Effectiveness of a Treatment for Impairments in Social Cognition and Emotion Regulation (T-ScEmo) After Traumatic Brain Injury: A Randomized Controlled Trial

Pilot study on the effectiveness of the socialmind program for the rehabilitation of social cognition following acquired brain injury

Background

People with acquired brain injury (ABI) often have Social Cognition (SC) deficits. Impairment of SC causes the individual to have difficulties in daily functioning and can lead to social isolation. Research aimed at rehabilitation of SC in individuals with ABI is scarce and almost always addresses only one component of this ability.

Objective

This pilot study aimed to assess the effectiveness of the new "SocialMind" program in improving all core components of SC in people with ABI.

Method

The study included 31 participants with ABI, divided into experimental and control groups. The study spanned 44 weeks, involving an initial meeting, evaluation, training, and final assessment phases. The SocialMind program, structured into four modules, each with a duration of 30 h, targeted each SC component through tailored exercises. The program addressed emotion recognition, social awareness, ToM, and empathy.

Results

The SocialMind group demonstrated significant improvements in emotion recognition (p = 0.017), social knowledge (p < 0.001), and empathy (p = 0.001) compared to the control group. ToM also showed a notable improvement that approached significance (p = 0.057).

Conclusion

This pilot study suggests that the SocialMind program effectively enhances three of the four core components of SC in individuals with ABI.

Protocol for the MS-CEBA study: an observational, prospective cohort study identifying Cognitive, Energetic, Behavioural and Affective (CEBA) profiles in Multiple Sclerosis to guide neuropsychological treatment choice

BACKGROUND

Neuropsychological symptoms in the Cognitive, Energetic, Behavioural, and Affective (CEBA) domains are common in people with multiple sclerosis (PwMS) and can negatively affect societal participation. The current study aims to investigate whether there are combinations of symptoms in the different CEBA domains that consistently occur together, that is, if there are CEBA profiles that can be identified. If so, this study aims to develop a screening instrument identifying CEBA profiles in PwMS to select the most suitable neuropsychological rehabilitation treatment for a given CEBA profile and consequently improve the societal participation of PwMS.

METHODS

This study is an observational, prospective cohort study consisting of 3 phases. Phase 1 focuses on the identification of CEBA profiles in a large sample of PwMS (n = 300). Phase 2 focuses on validating these CEBA profiles through replication of results in a new sample (n = 100) and on the development of the screening instrument. Phase 3 focuses on qualitatively evaluating in a small group of PwMS whether the selected treatment is suitable for the given CEBA profile or whether existing neuropsychological treatments should be adapted to meet the needs of PwMS suffering from symptoms in multiple CEBA domains simultaneously. Primary outcome is the CEBA profile, which will be derived from performance on neuropsychological assessment consisting of tests and questionnaires regarding the CEBA domains using a latent profile analysis. Inclusion criteria include MS diagnosis, sufficient ability in the Dutch language, and an age between 18 and 70 years.

DISCUSSION

The results of the current study will contribute to a more comprehensive understanding of the entire spectrum of neuropsychological symptoms in PwMS. Identification of possible CEBA profiles, and accordingly, the development of a screening instrument determining the CEBA profile of PwMS in clinical practice, contributes to the timely referral of PwMS to the most suitable neuropsychological rehabilitation treatment. If necessary, adjustments to existing treatments will be suggested in order to sufficiently meet the needs of PwMS. All of this with the ultimate aim to improve societal participation, and thereby quality of life, of PwMS.

TRIAL REGISTRATION

Dutch Central Committee on Research Involving Human Subjects (CCMO) NL83954.042.23; ClinicalTrials.gov NCT06016309.

Wishes, beliefs, and jealousy: use of mental state terms in Cinderella retells after traumatic brain injury

Introduction

Traumatic brain injury (TBI) negatively impacts social communication in part due to social cognitive difficulties, which may include reduced mental state term (MST) use in some discourse genres. As social cognitive difficulties can negatively impact relationships, employment, and meaningful everyday activities, assessing and treating these difficulties post-TBI is crucial. To address knowledge gaps, the present study examined MST use in the narrative retells of adults with and without severe TBI to compare between-group performance, evaluate changes over the first two years post-TBI, and investigate the impact of participant and injury-related variables.

Methods

The total number of MSTs, ratio of MSTs to total utterances, and diversity of MSTs were identified in the Cinderella narratives of 57 participants with no brain injury and 57 with TBI at 3, 6, 9, 12, and 24-months post-TBI.

Results

Reduced MST use in participants with TBI was found at 3, 6, 9, and 12-months post-TBI, but these reductions disappeared when story length (total utterances) was accounted for. Further, MST diversity did not differ between groups. Similarly, although the total number of MSTs increased over time post-TBI, no changes were observed in the ratio of MSTs to total utterances or MST diversity over time. Injury severity (post-traumatic amnesia duration), years of education, and verbal reasoning abilities were all related to MST use.

Discussion

Overall, although individuals used fewer MSTs in complex story retells across the first year following severe TBI, this reduction reflected impoverished story content, rather than the use of a lower ratio of MSTs. Further, key prognostic factors related to MST use included injury severity, educational attainment, and verbal reasoning ability. These findings have important implications for social communication assessment and treatment targeting social cognition post-TBI.

Compensatory cognitive training for people with traumatic brain injury: A systematic review of randomized controlled trial

Cognitive impairments are a common consequence in people with traumatic brain injury (TBI). Compensatory cognitive training is a therapeutic strategy that offers alternative methods to manage cognitive deficits. This systematic review aims to examine the effects of compensatory cognitive training on cognitive function in people with TBI. We searched PubMed, SCOPUS, MEDLINE, PEDro, Web of Science, REHABDATA, and EMBASE from inception until October 2023. The Cochrane Collaboration tool was used to assess the methodological quality of the selected studies. Of 318 articles, eight studies (n = 615), with 8% of participants being females, were included in this review. Four studies were classified as having 'high' quality according to the Cochrane Collaboration tool, while four were categorized as 'moderate' quality. There were variations in treatment protocols and outcome measures, resulting in heterogeneous findings. The effects of compensatory cognitive training on cognitive outcomes showed inconsistency. In conclusion, the evidence for the effects of compensatory cognitive training on cognition in people with TBI is promising. Further trials are needed to investigate the effects of compensatory cognitive training on various cognitive domains in people with TBI.

Treating social cognition impairment with the online therapy 'SoCoBo': A randomized controlled trial including traumatic brain injury patients

OBJECTIVE

Acquired brain injuries (ABIs), such as traumatic brain injuries (TBIs), often entail impairments of general cognition (e.g., memory, attention or executive functions) and social cognition (e.g. emotion recognition, theory of mind [ToM], social problem-solving). The availability of fully computerized interventions targeting sociocognitive deficits specifically in neurologically impaired patients is extremely limited. Therefore, the Treatment Program for Deficits in Social Cognition and Social Competencies of the Ruhr University Bochum (SoCoBo), a fully computerized online therapy designed for ABI patients was evaluated in a randomized controlled trial involving TBI patients.

METHOD

Sixty-four patients with TBI were randomly assigned to two groups with 43 patients fully completing either SoCoBo (N = 27) or a commercially available computerized program for cognitive rehabilitation (RehaCom®, N = 16). All participants underwent comprehensive pre-post online neuropsychological assessment and worked with their respective rehabilitation programs for four days a week during a scheduled period of 12 weeks.

RESULTS

After treatment, the SoCoBo group, but not the RehaCom® group showed significant improvements in facial emotion recognition and self-rated empathy. Moreover, in the SoCoBo group, an increase in empathy was also associated with increased life satisfaction after treatment. There were no improvements in ToM and social problem-solving. Furthermore, general cognition did not improve in any of the groups.

CONCLUSIONS

SoCoBo represents an effective new online therapy for the amelioration of deficits in key domains of social cognition. Its implementation in clinical practice will serve as a meaningful addition to the existing fully computerized approaches specifically in neurological patient groups.

Computer-assisted cognitive rehabilitation in neurological patients: state-of-art and future perspectives

Background and aim

Advances in computing technology enabled researchers and clinicians to exploit technological devices for cognitive training and rehabilitation interventions. This expert review aims to describe the available software and device used for cognitive training or rehabilitation interventions of patients with neurological disorders.

Methods

A scoping review was carried out to analyze commercial devices/software for computerized cognitive training (CCT) in terms of feasibility and efficacy in both clinical and home settings. Several cognitive domains responding to the different patients' needs are covered.

Results

This review showed that cognitive training for patients with neurological diseases is largely covered by several devices that are widely used and validated in the hospital setting but with few translations to remote/home applications. It has been demonstrated that technology and software-based devices are potential and valuable tools to administer remotely cognitive rehabilitation with accessible costs.

Conclusion

According to our results, CCT entails the possibility to continue cognitive training also in different settings, such as home, which is a significant breakthrough for the improvement of community care. Other possible areas of use should be the increase in the amount of cognitive therapy in the free time during the hospital stay.

Effectiveness of training in expressing positive emotions, reacting to change and greeting peers after childhood traumatic brain injury: a single-case experimental study

Background

Social cognitive deficits are common after traumatic brain injury (TBI). The participant in this single-case experimental design (SCED) was 7 years old when he sustained a severe TBI. After 2 years in rehabilitation, he continues to show deficits in social cognition.

Objective

To determine the effectiveness of three interventions, each aimed at improving a behavior altered by social cognition deficits. These behaviors were: (1) expression of positive emotions, (2) reacting to changes in plans, and (3) greeting classmates.

Method

An A-B-A' design was used for each behavior. In addition, each behavior was targeted with a rehabilitation program applied over 10 sessions.

Results

For the first behavior, changes between phases B-A' (NAP = 0.712) and A-A' (NAP = 0.864) indicated improvements in the child's ability to express positive emotions. In the second behavior, changes in the intensity of reactions between phases B and A' (NAP = 0.815) and A vs. A' (NAP = 0.834) indicated that the child adapted to changes in a plan and to unexpected situations in a more adaptive way. For the third behavior, changes in the number of greetings between phases A and B (NAP = 0.883) and A vs. A' (NAP = 0.844) suggested that during the third phase of the study, the participant fully acquired the habit of greeting peers and increased his interactions with others.

Conclusion

While the participant showed improvements in all three targeted behaviors, due to the complexity of the third behavior, it is recommended that in future research, the intervention targeting social interactions should be applied over a longer timeframe to ensure that improvements are more stable in the long term.

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.

Facial Emotion Recognition in Patients with Juvenile Myoclonic Epilepsy

Previous studies have found facial emotion recognition (FER) impairments in individuals with epilepsy. While such deficits have been extensively explored in individuals with focal temporal lobe epilepsy, studies on individuals with generalized epilepsies are rare. However, studying FER specifically in individuals with juvenile myoclonic epilepsy (JME) is particularly interesting since they frequently suffer from social and neuropsychological difficulties in addition to epilepsy-specific symptoms. Furthermore, recent brain imaging studies have shown subtle microstructural alterations in individuals with JME. FER is considered a fundamental social skill that relies on a distributed neural network, which could be disturbed by network dysfunction in individuals with JME. This cross-sectional study aimed to examine FER and social adjustment in individuals with JME. It included 27 patients with JME and 27 healthy controls. All subjects underwent an Ekman-60 Faces Task to examine FER and neuropsychological tests to assess social adjustment as well as executive functions, intelligence, depression, and personality traits. Individuals with JME performed worse in global FER and fear and surprise recognition than healthy controls. However, probably due to the small sample size, no significant difference was found between the two groups. A potential FER impairment needs to be confirmed in further studies with larger sample size. If so, patients with JME could benefit from addressing possible deficits in FER and social difficulties when treated. By developing therapeutic strategies to improve FER, patients could be specifically supported with the aim of improving social outcomes and quality of life.

Calling on clinicians to get social and emotional

OBJECTIVE

Disorders of social cognition, such as difficulties with emotion perception, alexithymia, Theory of Mind (ToM), empathy and disorders of emotion regulation, are prevalent and pervasive problems across many neurological, neurodevelopmental and neuropsychiatric conditions. Clinicians are familiar with how these difficulties present but assessment and treatment has lagged behind other traditional cognitive domains, such as memory, language and executive functioning.

METHOD

In this paper, we review the prevalence and degree of impairment associated with disorders of social cognition and emotion regulation across a range of clinical conditions, with particular emphasis on their relationship to cognitive deficits and also real-world functioning. We reported effects sizes from published meta-analyses for a range of clinical disorders and also review test usage and available tests.

RESULTS

In general, many clinical conditions are associated with impairments in social cognition and emotion regulation. Effect sizes range from small to very large and are comparable to effect sizes for impairments in nonsocial cognition. Socio-emotional impairments are also associated with social and adaptive functioning. In reviewing prior research, it is apparent that the standardized assessment of social cognition, in particular, is not routine in clinical practice. This is despite the fact that there are a range of tools available and accruing evidence for the efficacy of interventions for social cognitive impairments.

CONCLUSION

We are using this information to urge and call for clinicians to factor social cognition into their clinical assessments and treatment planning, as to provide rigorous, holistic and comprehensive person-centred care.

Update on the Efficacy of Cognitive Rehabilitation After Moderate to Severe Traumatic Brain Injury: A Scoping Review

OBJECTIVES

To identify, categorize, and analyze the methodological issues of cognitive rehabilitation of patients with moderate to severe traumatic brain injury and its efficacy.

DATA SOURCES

Pubmed and PsycINFO were searched for studies published between 2015 and 2021 using keywords for cognitive intervention and traumatic brain injury.

STUDY SELECTION

Two independent reviewers selected articles concerning cognitive rehabilitation for adults with traumatic brain injury. Of 458 studies, 97 full-text articles were assessed and 46 met the inclusion criteria.

DATA EXTRACTION

Data were analyzed by 1 reviewer according to criteria concerning the methodological quality of studies.

DATA SYNTHESIS

Results showed a large scope of 7 cognitive domains targeted by interventions, delivered mostly in individual sessions (83%) with an integrative cognitive approach (48%). Neuroimaging tools as a measure of outcome remained scarce, featuring in only 20% of studies. Forty-three studies reported significant effects of cognitive rehabilitation, among which 7 fulfilled a high methodological level of evidence.

CONCLUSIONS

Advances and shortcomings in cognitive rehabilitation have both been highlighted and led us to develop methodological key points for future studies. The choice of outcome measures, the selection of control interventions, and the use of combined rehabilitation should be investigated in further studies.

Differentiating Use of Facial Expression between Individuals with and without Traumatic Brain Injury Using Affectiva Software: A Pilot Study

This study investigated the feasibility of using an automated facial coding engine, Affectiva (integrated in iMotions, version 8.2), for evaluating facial expression after traumatic brain injury (TBI). An observational cross-sectional study was conducted based on facial expression data from videos of participants with TBI and control participants. The aims were to compare TBI and control groups, and identify confounding factors affecting the data analysis. Video samples of two narrative tasks (personal event and story retell) from ten participants with severe TBI and ten control participants without TBI were analyzed using Affectiva. Automated data on participants' engagement, smile and brow furrow were compared statistically between and within groups. Qualitative notes for each sample were also recorded. Affectiva detected a higher percentage of time of engagement for TBI participants than for control participants on both tasks. There was also a higher percentage of time of smiling for TBI participants in one task. Within groups, there were no significant differences between the two narrative tasks. Affectiva provides standardized data about facial expression and may be sensitive to detecting change in the use of facial expression after TBI. This study also identified factors to avoid during videorecording to ensure high quality samples for future research.

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part IV: Cognitive-Communication and Social Cognition Disorders

INTRODUCTION

Moderate to severe traumatic brain injury causes significant cognitive impairments, including impairments in social cognition, the ability to recognize others' emotions, and infer others' thoughts. These cognitive impairments can have profound negative effects on communication functions, resulting in a cognitive-communication disorder. Cognitive-communication disorders can significantly limit a person's ability to socialize, work, and study, and thus are critical targets for intervention. This article presents the updated INCOG 2.0 recommendations for management of cognitive-communication disorders. As social cognition is central to cognitive-communication disorders, this update includes interventions for social cognition.

METHODS

An expert panel of clinicians/researchers reviewed evidence published since 2014 and developed updated recommendations for interventions for cognitive-communication and social cognition disorders, a decision-making algorithm tool, and an audit tool for review of clinical practice.

RESULTS

Since INCOG 2014, there has been significant growth in cognitive-communication interventions and emergence of social cognition rehabilitation research. INCOG 2.0 has 9 recommendations, including 5 updated INCOG 2014 recommendations, and 4 new recommendations addressing cultural competence training, group interventions, telerehabilitation, and management of social cognition disorders. Cognitive-communication disorders should be individualized, goal- and outcome-oriented, and appropriate to the context in which the person lives and incorporate social communication and communication partner training. Group therapy and telerehabilitation are recommended to improve social communication. Augmentative and alternative communication (AAC) should be offered to the person with severe communication disability and their communication partners should also be trained to interact using AAC. Social cognition should be assessed and treated, with a focus on personally relevant contexts and outcomes.

CONCLUSIONS

The INCOG 2.0 recommendations reflect new evidence for treatment of cognitive-communication disorders, particularly social interactions, communication partner training, group treatments to improve social communication, and telehealth delivery. Evidence is emerging for the rehabilitation of social cognition; however, the impact on participation outcomes needs further research.

Working Memory for Emotions in Adolescents and Young Adults with Traumatic Brain Injury

This preliminary study investigated the interaction between working memory and social cognition in adolescents and young adults with traumatic brain injury (TBI). It was hypothesized that participants with or without TBI would better recognize social information when working memory or social cognitive load was low, and that adolescents and young adults with TBI would be more affected by increased cognitive demand than their uninjured peers. Eight adolescents and young adults with complicated mild-severe TBI (aged 14-22 years) and eight age- and sex-matched typically developing (TD) adolescents completed computer-based n-back tasks requiring recognition of either face identity or facial affect, with 0-back, 1-, and 2-back conditions. The TBI group had lower scores overall than the TD group, and scores for both groups were lower for affect recognition than identity recognition. Scores for both groups were lower in conditions with a higher working memory load. There was a significant group-by-working memory interaction, with larger group differences in high-working memory conditions. Study results and their potential implications for social outcomes are discussed.

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).

Computerized social cognitive training in the subacute phase after traumatic brain injury: A quasi-randomized controlled trial

OBJECTIVES

To assess the usefulness of a computerized tasks module designed for the rehabilitation of social cognition (SC) in acquired brain injury.

METHODS

Quasi-randomized controlled trial (ClinicalTrials.gov:NCT03479970) involving 45 patients with moderate-severe traumatic brain injury (TBI) in a subacute inpatient rehabilitation hospital. The experimental group (n = 28) received treatment with a computerized SC module in combination with a non-SC module. The control group (n = 26) only received a treatment with non-SC module.

RESULTS

Intragroup comparisons showed that the experimental group had better results for all SC measures, except for International Affective Picture System (IAPS). The control group improved for Facial Expressions of cEmotion-Stimuli and Tests (FEEST) and Moving Shapes Paradigm (MSP), showing no changes with respect to pretreatment in IAPS, MSP and Reading the Mind in the Eyes Test (RMET). Intergroup comparisons did not present differences between the two groups for pretreatment measures. Post-treatment comparison showed that the experimental group obtained better results for RMET than the control group.

CONCLUSION

The computerized SC module was useful for the rehabilitation of SC in patients with moderate-severe TBI in the subacute phase. The group that received combined rehabilitative treatment (SC + non-SC) obtained better results for SC than the group that received treatment intended only for non-SC.

Theory of mind and facial emotion recognition in adults with temporal lobe epilepsy: A meta-analysis

BACKGROUND

Mounting studies have investigated impairments in social cognitive domains (including theory of mind [ToM] and facial emotion recognition [FER] in adult patients with temporal lobe epilepsy (TLE). However, to date, inconsistent findings remain.

METHODS

A search of PubMed, Web of Science, and Embase databases was conducted until December 2021. Hedges g effect sizes were computed with a random-effects model. Meta-regressions were used to assess the potential confounding factors of between-study variability in effect sizes.

RESULTS

The meta-analysis included 41 studies, with a combined sample of 1,749 adult patients with TLE and 1,324 healthy controls (HCs). Relative to HCs, adult patients with TLE showed large impairments in ToM (g = -0.92) and cognitive ToM (g = -0.92), followed by medium impairments in affective ToM (g = -0.79) and FER (g = -0.77). Besides, no (statistically) significant differences were observed between the magnitude of social cognition impairment in adult with TLE who underwent and those who did not undergo epilepsy surgery. Meta-regressions exhibited that greater severity of executive functioning was associated with more severe ToM defects, and older age was associated with more severe FER defects.

CONCLUSIONS

Results of this meta-analysis suggest that adult patients with TLE show differential impairments in the core aspects of social cognitive domains (including ToM and FER), which may help in planning individualized treatment with appropriate cognitive and behavioral interventions.

Behaviors of Concern after Acquired Brain Injury: The Role of Negative Emotion Recognition and Anger Misattribution

OBJECTIVE

Behavioral changes are common after acquired brain injury (ABI) and may be caused by social cognition impairments. We investigated whether impaired emotion recognition, specifically Negative Emotion Recognition (NER) and Anger Misattribution (AM), after ABI was related to behavioral problems, so-called Behaviors of Concern (BoC).

METHOD

The study included 139 participants with ABI and 129 healthy controls. BoC was measured using four scales of the Brock Adaptive Functioning Questionnaire (BAFQ): Impulsivity, Aggression, Social Monitoring, and Empathy. Both self-ratings and informant ratings of BoC were obtained. Emotion recognition was measured with the Ekman 60 Faces Test (FEEST). A NER score was composed of the summed scores on Anger, Disgust, Fear, and Sadness. An AM score was composed of the number of facial expressions wrongly recognized as Anger.

RESULTS

Total FEEST scores in ABI participants were significantly worse than in healthy controls. The effect size is moderate. Informants rated significantly more problems in Social Monitoring and Empathy than participants. Effect sizes were small. Scores on FEEST total, NER, and AM were significantly correlated to informant ratings of Social Monitoring. Correlations were weak to moderate.

CONCLUSIONS

Worse NER and more profound AM were related to more informant-rated problems in social monitoring. In addition, informants rated more problems in social monitoring and empathy than participants. This strongly suggests problems in self-awareness in ABI participants. Consequently, social cognition tests and informant ratings should be used in clinical practice to improve the detection and treatment of BoC after ABI.

The Role of Presumed Head and Neck Injuries in Emotion Dysregulation Among Community Women With a History of Physical Intimate Partner Violence

Intimate partner violence (IPV) is prevalent among women and associated with negative outcomes, including emotion dysregulation. Limited research has examined factors that contribute to emotion dysregulation in this population. This study explores the potential influence of presumed head and neck injuries from IPV on five dimensions of emotion dysregulation. Participants were 352 community women who responded to an online survey. Results of a path analysis indicated that presumed head and neck injuries from IPV were significantly associated with lack of emotional clarity and difficulties engaging in goal-directed behaviors when experiencing emotions. Findings suggest an association between presumed head and neck injuries from IPV and emotion dysregulation, underscoring the potential need for considering both neurological and psychological factors in the assessment and treatment of emotion dysregulation in this population.

Negative Attribution Bias and Related Risk Factors After Brain Injury

OBJECTIVE

In participants with traumatic brain injury (TBI) and peer controls, examine (1) differences in negative attributions (interpret ambiguous behaviors negatively); (2) cognitive and emotional factors associated with negative attributions; and (3) negative attribution associations with anger responses, life satisfaction, and participation.

SETTING

Two TBI outpatient rehabilitation centers.

PARTICIPANTS

Participants with complicated mild to severe TBI (n = 105) and peer controls (n = 105).

DESIGN

Cross-sectional survey study.

MAIN MEASURES

Hypothetical scenarios describing ambiguous behaviors were used to assess situational anger and attributions of intent, hostility, and blame. Executive functioning, perspective taking, emotion perception and social inference, alexithymia, aggression, anxiety, depression, participation, and life satisfaction were also assessed.

RESULTS

Compared with peer controls, participants with TBI rated behaviors significantly more intentional, hostile, and blameworthy. Regression models explained a significant amount of attribution variance (25%-43%). Aggression was a significant predictor in all models; social inference was also a significant predictor of intent and hostility attributions. Negative attributions were associated with anger responses and lower life satisfaction.

CONCLUSION

People with TBI who have higher trait aggression and poor social inferencing skills may be prone to negative interpretations of people's ambiguous actions. Negative attributions and social inferencing skills should be considered when treating anger problems after TBI.

Theory of mind in adults with traumatic brain injury: A meta-analysis

Studies of abnormal theory of mind (ToM) performance in adult patients with traumatic brain injury (TBI) have reported inconsistent results. Therefore, we conducted a meta-analysis to characterize ToM performance in adult patients with TBI. Random-effects models were employed to estimate the overall effect size and the differential effect sizes across different ToM aspects. Based on a sample of 28 studies (1031 patients and 865 healthy controls), the meta-analytic findings revealed that ToM was significantly impaired in adult patients with TBI compared to healthy controls (g = -1.13). Besides, patients with TBI showed significant impairments in individual ToM tasks, as well as for different stimulus modes and contents involved in these ToM tasks. A meta-regression indicated a positive association between ToM performance and Glasgow Coma Scale score. The results of the current meta-analysis suggest that the performance in ToM tasks may be a good predictor of functional outcomes in adults with TBI, which is important for the identification of targets for cognitive interventions and the development of useful training intervention programs.

Establishing 'proof of concept' for a social cognition group treatment program (SIFT IT) after traumatic brain injury: two case studies

OBJECTIVE

Social cognitive deficits are prevalent after traumatic brain injury (TBI). Despite this, few remediation studies exist. This study aimed to demonstrate 'proof of concept' for a novel group treatment that comprehensively targeted the core processes of social cognition.

DESIGN

Pre-post case study with two participants, "Greg" and "Aaron", living with severe TBI, with three assessment time points.

METHOD

Participants were screened at baseline to confirm social cognitive deficits: Greg exhibited difficulties with emotion perception and detecting hints; Aaron with detecting sarcasm and hints. Both reported everyday social problems. Participants then completed the 14-week group treatment program (SIFT IT). Feasibility and outcome measures were repeated post-group and at three-month follow-up.

RESULTS

The study procedure was implemented with 100% assessment and 89% SIFT IT session attendance, albeit with a lack of proxy-report measures. Both participants described procedures as acceptable, although suggested more group participants could be beneficial. They both demonstrated reliable improvements (RCI > 1.96) on relevant social cognitive measures. Qualitative feedback corroborated findings: Greg reported generalization of therapeutic gains, Aaron reported increased self-awareness but nominal generalization.

CONCLUSION

Feasibility and limited efficacy outcomes established 'proof of concept' of SIFT IT. Findings will inform the study protocol for a larger randomized-controlled trial.

Outcomes of Randomized Clinical Trials of Interventions to Enhance Social, Emotional, and Spiritual Components of Wisdom: A Systematic Review and Meta-analysis

Importance

Wisdom is a neurobiological personality trait made up of specific components, including prosocial behaviors, emotional regulation, and spirituality. It is associated with greater well-being and happiness.

Objective

To evaluate the effectiveness of interventions to enhance individual components of wisdom.

Data Sources

MEDLINE and PsycINFO databases were searched for articles published through December 31, 2018.

Study Eligibility Criteria

Randomized clinical trials that sought to enhance a component of wisdom, used published measures to assess that component, were published in English, had a minimum sample size of 40 participants, and presented data that enabled computation of effect sizes were included in this meta-analysis.

Data Extraction and Synthesis

Random-effect models were used to calculate pooled standardized mean differences (SMDs) for each wisdom component and random-effects meta-regression to assess heterogeneity of studies.

Main Outcomes and Measures

Improvement in wisdom component using published measures.

Results

Fifty-seven studies (N = 7096 participants) met review criteria: 29 for prosocial behaviors, 13 for emotional regulation, and 15 for spirituality. Study samples included people with psychiatric or physical illnesses and from the community. Of the studies, 27 (47%) reported significant improvement with medium to large effect sizes. Meta-analysis revealed significant pooled SMDs for prosocial behaviors (23 studies; pooled SMD, 0.43 [95% CI, 0.22-0.3]; P = .02), emotional regulation (12 studies; pooled SMD, 0.67 [95% CI, 0.21-1.12]; P = .004), and spirituality (12 studies; pooled SMD, 1.00 [95% CI, 0.41-1.60]; P = .001). Heterogeneity of studies was considerable for all wisdom components. Publication bias was present for prosocial behavior and emotional regulation studies; after adjusting for it, the pooled SMD for prosocial behavior remained significant (SMD, 0.4 [95% CI, 0.16-0.78]; P = .003). Meta-regression analysis found that effect sizes did not vary by wisdom component, although for trials on prosocial behaviors, large effect sizes were associated with older mean participant age (β, 0.08 [SE, 0.04]), and the reverse was true for spirituality trials (β, -0.13 [SE, 0.04]). For spirituality interventions, higher-quality trials had larger effect sizes (β, 4.17 [SE, 1.07]), although the reverse was true for prosocial behavior trials (β, -0.91 [SE 0.44]).

Conclusions and Relevance

Interventions to enhance spirituality, emotional regulation, and prosocial behaviors are effective in a proportion of people with mental or physical illnesses and from the community. The modern behavioral epidemics of loneliness, suicide, and opioid abuse point to a growing need for wisdom-enhancing interventions to promote individual and societal well-being.

Social cognition in patients with acquired brain lesions: An overview on an under-reported problem

Social cognition (SC) consists of mental representations of interpersonal relationships, which are used flexibly by the individual to promote functional social behaviors and achieve the goals. SC is a multidimensional construct and is supported by the activity of distributed neural networks in which different cortical and subcortical regions of the brain are involved. The review aims to evaluate the current literature on SC taking into account how it is compromised in acquired brain injury. Studies performed between 2010 and 2019 and fulfilling the selected criteria were searched on PubMed, Scopus, Cochrane and Web of Sciences databases. Impairment of SC is a neglected but common consequence of ABI, often leading to disordered interpersonal functioning and poor regulation of personal behavior with impaired social adaptation and quality of life of both the patient and his/her family. This review supports the idea that SC could have an important role in the management of neurological patients by both clinicians and caregivers.

The relationship between social cognition and participation in the long term after stroke

Social cognitive impairments may play a role in participation restrictions after stroke. Understanding their relationship could inform treatment approaches to improve participation. We investigated the relationship between social cognition and participation in the long term after stroke. Of 395 patients participating in a large prospective cohort study, cross-sectional data were available at 3-4 years post-stroke of 118 patients on tests for emotion recognition, theory of mind, empathy, and behaviour regulation. Participation was assessed with the Utrecht Scale for Evaluation of Rehabilitation - Participation (USER-P). Bivariate and multivariate regression analysis were used to examine the relationship between social cognitive domains and participation. The majority suffered from minor stroke (83.1% scored NIHSS 0-4). Only behaviour regulation was related to participation restrictions in bivariate analysis, but social cognitive impairments did not predict participation restrictions in multivariate regression in this group. To conclude, in a sample of minor stroke patients with mild impairments in theory of mind, emotion recognition and behavioural control, there were no associations with restrictions in participation. Research should examine whether a relationship is present in patients with more severe stroke. In addition, measuring social aspects of participation is necessary to further unravel this relationship, to determine treatment targets for improving participation.

Intensive and standard group-based treatment for persons with social communication difficulties after an acquired brain injury: study protocol for a randomised controlled trial

INTRODUCTION

Social communication difficulties (SCDs) occur frequently after an acquired brain injury (ABI) and have disabling consequences, but effective interventions are scant. Group Interactive Structured Treatment (GIST) is a holistic group treatment targeting SCD that has received empirical support.

OBJECTIVE

To determine the efficacy of two GIST protocols, standard GIST and a newly developed intensive GIST, comparing standard GIST results to a wait-list control group (WL), as well as to intensive GIST received by participants following WL. The within subject results for WL and intensive GIST will also be examined.

METHODS AND ANALYSIS

Sixty adults (18-75 years) with SCD after ABI will be recruited for this randomised controlled trial. Standard GIST (n=30) will be delivered via outpatient sessions for 2.5 hours once per week for 12 weeks, plus one initial orientation session. Participants will be assessed at preintervention and postintervention and at 3-month and 6-month follow-ups (T1-T4). Intensive GIST (n=30) participants will be admitted to an inpatient rehabilitation unit for 4 weeks (two times 3 days/week, two times 4 days/week) and receive full-day sessions each week. Those participants will complete four assessments (T1-T4) in 12-week intervals as part of WL, assessments preintensive and postintensive GIST and at 3-month and 6-month follow-ups (T4-T7). The primary outcome measure is the La Trobe Questionnaire (self-report). Secondary outcome measures include the Profile of Pragmatic Impairment in Communication, a test of emotion recognition, the Goal Attainment Scale and questionnaires addressing social, emotional and cognitive functions, self-efficacy and quality of life.

ETHICS AND DISSEMINATION

Results will be communicated through international, peer-reviewed and popular science journals and presentations at scientific conferences. The study is approved by the Regional Committees for Medical and Health Research Ethics Norway (2017/1360). The trial will be conducted in accordance with the Declaration of Helsinki and reported in accordance with the Consolidated Standards of Reporting Trials 2010 statement and Standard Protocol Items: Recommendations for Interventional Trials recommendations.

TRIAL REGISTRATION NUMBER

NCT03636399.

Social communication following traumatic brain injury part 2: Identifying effective treatment ingredients

PURPOSE

Social communication deficits are a severely debilitating aspect of traumatic brain injury (TBI), and there is strong clinical and research interest in how social communication interventions work for this population. Informed by a companion paper targeting assessment of social communication impairments post-TBI, this paper reviews relevant treatment theories and provides an inventory of social communication treatment components.

METHOD

We completed a mapping review examining 17 articles from recent literature reviews and 4 updated articles from a literature search to identify treatment targets and ingredients using the Rehabilitation Treatment Specification System (RTSS).

RESULT

Social communication interventions are primarily based on behavioural and cognitive treatment theories. Common social communication treatment targets include changing skilled behaviours and cognitive or affective representations. We offer a menu of therapeutic ingredients and treatment considerations which represent the current state of social communication interventions.

CONCLUSION

By reviewing the social communication intervention literature through a theoretical lens, we identify which treatment targets are missing, which targets are being addressed, and which therapeutic ingredients (i.e. clinician activities) are recommended. A hypothetical case study is provided as a supplement to demonstrate how speech-language pathologists may integrate treatment theory, ingredients, and targets into clinical practice.

Social cognition impairments are associated with behavioural changes in the long term after stroke

BACKGROUND AND PURPOSE

Behavioural changes after stroke might be explained by social cognition impairments. The aim of the present study was to investigate whether performances on social cognition tests (including emotion recognition, Theory of Mind (ToM), empathy and behaviour regulation) were associated with behavioural deficits (as measured by proxy ratings) in a group of patients with relatively mild stroke.

METHODS

Prospective cohort study in which 119 patients underwent neuropsychological assessment with tests for social cognition (emotion recognition, ToM, empathy, and behaviour regulation) 3-4 years post stroke. Test scores were compared with scores of 50 healthy controls. Behavioural problems were assessed with the Dysexecutive Questionnaire (DEX) self rating and proxy rating scales. Pearson correlations were used to determine the relationship between the social cognition measures and DEX scores.

RESULTS

Patients performed significantly worse on emotion recognition, ToM and behaviour regulation tests than controls. Mean DEX-self score did not differ significantly from the mean DEX-proxy score. DEX-proxy ratings correlated with tests for emotion recognition, empathy, and behavioural regulation (lower scores on these items were associated with more problems on the DEX-proxy scale).

CONCLUSIONS

Social cognition impairments are present in the long term after stroke, even in a group of mildly affected stroke patients. Most of these impairments also turned out to be associated with a broad range of behavioural problems as rated by proxies of the patients. This strengthens the proposal that social cognition impairments are part of the underlying mechanism of behavioural change. Since tests for social cognition can be administered in an early stage, this would allow for timely identification of patients at risk for behavioural problems in the long term.

Social cognition and emotion regulation: a multifaceted treatment (T-ScEmo) for patients with traumatic brain injury

BACKGROUND

Many patients with moderate to severe traumatic brain injury have deficits in social cognition. Social cognition refers to the ability to perceive, interpret, and act upon social information. Few studies have investigated the effectiveness of treatment for impairments of social cognition in patients with traumatic brain injury. Moreover, these studies have targeted only a single aspect of the problem. They all reported improvements, but evidence for transfer of learned skills to daily life was scarce. We evaluated a multifaceted treatment protocol for poor social cognition and emotion regulation impairments (called T-ScEmo) in patients with traumatic brain injury and found evidence for transfer to participation and quality of life.

PURPOSE

In the current paper, we describe the theoretical underpinning, the design, and the content of our treatment of social cognition and emotion regulation (T-ScEmo).

THEORY INTO PRACTICE

The multifaceted treatment that we describe is aimed at improving social cognition, regulation of social behavior and participation in everyday life. Some of the methods taught were already evidence-based and derived from existing studies. They were combined, modified, or extended with newly developed material.

PROTOCOL DESIGN

T-ScEmo consists of 20 one-hour individual sessions and incorporates three modules: (1) emotion perception, (2) perspective taking and theory of mind, and (3) regulation of social behavior. It includes goal-setting, psycho-education, function training, compensatory strategy training, self-monitoring, role-play with participation of a significant other, and homework assignments.

RECOMMENDATIONS

It is strongly recommended to offer all three modules, as they build upon each other. However, therapists can vary the time spent per module, in line with the patients' individual needs and goals. In future, development of e-learning modules and virtual reality sessions might shorten the treatment.

Social cognitive training for adults with Noonan syndrome: a feasibility study

PURPOSE

Noonan syndrome (NS) is a genetic disorder that is associated with social cognitive problems. While treatment aimed at the improvement of social cognition is available for other neuropsychiatric disorders, no such interventions yet exist for NS patients. In this study, the development of the first social cognitive training for NS patients is described and its applicability and feasibility evaluated.

METHODS

Eleven adult patients with NS participated in this controlled proof-of-principle study. Six patients were included in the treatment group and five in the control group. Neuropsychological testing was performed in both groups at baseline and posttreatment. Social cognition was a primary outcome measure and nonsocial cognition and psychopathology secondary outcome measures. Differences between pre- and posttest were investigated with Wilcoxon signed-rank tests, and a process evaluation was performed to aid interpretation of the results.

RESULTS

Both groups were comparable with regard to age, estimated intelligence, and baseline performance. Although no significant differences were found between pre- and posttest scores on primary and secondary outcome measures in either group, a medium-large effect size was found on emotion recognition in the treatment group. Also, the process evaluation demonstrated the feasibility of the training.

CONCLUSION

This first social cognitive training for adult patients with NS has proven to be feasible for this population and showed some encouraging results regarding emotion recognition, although the training protocol could be optimized. Further investigation is required using a randomized controlled design in a larger sample, in order to substantiate the overall effectiveness of the training.

Rehabilitation of social cognition impairment after traumatic brain injury: A systematic review

INTRODUCTION

Many studies have described the presence of difficulty processing and generating social behaviour in patients who have suffered a traumatic brain injury (TBI). These difficulties in social cognition (SC) deteriorate personal relationships in the family, at work, or in the community. However, therapeutic programmes aiming to improve SC continue to be an outstanding issue in clinical practice. We performed a systematic review of the existing literature on the recovery of SC in patients with TBI, assessing the methodological quality of the included studies and the therapeutic effectiveness of the rehabilitation strategies used.

DEVELOPMENT

We performed a bibliographic search of papers published before June 2018 in the Medline/PubMed, Google Scholar, PsycINFO, and ClinicalTrials.gov databases. Of the 198 potentially relevant articles, 10 met our eligibility criteria. Two of the authors independently and blindly assessed the methodological quality of these studies using the PEDro scale.

CONCLUSIONS

The articles included in this systematic review essentially studied the effect of different interventions aimed at the rehabilitation of SC in patients with chronic TBIs. The analysis showed adequate methodological quality and an acceptable level of evidence. Future research should analyse the effect of these interventions in patients with TBIs in the sub- and post-acute phases.

Treatment of social cognition impairments in patients with traumatic brain injury: a critical review

Objective: The aim of this study is to review published research on treatment of social cognition impairments in patients with traumatic brain injury (TBI).Methods: Following the PRISMA guidelines, a PubMed literature search was conducted, followed by a manual search in recently published papers. Main criteria for selection were that patients had sustained a TBI, and that social cognition was the main target of treatment. A total of 16 papers and three reviews were selected and included in the present review.Results: Five studies (including three randomized controlled trials (RCT)) addressed facial affect recognition, one study specifically addressed emotional prosody, two RCTs used a combination of treatment strategies addressing social perception deficits. Six studies, including two RCTs, addressed social communication skills or theory of mind. Finally, two RCTs reported the effectiveness of a more global approach, addressing multiple domains of social cognition, such as emotion perception, social skills training, and theory of mind.Discussion/conclusion: Although there has been much less research on treatment of social cognition in patients with TBI as compared with psychiatric conditions, the findings reported in the present review are encouraging. Further multicenter large-scale RCTs are needed, with special emphasis on the generalization of treatment effects to social skills in everyday life.

Empathic Responses to Affective Film Clips Following Brain Injury and the Association With Emotion Recognition Accuracy

OBJECTIVE

To compare empathic responses to affective film clips in participants with traumatic brain injury (TBI) and controls, and examine associations with affect recognition.

DESIGN

Cross sectional study using a quasi-experimental design.

SETTING

Multi-site study conducted at a postacute rehabilitation facility in the United States and a university in Canada.

PARTICIPANTS

Adults (N=120) with moderate to severe TBI (n=60) and those without TBI (n=60), frequency matched for age and sex. Average time postinjury was 14 years (range: .5-37).

MAIN OUTCOME MEASURES

Participants were shown affective film clips and asked to report how the main character in the clip felt and how they personally felt in response to the clip. Empathic responses were operationalized as participants feeling the same emotion they identified the character to be feeling.

RESULTS

Participants with TBI had lower emotion recognition scores (P=.007) and fewer empathic responses than controls (67% vs 79%; P<.001). Participants with TBI accurately identified and empathically responded to characters' emotions less frequently (65%) than controls (78%). Participants with TBI had poorer recognition scores and fewer empathic responses to sad and fearful clips compared to controls. Affect recognition was associated with empathic responses in both groups (P<.001). When participants with TBI accurately recognized characters' emotions, they had an empathic response 71% of the time, which was more than double their empathic responses for incorrectly identified emotions.

CONCLUSIONS

Participants with TBI were less likely to recognize and respond empathically to others' expressions of sadness and fear, which has implications for interpersonal interactions and relationships. This is the first study in the TBI population to demonstrate a direct association between an affect stimulus and an empathic response.