referrals.
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Affiliation(s)
- Eu Gene Chin
- Department of Psychology, Southeast Missouri State University, Cape Girardeau, MO, USA
| | - Erin M Buchanan
- Psychology Department, Missouri State University, Springfield, MO, USA
| | - Chad Ebesutani
- Department of Psychology, Duksung Women's University, Seoul, South Korea
| | - John Young
- Department of Psychology, University of Mississippi, Oxford, MS, USA
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Ownsworth T, Gooding K, Beadle E. Self-focused processing after severe traumatic brain injury: Relationship to neurocognitive functioning and mood symptoms. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 58:35-50. [DOI: 10.1111/bjc.12185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Tamara Ownsworth
- School of Applied Psychology; Menzies Health Institute Queensland; Griffith University; Nathan Qld Australia
| | - Kynan Gooding
- School of Applied Psychology; Menzies Health Institute Queensland; Griffith University; Nathan Qld Australia
| | - Elizabeth Beadle
- School of Applied Psychology; Menzies Health Institute Queensland; Griffith University; Nathan Qld Australia
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19
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Wong CKH, Choi EPH, Chan SWH, Tsu JHL, Fan CW, Chu PSK, Cheung FK, Ma WK, Mah ISF, Yip SKH, Hou SSM, So HS, Lam CK. Use of the International Prostate Symptom Score (IPSS) in Chinese male patients with benign prostatic hyperplasia. Aging Male 2017; 20:241-249. [PMID: 28787255 DOI: 10.1080/13685538.2017.1362380] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To test the psychometric properties of the International Prostate Symptom Score (Hong Kong Chinese version 2) (IPSS) in Chinese male patients with benign prostatic hyperplasia (BPH) under secondary care. METHODS A prospective longitudinal study was done by interviewing subjects at baseline, at 2 week after baseline for assessing test-retest reliability and at 26 week after baseline for assessing responsiveness. All subjects were interviewed to complete a structured questionnaire including IPSS, Short Form-12 Health Survey version 2 (SF-12v2) and Depression Anxiety Stress Scale (DASS). RESULTS The IPSS HRQOL score had weak correlations with SF-12v2 summary and DASS domain scores. For reliability analysis, Cronbach's alpha coefficient was 0.90 for the seven symptom-related items. The intraclass correlation coefficients of the IPSS total symptom score and HRQOL score were 0.90 and 0.86, respectively. For sensitivity, statistically significant differences were detected between the subjects with BPH and those without for IPSS total symptom score (effect size = 0.68) but not the IPSS HRQOL score. The areas under ROC curves for the IPSS total symptom and HRQOL scores were 0.67 and 0.60, respectively. CONCLUSIONS The IPSS was valid, reliable instrument in Chinese patients with BPH. The IPSS total symptom score, but not the HRQOL score, is sensitive in differentiating subgroups.
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Affiliation(s)
- Carlos King-Ho Wong
- a Department of Family Medicine and Primary Care , The University of Hong Kong , Hong Kong
| | | | | | | | - Chi-Wai Fan
- e Department of Surgery , Pamela Youde Nethersole Eastern Hospital , Hong Kong
| | | | - Fu-Keung Cheung
- g Department of Surgery , Princess Margaret Hospital , Hong Kong
| | - Wai-Kit Ma
- d Department of Surgery , Queen Mary Hospital , Hong Kong
| | | | | | | | - Hing-Shing So
- k Department of Surgery , United Christian Hospital , Hong Kong
| | - CindyLo-Kuen Lam
- a Department of Family Medicine and Primary Care , The University of Hong Kong , Hong Kong
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20
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Simpson GK, McCann B, Lowy M. Treating male sexual dysfunction after traumatic brain injury: Two case reports. NeuroRehabilitation 2017; 38:281-9. [PMID: 27030904 DOI: 10.3233/nre-161319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Sexual dysfunction is common after traumatic brain injury (TBI) but evaluation of treatment interventions have been sparse. OBJECTIVE To report on the treatment of sexual dysfunction for two males with severe TBI. METHODS AND RESULTS Case one was treated for erectile dysfunction (ED). After a medical examination which found no underlying physiological problems, Sildenafil was prescribed. Scores on the Golombok Rust Inventory of Sexual Satisfaction Impotence subscale found that scores had improved from the dysfunction range at baseline to the functional range at 6 weeks follow-up. There was some reduction in this improvement at 3 months follow-up, maybe associated with a co-morbid deterioration of emotional state. Case two was treated for idiopathic delayed ejaculation (DE). A standard sex therapy intervention was employed that resulted in the resolution of the problem, documented on the Sex Behavior sub-scale of the Derogatis Inventory for Sexual Functioning-Self Report (comparing baseline to post intervention and follow-up scores). CONCLUSIONS The case reports show promise for the treatment of sexual dysfunction after severe TBI using standard medical and sex therapy treatments. In the future, controlled evaluations are required to demonstrate the efficacy of such interventions.
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Affiliation(s)
- Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.,Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, NSW, Australia
| | - Brett McCann
- Australasian Institute of Sexual Health Medicine, Sydney, NSW, Australia
| | - Michael Lowy
- Australasian Institute of Sexual Health Medicine, Sydney, NSW, Australia
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21
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Depression Anxiety Stress Scales (DASS-21): Factor Structure in Traumatic Brain Injury Rehabilitation. J Head Trauma Rehabil 2017; 32:134-144. [DOI: 10.1097/htr.0000000000000250] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Coping with the Unthinkable: Psychosocial Advances in the Management of Primary Brain Tumour. BRAIN IMPAIR 2016. [DOI: 10.1017/brimp.2016.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Brain cancer is a complex and distressing illness with a typically poor prospect for survival. Worldwide, approximately 256,000 people (1800 in Australia) are diagnosed each year (Ferlay, Soerjomataram & Ervik, 2013). Cancer of the brain poses a double threat – to one's survival and sense of self. Most people with primary brain tumour develop serious neuro-cognitive symptoms (e.g., seizures, memory loss) and experience poor mental health and quality of life, which places enormous burden on family care givers. Not surprisingly, high rates of psychological distress have been reported by people with brain tumour and their family care givers. Psychological distress can persist beyond primary treatment, and often increases in the long-term phase of illness due to the perceived threat and experience of recurrence and functional decline. Over the last decade, there have been many advances in the psychosocial management of people with brain tumour. This paper provides an overview of the functional, psychological and social consequences of brain tumour, summarises some leading developments in psychological assessment and management, and outlines future directions in intervention research.
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Nalder E, Fleming J, Cornwell P, Foster M, Skidmore E, Bottari C, Dawson DR. Sentinel Events During the Transition From Hospital to Home: A Longitudinal Study of Women With Traumatic Brain Injury. Arch Phys Med Rehabil 2016; 97:S46-53. [DOI: 10.1016/j.apmr.2014.07.428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/21/2014] [Accepted: 07/25/2014] [Indexed: 11/16/2022]
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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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Baker PD, Bambrough J, Fox JRE, Kyle SD. Health-related quality of life and psychological functioning in patients with primary malignant brain tumors: a systematic review of clinical, demographic and mental health factors. Neurooncol Pract 2015; 3:211-221. [PMID: 31386034 DOI: 10.1093/nop/npv042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Indexed: 12/18/2022] Open
Abstract
Background The impact of primary malignant brain tumors on patient quality of life and psychological functioning is poorly understood, limiting the development of an evidence base for supportive interventions. We conducted a thorough systematic review and quality appraisal of the relevant literature to identify correlates of health-related quality of life (HRQoL) and psychological functioning (depression, anxiety and distress) in adults with primary malignant brain tumors. Method Twenty-three articles met predefined inclusion criteria from a pool of peer-reviewed literature published between January 1984 and July 2015 (N = 2407). Methodological quality of included studies was assessed using an adapted version of the Newcastle-Ottawa Scale. Results The overall methodological quality of the literature was moderate. Factors relating consistently with HRQoL and/or psychological functioning were cognitive impairment, corticosteroid use, current or previous mental health difficulties, fatigue, functional impairment, performance status and motor impairment. Conclusions Practitioners should remain alert to the presence of these factors as they may indicate patients at greater risk of poor HRQoL and psychological functioning. Attention should be directed towards improving patients' psychological functioning and maximizing functional independence to promote HRQoL. We outline several areas of future research with emphasis on improved methodological rigor.
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Affiliation(s)
- Paul D Baker
- Section for Clinical and Health Psychology, University of Manchester, Manchester, UK (P.D.B.); Department of Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK (J.B.); Department of Psychology, Royal Holloway, University of London, Surrey, UK (J.R.E.F.); Enfield Complex Care Team, Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK (J.R.E.F.); Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (S.D.K.)
| | - Jacki Bambrough
- Section for Clinical and Health Psychology, University of Manchester, Manchester, UK (P.D.B.); Department of Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK (J.B.); Department of Psychology, Royal Holloway, University of London, Surrey, UK (J.R.E.F.); Enfield Complex Care Team, Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK (J.R.E.F.); Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (S.D.K.)
| | - John R E Fox
- Section for Clinical and Health Psychology, University of Manchester, Manchester, UK (P.D.B.); Department of Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK (J.B.); Department of Psychology, Royal Holloway, University of London, Surrey, UK (J.R.E.F.); Enfield Complex Care Team, Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK (J.R.E.F.); Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (S.D.K.)
| | - Simon D Kyle
- Section for Clinical and Health Psychology, University of Manchester, Manchester, UK (P.D.B.); Department of Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK (J.B.); Department of Psychology, Royal Holloway, University of London, Surrey, UK (J.R.E.F.); Enfield Complex Care Team, Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK (J.R.E.F.); Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (S.D.K.)
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Horton L, Duffy T, Martin C. Neurocognitive, psychosocial and functional status of individuals with alcohol-related brain damage (ARBD) on admission to specialist residential care. DRUGS: EDUCATION, PREVENTION AND POLICY 2015. [DOI: 10.3109/09687637.2015.1050997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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28
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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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29
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Ownsworth T, Chambers S, Damborg E, Casey L, Walker DG, Shum DHK. Evaluation of the making sense of brain tumor program: a randomized controlled trial of a home-based psychosocial intervention. Psychooncology 2014; 24:540-7. [DOI: 10.1002/pon.3687] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 08/26/2014] [Accepted: 08/29/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Tamara Ownsworth
- School of Applied Psychology and Griffith Health Institute; Griffith University; Brisbane Australia
| | - Suzanne Chambers
- School of Applied Psychology and Griffith Health Institute; Griffith University; Brisbane Australia
- Cancer Council Queensland; Australia
- Health and Wellness Institute; Edith Cowan University; Australia
- Centre for Clinical Research; University of Queensland; Australia
| | - Ea Damborg
- School of Applied Psychology and Griffith Health Institute; Griffith University; Brisbane Australia
| | - Leanne Casey
- School of Applied Psychology and Griffith Health Institute; Griffith University; Brisbane Australia
| | - David G. Walker
- Newro Foundation and Briz Brain and Spine; Brisbane Australia
| | - David H. K. Shum
- School of Applied Psychology and Griffith Health Institute; Griffith University; Brisbane Australia
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30
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Graham CD, Gillanders D, Stuart S, Gouick J. An Acceptance and Commitment Therapy (ACT)–Based Intervention for an Adult Experiencing Post-Stroke Anxiety and Medically Unexplained Symptoms. Clin Case Stud 2014. [DOI: 10.1177/1534650114539386] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To date, there is little support for the use of any psychotherapy to address post-stroke anxiety. Similarly, there have been no trials of acceptance and commitment therapy (ACT) for post-stroke anxiety, but clinician opinion suggests that an ACT approach may be effective in this context. In this case study, a high-functioning younger man with post-stroke anxiety and associated medically unexplained symptoms (chest pain and dizziness) was assessed and treated using an ACT approach. Mediators of change for both ACT (psychological flexibility) and cognitive therapy (illness perceptions) were recorded as were measures of depression, anxiety, and stress. By the end of treatment, the client was free of chest pain, had successfully returned to work, and had considerable reductions in anxiety, with smaller reductions in depression and stress. As outcomes improved, concomitant changes in psychological flexibility and illness perceptions were observed. The potential benefits offered by an ACT approach to post-stroke anxiety are discussed.
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Affiliation(s)
| | | | - Simon Stuart
- University of Edinburgh, UK
- Royal Edinburgh Hospital, UK
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Ownsworth T, Dwan T, Chambers S, Walker DG, Shum DHK. The moderating effect of estimated pre-morbid IQ on the relationship between neuropsychological status and subjective well-being after brain tumour. J Psychosom Res 2014; 76:257-60. [PMID: 24529047 DOI: 10.1016/j.jpsychores.2013.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/19/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE People with brain tumour experience complex and distressing symptoms. Neuropsychological impairment is proposed to have a negative impact on subjective well-being; however, research is yet to examine the influence of estimated premorbid IQ on this relationship. This preliminary study investigated the moderating effect of estimated premorbid IQ on the relationship between global neuropsychological status (GNF) and depression and quality of life. METHODS 73 adults (51% male) aged 21-65 years with primary brain tumour (52% benign) were administered a test battery assessing estimated premorbid IQ, GNF, depression (Depression Anxiety Stress Scales) and quality of life (Functional Assessment of Cancer Therapy, FACT). RESULTS A series of two-way analysis of covariance (ANCOVA) controlling for education found a significant interaction between estimated premorbid IQ (low average to average vs high average) and GNF (low vs high) on levels of depression (p < .05) and FACT emotional well-being (p < .05). For these outcomes, individuals with high average estimated premorbid IQ and low GNF reported better well-being than those with low-average to average estimated premorbid IQ and low GNF. Higher GNF was related to greater functional well-being (p < .01) irrespective of estimated premorbid IQ. CONCLUSION The finding that higher premorbid cognitive ability buffers the effect of neuropsychological impairment on emotional well-being after brain tumour advances understanding of the role of cognitive reserve in adjustment to neurological disorders.
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Affiliation(s)
- Tamara Ownsworth
- School of Applied Psychology and Griffith Health Institute, Griffith University, Brisbane, Australia.
| | - Toni Dwan
- School of Applied Psychology and Griffith Health Institute, Griffith University, Brisbane, Australia
| | - Suzanne Chambers
- School of Applied Psychology and Griffith Health Institute, Griffith University, Brisbane, Australia; Cancer Council Queensland, Australia; Health and Wellness Institute, Edith Cowan University, Australia; Centre for Clinical Research, University of Queensland, Australia
| | - David G Walker
- Newro Foundation and Briz Brain & Spine, Brisbane, Australia
| | - David H K Shum
- School of Applied Psychology and Griffith Health Institute, Griffith University, Brisbane, Australia
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Cocks E, Bulsara C, O'Callaghan A, Netto J, Boaden R. Exploring the experiences of people with the dual diagnosis of acquired brain injury and mental illness. Brain Inj 2014; 28:414-21. [PMID: 24475744 DOI: 10.3109/02699052.2014.880799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE People with the dual diagnosis of acquired brain injury and mental illness (ABI/MI) are vulnerable to a range of negative life experiences, which has received limited attention in the literature. The objective of the project described in this paper was to identify and describe these experiences in order to distinguish barriers and facilitators to successful rehabilitation and recovery. RESEARCH DESIGN The project used qualitative methodologies. METHODS AND PROCEDURES The 15 participants were eight people with ABI/MI, two family members and five support workers. Nineteen interviews were conducted. Analysis of these interviews produced a set of five key themes, with each theme elaborated by a set of descriptive issues. MAIN OUTCOMES AND RESULTS The five themes were loss, personal development, occupation, family and services. The experiences of people with ABI/MI were strongly negative. They faced more barriers than facilitators to recovery. Current policies and practices were inadequate. CONCLUSIONS Enhanced stakeholder collaboration and co-ordination and a more individualized, long-term perspective on the needs of people with ABI/MI are recommended to guide future policy and practice. Future research on quality-of-life, wellbeing, community inclusion and participation in ordinary life was recommended.
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Affiliation(s)
- Errol Cocks
- Centre for Research into Disability and Society, School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University , Perth, WA , Australia
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Dahm J, Wong D, Ponsford J. Validity of the Depression Anxiety Stress Scales in assessing depression and anxiety following traumatic brain injury. J Affect Disord 2013; 151:392-6. [PMID: 23830002 DOI: 10.1016/j.jad.2013.06.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 06/06/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Anxiety and depression following traumatic brain injury (TBI) are associated with poorer outcomes. A brief self-report questionnaire would assist in identifying those at risk, however validity of such measures is complicated by confounding symptoms of the injury. This study investigated the validity of the Depression Anxiety Stress Scales (DASS) and Hospital Anxiety and Depression Scale (HADS), in screening for clinical diagnoses of anxiety and mood disorders following TBI. METHODS One hundred and twenty-three participants with mild to severe TBI were interviewed using the SCID (Axis I) and completed the DASS and HADS. RESULTS The DASS, DASS21 and HADS scales demonstrated validity compared with SCID diagnoses of anxiety and mood disorders as measured by Area Under ROC Curve, sensitivity and specificity. Validity of the DASS depression scale benefited from items reflecting symptoms of devaluation of life, self-deprecation, and hopelessness that are not present on the HADS. Validity of the HADS anxiety scale benefited from items reflecting symptoms of tension and worry that are measured separately for the DASS on the stress scale. LIMITATIONS Participants were predominantly drawn from a rehabilitation centre which may limit the extent to which results can be generalized. Scores for the DASS21 were derived from the DASS rather than being administered separately. CONCLUSIONS The DASS, DASS21 and HADS demonstrated validity as screening measures of anxiety and mood disorders in this TBI sample. The findings support use of these self-report questionnaires for individuals with TBI to identify those who should be referred for clinical diagnostic follow-up.
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Affiliation(s)
- Jane Dahm
- School of Psychology and Psychiatry, Monash University, Melbourne, Australia
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Wong D, Dahm J, Ponsford J. Factor structure of the Depression Anxiety Stress Scales in individuals with traumatic brain injury. Brain Inj 2013; 27:1377-82. [PMID: 23924030 DOI: 10.3109/02699052.2013.823662] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE The Depression Anxiety Stress Scales (DASS) and its shorter version, the DASS21, demonstrate a consistent factor structure. However, when these scales are used with people with traumatic brain injury (TBI), it is possible that TBI symptoms that overlap with anxiety and depression (e.g., irritability, inertia, emotional lability) result in changes to the underlying structure. This study aimed to establish whether the factor structure of the DASS and DASS21 when used with individuals with TBI is consistent with the three scales designated in the manual. METHODS AND PROCEDURES One hundred and twenty-three participants with mild-to-severe TBI completed the DASS. MAIN OUTCOMES AND RESULTS The factor structure of the DASS was found to be consistent with the designated scales, with the exception of four items that cross-loaded weakly on multiple factors. However, the factor structure of the DASS21 did not correspond as closely to the designated depression, anxiety and stress scales, which appeared to be due to the fact that many of the highest loading items on the DASS were not included items in the DASS21. CONCLUSIONS These results indicate that it may be preferable to use the full DASS, rather than the DASS21, with individuals with TBI.
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Affiliation(s)
- Dana Wong
- School of Psychology and Psychiatry, Monash University , Melbourne , Australia
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Acceptance and Commitment Therapy (ACT) for Psychological Adjustment after Traumatic Brain Injury: Reporting the Protocol for a Randomised Controlled Trial. BRAIN IMPAIR 2013. [DOI: 10.1017/brimp.2012.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Following a severe traumatic brain injury (TBI) there is a complex presentation of psychological symptoms which may impact on recovery. Validated treatments addressing these symptoms for this group of people are limited. This article reports on the protocol for a single-centre, two-armed, Phase II Randomised Control Trial (RCT) to address the adjustment process following a severe TBI. Participants will be recruited from Liverpool Brain Injury Rehabilitation Unit and randomly allocated to one of two groups, Acceptance and Commitment Therapy (ACT) or an active control (Befriending). The active treatment group utilises the six core processes of ACT with the intention of increasing participation and psychological flexibility and reducing psychological distress. A number of primary and secondary outcome measures, administered at assessment, post-treatment and 1-month follow-up, will be used to assess clinical outcomes. The publication of the protocol before the trial results are available addresses fidelity criterion (intervention design) for RCTs. This ensures transparency in the RCT and that it meets the guidelines according to the CONSORT statement. The protocol has also been registered on the Australian New Zealand Clinical Trials Registry ACTRN12610000851066.
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Rajeswaran J, Sadana D, Kashyap H. Neuropsychological Rehabilitation. Neuropsychol Rehabil 2013. [DOI: 10.1016/b978-0-12-416046-0.00003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Del Re AC, Flückiger C, Goldberg SB, Hoyt WT. Monitoring mindfulness practice quality: an important consideration in mindfulness practice. Psychother Res 2012; 23:54-66. [PMID: 23046287 DOI: 10.1080/10503307.2012.729275] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Mindfulness-Based Stress Reduction (MBSR) is an experientially based group intervention empirically supported to reduce psychological symptomology. Although MBSR has shown to be an effective intervention, little is known about which facets of the intervention are important in producing positive outcomes. This study tested several aspects of mindfulness practice (total practice duration, practice frequency and practice quality) with the primary focus being on validating (i.e., predictive and convergent validity) a new measure of mindfulness practice quality (PQ-M). The PQ-M fit a two-factor solution via a Maximum Likelihood Exploratory Factor Analysis (n=99). Using longitudinal multilevel modeling on a smaller subsample (n=19), preliminary support was found for changes in practice quality over the course of the MBSR intervention. Further, change in practice quality was associated with improvements in psychological symptoms. While this study was exploratory, these findings suggest that practice quality is a relevant factor to promote positive outcomes and may guide mindfulness instructors in providing highly tailored interventions.
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Affiliation(s)
- A C Del Re
- Center for Health Care Evaluation, VA Palo Alto Health Care System & Stanford University Medical School, Palo Alto, CA, USA.
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Hsieh MY, Ponsford J, Wong D, Schönberger M, McKay A, Haines K. Development of a motivational interviewing programme as a prelude to CBT for anxiety following traumatic brain injury. Neuropsychol Rehabil 2012; 22:563-84. [DOI: 10.1080/09602011.2012.676284] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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García-Molina A, Tormos JM, Bernabeu M, Junqué C, Roig-Rovira T. Do traditional executive measures tell us anything about daily-life functioning after traumatic brain injury in Spanish-speaking individuals? Brain Inj 2012; 26:864-74. [PMID: 22583177 DOI: 10.3109/02699052.2012.655362] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To examine the relationship between traditional executive function measures and everyday competence in Spanish-speaking individuals with moderate-to-severe traumatic brain injury (TBI). METHODS AND PROCEDURES Thirty-two TBI patients (24 men, eight women) with an age range of 17-59 years (mean age = 30.73 years; SD = 13.34) were administered a battery of performance-based executive function measures. Such measures included the Trail Making Test part B, Wisconsin Card Sorting Test, Stroop Colour Word Interference Test, Controlled Oral Word Association Test and Letter-Number Sequencing. Behavioural manifestations of executive deficits were assessed by the Behaviour Rating Inventory of Executive Function-Adult version (BRIEF-A). Patient's everyday functioning was examined with the Patient Competency Rating Scale (PCRS). MAIN OUTCOMES AND RESULTS Traditional performance-based executive measures correlated significantly, although moderately, with the PCRS; this relationship was more significant in the Controlled Oral Word Association Test and Trail Making Test part B. A significant correlation was obtained between the BRIEF-A clinical scales and patient's everyday competence as measured by the PCRS. CONCLUSIONS The current findings suggest that traditional performance-based executive measures reveal some degree of ecological validity or real-world relevance, providing relevant information for predicting everyday competence after moderate-to-severe TBI.
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Affiliation(s)
- A García-Molina
- Institut Universitari de Neurorehabilitació Guttmann-UAB, Badalona, Spain.
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Improving memory in outpatients with neurological disorders using a group-based training program. J Int Neuropsychol Soc 2012; 18:738-48. [PMID: 22594962 DOI: 10.1017/s1355617712000379] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Memory problems are common in patients with a range of neurological conditions, but there have been few attempts to provide and evaluate the usefulness of memory training for groups of neurological outpatients. We used a waitlist-controlled trial design to assess the effectiveness of a newly created, 6-session intervention, which involved training in the use of compensatory strategies as well as education regarding memory function, neurological damage, sleep and lifestyle factors that have an impact on memory. Fifty-six patients with neurological conditions (e.g., stroke, epilepsy) and memory complaints completed the training and assessments. Outcomes were evaluated in terms of reported strategy use as well as objective and subjective measures of anterograde and prospective memory. Training resulted in significant improvements on number of strategies used, scores on the Rey Auditory Verbal Learning Test (total learning and delayed recall) and self-report on the Comprehensive Assessment of Prospective Memory. Improvements were stable at 3-month follow-up. Better individual outcomes were related to lower baseline memory scores, fewer symptoms of depression and greater self-awareness of memory function. Overall the study provides encouraging results to indicate that patients with neurological conditions such as stroke and epilepsy can show improvements in memory after a relatively short group-based intervention.
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Hsieh MY, Ponsford J, Wong D, Schönberger M, Taffe J, McKay A. Motivational interviewing and cognitive behaviour therapy for anxiety following traumatic brain injury: a pilot randomised controlled trial. Neuropsychol Rehabil 2012; 22:585-608. [PMID: 22632385 DOI: 10.1080/09602011.2012.678860] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although cognitive-behavioural therapy (CBT) is the treatment of choice for anxiety, its delivery needs to be adapted for individuals with traumatic brain injury (TBI). It also requires clients' active engagement for maximum benefit. This study was a pilot randomised controlled trial involving an anxiety treatment programme adapted for people with TBI, based on CBT and motivational interviewing (MI). Twenty-seven participants with moderate/severe TBI (aged 21-73 years, 78% males) recruited from a brain injury rehabilitation hospital were randomly allocated to receive MI + CBT (n = 9), non-directive counselling (NDC) + CBT (n = 10) and treatment-as-usual (TAU) (n = 8). CBT and MI were manualised and delivered in 12 weekly individual sessions. Primary outcome was self-reported anxiety symptoms assessed at baseline, at the end of NDC/MI and immediately following CBT. Assessment was conducted by assessors blinded to group assignment. Intention-to-treat analyses showed that the two active treatment groups demonstrated significantly greater anxiety reduction than TAU. Participants receiving MI showed greater response to CBT, in terms of reduction in anxiety, stress and non-productive coping, compared to participants who received NDC. The results provided preliminary support for the adapted CBT programme, and the potential utility of MI as treatment prelude. Longer follow-up data are required to evaluate the maintenance of treatment effects.
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Affiliation(s)
- Ming-Yun Hsieh
- School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia
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Identifying Factors Associated With Perceived Success in the Transition From Hospital to Home After Brain Injury. J Head Trauma Rehabil 2012; 27:143-53. [DOI: 10.1097/htr.0b013e3182168fb1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hsieh MY, Ponsford J, Wong D, Schönberger M, McKay A, Haines K. A cognitive behaviour therapy (CBT) programme for anxiety following moderate–severe traumatic brain injury (TBI): Two case studies. Brain Inj 2012; 26:126-38. [DOI: 10.3109/02699052.2011.635365] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ownsworth T, Hawkes AL, Chambers S, Walker DG, Shum D. Applying a Biopsychosocial Perspective to Investigate Factors Related to Emotional Adjustment and Quality of Life for Individuals With Brain Tumour. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.11.3.270] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:This exploratory study applied a biopsychosocial perspective to investigate cognitive and psychosocial factors related to emotional adjustment and QoL after brain tumour.Methods:Participants included 30 adults with a brain tumour (60% benign and 40% malignant) who were aged 28 to 71 years (M= 51.5,SD= 12.3) and on average 5.4 years post-diagnosis (SD= 5.6 years). Participants completed a brief battery of cognitive tests and self-report measures of emotional status (Depression, Anxiety Stress Scale), subjective impairment (Patient Competency Rating Scale), coping (COPE), social support (Brief Social Support Questionnaire), and QoL (Functional Assessment of Cancer Therapy — Brain Tumour [FACT-Br]).Results:QoL was significantly associated with global cognitive ability (r= .49,p< .01), subjective impairment (r= .66,p< .01), and satisfaction with support (r= .50,p< .05). Level of depressive symptoms was significantly correlated with premorbid IQ (r= -.49,p< .01), use of planning to cope (r= -.48,p< .01), and satisfaction with support (r= -.47,p< .01).Conclusions:Overall, these exploratory findings indicate that emotional adjustment and QoL after brain tumour is related to a slightly different pattern of neuropsychological, psychological (self-perceptions and coping) and social factors. The clinical implications for interventions with individuals with brain tumour are discussed.
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Development of depressive symptoms during early community reintegration after traumatic brain injury. J Int Neuropsychol Soc 2011; 17:112-9. [PMID: 21083964 DOI: 10.1017/s1355617710001311] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The early onset of depression following traumatic brain injury (TBI) is associated with poorer psychosocial outcomes; however, the direction of this relationship is unclear. This study investigated the relationship between progress in resuming preinjury lifestyle (transition events), change in perceived functioning and level of depressive symptoms at discharge and 3-months postdischarge. As part of a prospective longitudinal study of brain injury outcomes, 96 consecutively discharged patients with TBI completed measures of transition events (Sentinel Events Questionnaire) and perceived functioning (Mayo-Portland Adaptability Inventory-4 Ability and Adjustment indices) at discharge and 3-months follow-up. Level of depressive symptoms was assessed at discharge and 3-months follow-up using the Depression Anxiety Stress Scale 21. After controlling for age and discharge depressive symptoms, change in perceived functioning was found to mediate the relationship between total transition events and depressive symptoms at 3-months postdischarge (β reduced from .21 to .14), with a significant indirect effect observed. The present findings indicate that lack of progress in resuming preinjury lifestyle contributes to postdischarge depressive symptoms through an influence on perceived functioning, thus providing an improved conceptualization of reactive depression in the context of brain injury.
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Ownsworth T, Chambers S, Hawkes A, Walker DG, Shum D. Making sense of brain tumour: A qualitative investigation of personal and social processes of adjustment. Neuropsychol Rehabil 2011; 21:117-37. [DOI: 10.1080/09602011.2010.537073] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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