Emotion Regulation After Traumatic Brain Injury: Distinct Patterns of Sympathetic Activity During Anger Expression and Recognition

Improving emotion regulation ability after brain injury: A systematic review of targeted interventions

Emotion dysregulation is a common sequela after a brain injury, and it can have serious negative consequences for individuals, families, and the community. A systematic review of the literature was conducted to identify and evaluate interventions designed to improve emotion regulation ability in adults with acquired brain injury. Studies were identified on ProQuest, PsycInfo, ScienceDirect, Scopus, and Web of Science; last searched on 3 August 2023. A review protocol was prospectively registered on PROSPERO (CRD42020218175). Risk of bias was assessed using the Cochrane Risk-of-Bias tool (version 2). Sixteen studies were included in the review comprising one case series, five pilot studies, four pre-post studies, and six RCTs. There was a total of 652 participants across studies. Fourteen of the sixteen studies reported statistically significant improvements in at least one emotional functioning variable. Ten studies reported medium-large effect sizes. Limitations included inconsistency in the measurement, reporting of intervention outcomes and processes. Future directions are discussed.

Evaluating social rehabilitation of aggression for persons with Acquired Brain Injury: a systematic review

PURPOSE

Social rehabilitation of aggression following an Acquired Brain Injury (ABI) is critically important for persons with ABI due to increased vulnerability of criminal behaviour related to post-injury changes in functioning. This review presents findings from studies that evaluated aggression interventions in both community and forensic populations of people with ABI.

METHODS

We searched PsycINFO, EMBASE, SocINDEX, CINAHL and Medline databases for studies published between 1st January 2000 and 15th October 2023.

RESULTS

There were 15 studies (14 community-based, one forensic) that met inclusion criteria. Pharmacological management (6) was largely ineffective and anger management interventions (6) presented with inconsistent effectiveness. Emotion regulation (1) may be effective for externalised aggression. Both mindfulness and transcranial direct current stimulation (1) were effective, and the results of a forensic peer group approach (1) were not tested for statistical significance. There was variability in the measurement of aggression, injury severity, and cognitive impairment.

CONCLUSIONS

Whilst community interventions for aggression in persons with ABI are prevalent, findings for effectiveness have been mixed and there is a paucity of evaluated interventions in forensic samples. Further research is needed to unravel the complex interplay of factors contributing to aggression and develop effective social rehabilitation for persons with ABI.

R2DRV: study protocol for longitudinal assessment of driving after mild TBI in young drivers

BACKGROUND

Mild traumatic brain injury (mTBI) and traffic-related injuries are two major public health problems disproportionately affecting young people. Young drivers, whose driving skills are still developing, are particularly vulnerable to impaired driving due to brain injuries. Despite this, there is a paucity of research on how mTBI impacts driving and when it is safe to return to drive after an mTBI. This paper describes the protocol of the study, R2DRV, Longitudinal Assessment of Driving After Mild TBI in Young Drivers, which examines the trajectory of simulated driving performance and self-reported driving behaviors from acutely post-injury to symptom resolution among young drivers with mTBI compared to matched healthy drivers. Additionally, this study investigates the associations of acute post-injury neurocognitive function and cognitive load with driving among young drivers with and without mTBI.

METHODS

A total of 200 young drivers (ages 16 to 24) are enrolled from two study sites, including 100 (50 per site) with a physician-confirmed isolated mTBI, along with 100 (50 per site) healthy drivers without a history of TBI matched 1:1 for age, sex, driving experience, and athlete status. The study assesses primary driving outcomes using two approaches: (1) high-fidelity driving simulators to evaluate driving performance across four experimental study conditions at multiple time points (within 96 h of injury and weekly until symptom resolution or 8 weeks post-injury); (2) daily self-report surveys on real-world driving behaviors completed by all participants.

DISCUSSION

This study will fill critical knowledge gaps by longitudinally assessing driving performance and behaviors in young drivers with mTBI, as compared to matched healthy drivers, from acutely post-injury to symptom resolution. The research strategy enables evaluating how increased cognitive load may exacerbate the effects of mTBI on driving, and how post-mTBI neurocognitive deficits may impact the driving ability of young drivers. Findings will be shared through scientific conferences, peer-reviewed journals, and media outreach to care providers and the public.

Effects of abstract versus concrete rumination about anger on affect

BACKGROUND

The processing-mode theory of rumination proposes that an abstract mode of rumination results in more maladaptive consequences than a concrete ruminative mode. It is supported by evidence mostly from the area of depression and little is known of the relative consequences of abstract versus concrete rumination for anger.

AIMS

We investigated the differential effects of abstract versus concrete rumination about anger on individuals' current affect. We hypothesized that abstract rumination would increase current anger and negative affect, and decrease positive affect, to a greater extent than concrete rumination.

METHOD

In a within-subject design, 120 participants were instructed to focus on a past social event that resulted in intense anger and then to ruminate about the event in both an abstract and a concrete mode, in a randomly assigned order. Current anger, negative and positive affect were assessed before and after each rumination phase.

RESULTS

Anger and negative affect increased and positive affect decreased from pre- to post-rumination. Contrary to expectations, these patterns were observed irrespective of the ruminative mode induced.

CONCLUSIONS

This initial study does not support the hypothesis that abstract and concrete rumination about anger have different consequences for current affect. Replications and more extensive designs are needed.

Occupational Therapy Practice Guidelines for Adults With Traumatic Brain Injury

IMPORTANCE

Occupational therapy practitioners are uniquely qualified to address the occupational needs of people with traumatic brain injury (TBI) and their caregivers to maximize participation, health, and well-being.

OBJECTIVE

These Practice Guidelines are informed by systematic reviews of the effectiveness of interventions that address impairments and skills to improve the occupational performance of people with TBI, as well as interventions for caregivers of people with TBI. The purpose of these guidelines is to summarize the current evidence available to assist clinicians' clinical decision-making in providing interventions for people with TBI and their caregivers.

METHOD

We reviewed six systematic reviews and synthesized the results into clinical recommendations to be used in occupational therapy clinical practice.

RESULTS

Sixty-two articles served as the basis for the clinical recommendations.

CONCLUSIONS AND RECOMMENDATIONS

Strong to moderate evidence supports multimodal sensory stimulation, unimodal auditory stimulation, physical activity, virtual reality, cognitive interventions, vision therapy, goal-focused interventions, individual and group training and education, and caregiver supports. Occupational therapy practitioners should incorporate these interventions into individual and group sessions to maximize recovery and promote occupational participation. Additional interventions are also available, based on emerging evidence and expert opinion, including prevention approaches, complexity of injury, and the use of occupation-based performance assessments. What This Article Adds: These Practice Guidelines provide a summary of evidence in clinical recommendations tables supporting occupational therapy interventions that address impairments resulting from and skills to improve occupational performance after TBI. The guidelines also include case study examples and evidence graphics for practitioners to use to support clinical reasoning when selecting interventions that address the goals of the person with TBI and their caregiver's needs.

Impairments in Physiological Reactivity to Emotive Stimuli After Traumatic Brain Injury: A Systematic Review of Skin Conductance and Heart Rate Variability Evidence

OBJECTIVE

To examine evidence of impairments in physiological reactivity to emotive stimuli following traumatic brain injury (TBI).

METHODS

A search of PsychINFO, CINAHL (Cumulative Index to Allied Health Literature), Web of Science, EMBASE (Excerpta Medica dataBASE), and Scopus databases was conducted from 1991 to June 24, 2021, for studies comparing changes in skin conductance or heart rate variability to emotive stimuli between adults with TBI and controls. Two reviewers independently assessed eligibility and rated methodological quality.

RESULTS

Twelve eligible studies examined physiological reactivity to laboratory-based emotive stimuli, which included nonpersonal pictures/videos, posed emotion, stressful events, and personal event recall. Overall, 9 reported evidence that individuals with TBI experience lower physiological reactivity to emotive stimuli compared with healthy controls, although the findings varied according to the type and valence of emotional stimuli and physiological parameter. Most studies using nonpersonal pictures or videos found evidence of lower physiological reactivity in TBI participants compared with controls.

CONCLUSIONS

Based on laboratory-based studies, individuals with TBI may experience lower physiological reactivity to emotive stimuli. Further research is needed to investigate physiological responses to personally relevant emotional stimuli in real-world settings and to understand the interplay between physiological reactivity, subjective experiences, and behavior.

Physiological reactivity at rest and in response to social or emotional stimuli after a traumatic brain injury: A systematic review

Numerous studies have shown that alterations in physiological reactivity (PR) after traumatic brain injury (TBI) are possibly associated with emotional deficits. We conducted a systematic review of these studies that evaluated PR in adults with moderate-to-severe TBI, either at rest or in response to emotional, stressful, or social stimuli. We focused on the most common measures of physiological response, including heart rate (HR), heart rate variability (HRV), respiratory sinus arrhythmia (RSA), electrodermal activity (EDA), salivary cortisol, facial electromyography (EMG), and blink reflex.

Methods

A systematic literature search was conducted across six databases (PsycINFO, Psycarticles, SciencDirect, Cochrane Library, PubMed, and Scopus). The search returned 286 articles and 18 studies met the inclusion criteria.

Results

Discrepancies were observed according to the type of physiological measure. Reduced physiological responses in patients with TBI have been reported in most EDA studies, which were also overrepresented in the review. In terms of facial EMG, patients with TBI appear to exhibit reduced activity of the corrugator muscle and diminished blink reflex, while in most studies, zygomaticus contraction did not show significant differences between TBI and controls. Interestingly, most studies measuring cardiac activity did not find significant differences between TBI and controls. Finally, one study measured salivary cortisol levels and reported no difference between patients with TBI and controls.

Conclusion

Although disturbed EDA responses were frequently reported in patients with TBI, other measures did not consistently indicate an impairment in PR. These discrepancies could be due to the lesion pattern resulting from TBI, which could affect the PR to aversive stimuli. In addition, methodological differences concerning the measurements and their standardization as well as the characteristics of the patients may also be involved in these discrepancies. We propose methodological recommendations for the use of multiple and simultaneous PR measurements and standardization. Future research should converge toward a common methodology in terms of physiological data analysis to improve inter-study comparisons.

Education and Skills Training Interventions for Adults With Traumatic Brain Injury (TBI) (Dates of Review: 2013-2020)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on education and skills training interventions that address psychosocial, behavioral, and emotional skills for people with traumatic brain injury (TBI).

Shades of Rage: Applying the Process Model of Emotion Regulation to Managing Anger After Brain Injury

Uncontrollable anger is common following an acquired brain injury (ABI), with impaired emotion regulation (ER) being one of the main contributors. Existing psychological interventions appear moderately effective, though studies typically include limitations such as small sample sizes, issues of long-term efficacy, and standardization of content. While ER has been a popular research field, the study of ER for anger management after ABI is less well investigated, and contains few interventions based on the widely used Process Model of ER. This review surveys the efficacy of ER strategies in individuals with ABI, and proposes a novel research design for future interventions. Recommendations are made about: strategy number and type, shared decision-making, approaches to data analysis, and mode of delivery.

The effect of severe traumatic brain injury on social cognition, emotion regulation, and mood

This chapter provides a review of the emotional and psychosocial consequences of moderate to severe traumatic brain injury (TBI). Many of the disorders affecting socioemotional function arise from damage to frontotemporal systems, exacerbated by white matter injury. They include disorders of social cognition, such as the ability to recognize emotions in others, the ability to attribute mental states to others, and the ability to experience empathy. Patients with TBI also often have disorders of emotion regulation. Disorders of drive or apathy can manifest across cognitive, emotional, and behavioral domains. Likewise, disorders of control can lead to dysregulated emotions and behavior. Other disorders, such as loss of self-awareness, are also implicated in poor psychosocial recovery. Finally, this chapter overviews psychiatric disorders associated with TBI, especially anxiety and depression. For each kind of disorder, the nature of the disorder and its prevalence, as well as theoretical considerations and impact on every day functions, are reviewed.

National Institutes of Health Toolbox Emotion Battery: Application of Summary Scores to Adults With Spinal Cord Injury, Traumatic Brain Injury, and Stroke

OBJECTIVE

To examine the validity of factor analytically based summary scores that were developed using the National Institutes of Health Toolbox Emotion Battery (NIHTB-EB); (ie, psychological well-being, social satisfaction, negative affect) normative sample in individuals with neurologic conditions.

DESIGN

Cross-sectional, observational cohort.

SETTING

Community.

PARTICIPANTS

A total of 1036 English-speaking adults from the National Institutes of Health Toolbox (NIHTB) normative project and 604 community-dwelling adults with neurologic conditions including spinal cord injury (SCI n=209), traumatic brain injury (TBI n=184), and stroke (cerebrovascular accident [CVA] n=211) (N=1640).

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

The NIHTB-EB.

RESULTS

A series of univariate analyses comparing summary scores across the 4 groups (SCI, TBI, CVA, normative group) were conducted to identify group differences. Base rates (defined as >1 SD toward the problematic direction) were also identified. The normative group demonstrated better emotional functioning characterized by greater social satisfaction and psychological well-being (normative group > SCI, TBI, CVA; P's <.0001), and less negative affect (normative group < SCI, P=.016; normative group < TBI, P<.001; normative group < CVA; P=.034) compared with each neurologic group. Using base rates to identify problematic emotions for the 3 summary scores, there were higher rates of problematic emotions on all 3 summary scores for the neurologic groups compared with the normative group.

CONCLUSIONS

The NIHTB-EB summary scores demonstrate an increased prevalence of problematic emotions among individuals with 3 neurologic conditions, and might be useful for identifying individuals with similar conditions and potentially in need of psychological support.