Evaluation of social problem solving after traumatic brain injury

Impairment of sociocognitive functions in patients with brain tumours

The ability to decode mental states and to come up with effective solutions for interpersonal problems aids successful initiation and maintenance of social interactions and contributes to participation and mental health. Since these abilities of social cognition are challenged in highly demanding situations, such as diagnosis and treatment of a life-threatening illness, this article reviews the literature on emotion recognition, empathy, Theory of Mind and socially skilled behaviour in brain tumour patients. The data available suggest that patients are affected by a slight but consistent impairment of emotion recognition, empathy and Theory of Mind before and immediately after brain tumour treatment, with the degree of impairment being influenced by tumour histology and localization. Impairments mostly decrease a few months after surgery due to assumed neuroplasticity. Future research may address more complex sociocognitive functions, such as social problem solving, and may investigate to which degree sociocognitive difficulties act as risk factors for poor or failed reintegration into occupational and social life following successful brain tumour treatment.

Anger Self-Management Training for Chronic Moderate to Severe Traumatic Brain Injury: Results of a Randomized Controlled Trial

OBJECTIVE

To test efficacy of 8-session, 1:1 treatment, anger self-management training (ASMT), for chronic moderate to severe traumatic brain injury (TBI).

SETTING

Three US outpatient treatment facilities.

PARTICIPANTS

Ninety people with TBI and elevated self-reported anger; 76 significant others (SOs) provided collateral data.

DESIGN

Multicenter randomized controlled trial with 2:1 randomization to ASMT or structurally equivalent comparison treatment, personal readjustment and education (PRE). Primary outcome assessment 1 week posttreatment; 8-week follow-up.

PRIMARY OUTCOME

Response to treatment defined as 1 or more standard deviation change in self-reported anger.

SECONDARY OUTCOMES

SO-rated anger, emotional and behavioral status, satisfaction with life, timing of treatment response, participant and SO-rated global change, and treatment satisfaction.

MAIN MEASURES

State-Trait Anger Expression Inventory-Revised Trait Anger (TA) and Anger Expression-Out (AX-O) subscales; Brief Anger-Aggression Questionnaire (BAAQ); Likert-type ratings of treatment satisfaction, global changes in anger and well-being.

RESULTS

After treatment, ASMT response rate (68%) exceeded that of PRE (47%) on TA but not AX-O or BAAQ; this finding persisted at 8-week follow-up. No significant between-group differences in SO-reported response rates, emotional/behavioral status, or life satisfaction. ASMT participants were more satisfied with treatment and rated global change in anger as significantly better; SO ratings of global change in both anger and well-being were superior for ASMT.

CONCLUSION

ASMT was efficacious and persistent for some aspects of problematic anger. More research is needed to determine optimal dose and essential ingredients of behavioral treatment for anger after TBI.

Training adults with acquired brain injury how to help-seek when wayfinding: an understudied critical life skill

The objective of this study was to investigate the efficacy of a group treatment protocol called NICE (Noticing you have a problem, Identifying the information you need for help, Compensatory strategies, Evaluating progress) to train help-seeking when wayfinding for individuals with acquired brain injury (ABI). Seven participants completed the NICE group treatment in an outpatient rehabilitation department at a university medical centre. A single subject multiple baseline design was employed to evaluate the efficacy of the NICE group treatment. The Social Behaviour Rating Scale and the Executive Function Route-Finding Task- Revised were repeated measures used to evaluate potential changes in help-seeking and wayfinding. Secondary outcome measures included pre- and post-treatment evaluation of social problem solving and social cognition. Results revealed that all participants improved on measures of help-seeking and wayfinding. Patterns of improvement and implications for rehabilitation are discussed. This is the first experimental study to evaluate the treatment of help-seeking behaviours and discuss its application to wayfinding in adults with ABI. Preliminary evidence supports further investigation of the NICE group treatment protocol.

Social factors predictive of social integration for adults with brain injury

INTRODUCTION

Individuals with acquired brain injury (ABI) may not only struggle with physical and cognitive impairments, but may also face challenges reintegrating into the community socially. Research has demonstrated that following ABI, individuals' social networks tend to dwindle, support may decline, and isolation increases. This study examined factors impacting social integration in a community-based sample of 102 individuals with ABI.

METHODS

Potential predictors included emotional support, instrumental support, problem solving confidence, and approach-avoidance style (AAS) of problem solving, while controlling for age, gender, education, and time since injury. Hierarchical regression was used to analyze whether these factors were predictive of social integration.

RESULTS

The final model accounted for 33% of the variance in social integration outcomes. Results demonstrated that emotional support was initially a significant predictor; however, when controlling for emotional support the variance in social integration was better accounted for by social problem solving - specifically, AAS. A follow-up mediation analysis indicated that the relationship between social problem solving (specifically, AAS) and social integration was partially mediated by emotional support.

CONCLUSIONS

This suggests that for individuals with ABI, a tendency to approach rather than avoid social problem solving issues is a significant predictor for social integration both directly and indirectly through its association with emotional social support. Implications for Rehabilitation Both instrumental and emotional social support should be assessed in patients with acquired brain injury (ABI), ensuring that emotional needs are met in addition to the more obvious instrumental needs. Barriers to problem solving for people with ABI may limit optimal social integration; thus, assessment and intervention aimed at increasing AAS are recommended. To enhance the social integration outcomes of people with brain injury, strength-based psychosocial rehabilitation should optimally balance an individual's abilities with areas requiring compensation, focusing on how to approach rather than avoid problems as well as strategies to cultivate emotional social support.

Social inference in individuals at clinical high risk for psychosis

AIM

Social cognition impairment is a hallmark of schizophrenia and contains multiple domains. The domain of social inference has been relatively understudied in schizophrenia and its risk states.

METHODS

Social inference was assessed in 60 clinical high-risk (CHR) patients and 28 healthy control subjects, using the video social inference task. We hypothesized a deficit in social inference in CHR participants and examined predictive value for psychosis transition.

RESULTS

Social inference was positively associated with increasing age. Social inference did not differ significantly between CHR patients and controls, or predict transition to psychosis.

CONCLUSIONS

Few studies have examined social inference of individuals at clinical high risk for psychosis, and findings have been inconclusive. Additional studies using a variety of measures of social inference in CHR participants are recommended.

Factor structure and item level psychometrics of the Social Problem Solving Inventory-Revised: Short Form in traumatic brain injury

Social problem-solving deficits characterise individuals with traumatic brain injury (TBI), and poor social problem solving interferes with daily functioning and productive lifestyles. Therefore, it is of vital importance to use the appropriate instrument to identify deficits in social problem solving for individuals with TBI. This study investigates factor structure and item-level psychometrics of the Social Problem Solving Inventory-Revised: Short Form (SPSI-R:S), for adults with moderate and severe TBI. Secondary analysis of 90 adults with moderate and severe TBI who completed the SPSI-R:S was performed. An exploratory factor analysis (EFA), principal components analysis (PCA) and Rasch analysis examined the factor structure and item-level psychometrics of the SPSI-R:S. The EFA showed three dominant factors, with positively worded items represented as the most definite factor. The other two factors are negative problem-solving orientation and skills; and negative problem-solving emotion. Rasch analyses confirmed the three factors are each unidimensional constructs. It was concluded that the total score interpretability of the SPSI-R:S may be challenging due to the multidimensional structure of the total measure. Instead, we propose using three separate SPSI-R:S subscores to measure social problem solving for the TBI population.

Training Adults with Brain Injury How to Help-seek when Lost: A Pilot Study

There is no research on the assessment or treatment of help-seeking behaviours for individuals with traumatic brain injury (TBI). This paper describes the development of a protocol, NICE (Noticing you have a problem, Identifying the information you need for help, Compensatory strategies, Evaluating progress) to train help-seeking for adults with TBI when lost. Theoretical and treatment components from three empirically validated interventions that target social problem-solving and communication skills were adapted to develop NICE: the Group Interactive Structured Treatment for Social Competence (GIST), the Problem Solving Group Protocol (PSG) and Interpersonal Recall (IPR). Preliminary pilot data evaluating the efficacy are presented for three adult persons with TBI. All three participants improved on the Executive Function Route Finding Task (EFRT) and help-seeking behaviours when wayfinding. Help-seeking is a constitutive factor in the wayfinding process capable of improvement. Preliminary evidence supports further investigation of this group intervention.

Lesion mapping of social problem solving

Accumulating neuroscience evidence indicates that human intelligence is supported by a distributed network of frontal and parietal regions that enable complex, goal-directed behaviour. However, the contributions of this network to social aspects of intellectual function remain to be well characterized. Here, we report a human lesion study (n = 144) that investigates the neural bases of social problem solving (measured by the Everyday Problem Solving Inventory) and examine the degree to which individual differences in performance are predicted by a broad spectrum of psychological variables, including psychometric intelligence (measured by the Wechsler Adult Intelligence Scale), emotional intelligence (measured by the Mayer, Salovey, Caruso Emotional Intelligence Test), and personality traits (measured by the Neuroticism-Extraversion-Openness Personality Inventory). Scores for each variable were obtained, followed by voxel-based lesion-symptom mapping. Stepwise regression analyses revealed that working memory, processing speed, and emotional intelligence predict individual differences in everyday problem solving. A targeted analysis of specific everyday problem solving domains (involving friends, home management, consumerism, work, information management, and family) revealed psychological variables that selectively contribute to each. Lesion mapping results indicated that social problem solving, psychometric intelligence, and emotional intelligence are supported by a shared network of frontal, temporal, and parietal regions, including white matter association tracts that bind these areas into a coordinated system. The results support an integrative framework for understanding social intelligence and make specific recommendations for the application of the Everyday Problem Solving Inventory to the study of social problem solving in health and disease.

Sensitivity of the evaluation of social interaction measures among people with and without neurologic or psychiatric disorders

OBJECTIVE

To determine whether the Evaluation of Social Interaction (ESI) is sensitive enough to differentiate between people without identified diagnoses and those with neurologic or psychiatric disorders in terms of their observed quality of social interaction.

METHOD

Participants were age 16-69 and were without identified diagnoses (n = 304) or had neurologic (n = 77) or psychiatric (n = 104) disorders. They were evaluated using the ESI.

RESULTS

Nonparametric Kruskal-Wallis tests and post hoc Mann-Whitney U tests revealed that the group without identified diagnoses had significantly better quality of social interaction than did either group with disabilities (Us = 3,172 and 3,189, respectively; p ≤ .001).

CONCLUSION

The ESI is sensitive with regard to detecting differences in quality of social interaction among groups expected to differ, suggesting that it is valid for use when the desired purpose is to identify people with diminished quality of social interaction.

Mild head injury and sympathetic arousal: investigating relationships with decision-making and neuropsychological performance in university students

SUMMARY

The purpose of this study was to examine the relationships between neuropsychological performance, physiological arousal and decision-making in university students who have or have not reported a history of mild head injury (MHI).

METHODS

Forty-four students, 18 (41%) reporting a history of MHI, performed a design fluency task and the Iowa Gambling Task (IGT) while electrodermal activity (EDA) was recorded.

RESULTS

General cognitive ability and overall choice outcomes did not differ between groups. However, self-reported MHI severity predicted decision-making performance such that the greater the neural indices of trauma, the more disadvantageous the choices made by participants. As expected, both groups exhibited similar base levels of autonomic arousal and physiological responses to reward and punishment outcomes; however, those reporting MHI produced significantly lower levels of EDA during the anticipatory stages of decision-making.

CONCLUSIONS

Overall, these findings encourage the acceptance of head injury as being on a continuum of brain injury severity, as MHI can emulate neurophysiological and neuropsychological features of more traumatic cases and may be impacting mechanisms which sustain adaptive social decision-making.

Information communication networks in severe traumatic brain injury

In this study we explored the use of coherence and Granger causality (GC) to separate patients in minimally conscious state (MCS) from patients with severe neurocognitive disorders (SND) that show signs of awareness. We studied 16 patients, 7 MCS and 9 SND with age between 18 and 49 years. Three minutes of ongoing electroencephalographic (EEG) activity was obtained at rest from 19 standard scalp locations, while subjects were alert but kept their eyes closed. GC was formulated in terms of linear autoregressive models that predict the evolution of several EEG time series, each representing the activity of one channel. The entire network of causally connected brain areas can be summarized as a graph of incompletely connected nodes. The 19 channels were grouped into five gross anatomical regions, frontal, left and right temporal, central, and parieto-occipital, while data analysis was performed separately in each of the five classical EEG frequency bands, namely delta, theta, alpha, beta, and gamma. Our results showed that the SND group consistently formed a larger number of connections compared to the MCS group in all frequency bands. Additionally, the number of connections in the delta band (0.1-4 Hz) between the left temporal and parieto-occipital areas was significantly different (P < 0.1%) in the two groups. Furthermore, in the beta band (12-18 Hz), the input to the frontal areas from all other cortical areas was also significantly different (P < 0.1%) in the two groups. Finally, classification of the subjects into distinct groups using as features the number of connections within and between regions in all frequency bands resulted in 100% classification accuracy of all subjects. The results of this study suggest that analysis of brain connectivity networks based on GC can be a highly accurate approach for classifying subjects affected by severe traumatic brain injury.