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Pepping N, Weinborn M, Pestell CF, Preece DA, Malkani M, Moore S, Gross JJ, Becerra R. Improving emotion regulation ability after brain injury: A systematic review of targeted interventions. Neuropsychol Rehabil 2024:1-41. [PMID: 39230344 DOI: 10.1080/09602011.2024.2398029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/25/2024] [Indexed: 09/05/2024]
Abstract
Emotion dysregulation is a common sequela after a brain injury, and it can have serious negative consequences for individuals, families, and the community. A systematic review of the literature was conducted to identify and evaluate interventions designed to improve emotion regulation ability in adults with acquired brain injury. Studies were identified on ProQuest, PsycInfo, ScienceDirect, Scopus, and Web of Science; last searched on 3 August 2023. A review protocol was prospectively registered on PROSPERO (CRD42020218175). Risk of bias was assessed using the Cochrane Risk-of-Bias tool (version 2). Sixteen studies were included in the review comprising one case series, five pilot studies, four pre-post studies, and six RCTs. There was a total of 652 participants across studies. Fourteen of the sixteen studies reported statistically significant improvements in at least one emotional functioning variable. Ten studies reported medium-large effect sizes. Limitations included inconsistency in the measurement, reporting of intervention outcomes and processes. Future directions are discussed.
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Affiliation(s)
- Natalie Pepping
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Michael Weinborn
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Carmela F Pestell
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - David A Preece
- School of Psychological Science, The University of Western Australia, Perth, Australia
- School of Population Health, Curtin University, Perth, Australia
- Psychological Sciences Research Institute, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Maya Malkani
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Sammy Moore
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Rodrigo Becerra
- School of Psychological Science, The University of Western Australia, Perth, Australia
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2
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MacKenzie HM, Flores-Sandoval C, Bateman EA, McIntyre A, Barua U, Mehta S, Bayley M, Teasell R. Evidence-Based Review of Randomized Controlled Trials of Interventions for the Management of Behavioral Issues in Individuals With Moderate to Severe Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:369-381. [PMID: 39256158 DOI: 10.1097/htr.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVE To present an evidence-based review of randomized controlled trials (RCTs) evaluating interventions for the management of behavioral issues post moderate to severe traumatic brain injury (MSTBI), as part of an extensive database that has been conceptualized as a living systematic review. METHODS Systematic searches were conducted in MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO, up to and including December 2022, for articles published in the English language, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of RCT was assessed using the Physiotherapy Evidence Database (PEDro) scale, and level of evidence was assigned using a modified Sackett scale. RESULTS Forty-six RCTs examining interventions and outcome measures related to behavioral issues post-MSTBI were included. These studies collectively enrolled 3,267 participants. The majority of RCTs were conducted in the United States (n = 27; 58.7%) and 28 (60.9%) were conducted after 2010. Of these, 27 RCTs examined non-pharmacological interventions and 19 examined pharmacological interventions. Effective pharmacological treatments included amantadine and dexmedetomidine. Effective non-pharmacological interventions included sensory stimulation in the acute phase, anger self-management programs, peer mentoring, problem-solving, and emotional regulation. Psychotherapy showed conflicting evidence. CONCLUSION This evidence-based review provides a comprehensive overview of the research landscape of RCTs addressing behavior post-MSTBI. The findings from these RCTs may be valuable for health care professionals, researchers, and policymakers involved in the field of TBI and behavior.
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Affiliation(s)
- Heather M MacKenzie
- Author Affiliations : Parkwood Institute Research, Lawson Health Research Institute (Dr MacKenzie, Dr Flores-Sandoval, Dr Bateman, Barua, Dr Mehta); Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario (Dr MacKenzie, Dr Bateman, Dr Mehta); Parkwood Institute, St. Joseph's Health Care London, London (Dr MacKenzie, Dr Flores-Sandoval, Dr Bateman); Arthur Labatt School of Nursing, Western University, London, Ontario (Dr McIntyre); Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto (Dr Bayley); KITE Research Institute, University Health Network, Toronto (Dr Bayley); and University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario (Dr Bayley)
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3
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Guala T, Harries T, Button K, de Andrade D, Miller P, Tonner L, Hill H, Langbein A, Curtis A. Evaluating social rehabilitation of aggression for persons with Acquired Brain Injury: a systematic review. Disabil Rehabil 2024:1-16. [PMID: 39033395 DOI: 10.1080/09638288.2024.2380475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
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.
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Affiliation(s)
- Tahnee Guala
- School of Psychology, Deakin University, Geelong, Australia
| | - Travis Harries
- School of Psychology, Deakin University, Geelong, Australia
| | - Kira Button
- School of Psychology, Deakin University, Geelong, Australia
| | - Dominique de Andrade
- School of Psychology, Deakin University, Geelong, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Australia
- School of Psychology, University of Queensland, Brisbane, Australia
- Griffith Centre for Mental Health, Griffith University, Brisbane, Australia
| | - Peter Miller
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Harry Hill
- Albury Wodonga Health, Wangaratta, Australia
- School of Medicine, Deakin University, Geelong, Australia
| | | | - Ashlee Curtis
- School of Psychology, Deakin University, Geelong, Australia
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4
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Filipčíková M, Wearne T, McDonald S. Disinhibited and angry: Investigating the relationship between social disinhibition and the components of aggression following severe TBI. Neuropsychol Rehabil 2024; 34:23-44. [PMID: 36445855 DOI: 10.1080/09602011.2022.2149560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
Social disinhibition and aggression share many similarities. But unlike with aggression, research evidence about social disinhibition following severe traumatic brain injury (TBI) is limited and treatments are missing. Establishing the association between aggression and social disinhibition would facilitate a better conceptualization of these disorders. This study aimed to determine the relationship between social disinhibition and aggression following severe TBI.In this case-control study, 25 individuals with severe TBI and 25 control participants completed the Buss-Perry Aggression Questionnaire (BPAQ), Frontal Systems Behaviour Scale (FrSBe), and Social Disinhibition Interview (SDI).Hierarchical multiple regression analyses revealed that, when controlling for covariates, the inclusion of BPAQ Anger in the model led to a 13% increase in proportion of explained variance of social disinhibition (Adjusted R2 increased from .243 to .363, p < .005). BPAQ Anger was not a significant predictor of SDI scores. Similarly, BPAQ Physical aggression scores did not contribute to the prediction of FrSBe Disinhibition or SDI scores.In conclusion, higher levels of self-reported anger (but no other components of aggression) are associated with higher levels of self-reported social disinhibition. While these findings have potential implications for the treatment of social disinhibition, further research into the possible relationship with aggression should be conducted.
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Affiliation(s)
| | - Travis Wearne
- School of Psychology, University of New South Wales, Sydney, Australia
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
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5
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Watson E, Raghavendra P, Lawn S, Watson J. Improving communication access in psychoeducational interventions for people with complex communication needs: a scoping review and stakeholder consultation. Disabil Rehabil 2023; 45:3388-3406. [PMID: 36172972 DOI: 10.1080/09638288.2022.2127932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/11/2022] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Psychoeducational interventions are commonly used to improve mental health among the general population; however, their application among people with complex communication needs is under explored. This scoping review aims to identify the psychoeducational interventions utilised with people with complex communication needs, any adaptations to improve communication access, and outcomes for this population. MATERIALS AND METHODS The scoping review was conducted using the Arksey and O'Malley guidelines and included stakeholder consultations. A systematic search of the literature was conducted. Stakeholder consultations were conducted via semi-structured interviews with informants from three populations: people with complex communication needs, everyday communication partners and mental health workers. RESULTS The search yielded 2112 articles. Twenty-four articles were retained for data extraction. Numerical analysis provided an overview of the existing literature. Thematic analysis highlighted the range of communication access strategies applied within psychoeducational interventions. Common aims and outcomes of interventions occurred across three interrelated themes: education, symptom reduction, and improved coping and wellbeing. Stakeholder consultations enabled contextualisation of literature. CONCLUSIONS People with complex communication needs may benefit from psychoeducational interventions when effective, personalised communication access strategies are employed. Future research should include lived-experience perspectives to ensure the relevance of communication access strategies in mental health support.Implications for rehabilitationThis scoping review adds to the evidence base supporting equitable access to mental health support for people with complex communication needs.A range of specific strategies are presented for mental health workers to consider when working with people with complex communication needs.Positive behaviour support (PBS) practitioners must be equipped to address the psychoeducational and mental health support requirements of people with complex communication needs.
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Affiliation(s)
- Eleanor Watson
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Parimala Raghavendra
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- College of Medicine & Public Health, Flinders University, Adelaide, Australia
| | - Joanne Watson
- School of Health & Social Development, Deakin University, Melbourne, Australia
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6
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Witten JA, Coetzer R, Rowlands L, Turnbull OH. "Talk and Chalk": An emotion regulation intervention for anger after acquired brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-16. [PMID: 37339498 DOI: 10.1080/23279095.2023.2224481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Uncontrollable anger is a debilitating consequence of acquired brain injury (ABI). This proof-of-concept study investigated the preliminary efficacy of an emotion regulation intervention for managing post-ABI anger. A secondary objective was to determine which participant characteristics were related to intervention gains. With a pre-post intervention design and three-month follow-up, there were five individually administered meetings on Zoom, over a four-month period. 24 adults who had sustained an ABI were enrolled. Participants were mostly males, from 24 to 85 years old. A series of one-way repeated-measures ANOVAs were conducted to determine the intervention's efficacy, and Spearman's rho bivariate correlations for the association between participant characteristics and intervention gains. Significant differences were observed in external anger from baseline to post-treatment; there were no further changes from post-treatment to follow-up. Of the participant characteristics, only readiness to change and anxiety were correlated. The proposed intervention presents a brief, feasible, and preliminary efficacious alternative for regulating post-ABI anger. Intervention gains are associated with readiness to change and anxiety, which has important implications for clinical delivery.
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Affiliation(s)
| | - Rudi Coetzer
- Department of Psychology, Bangor University, Bangor, United Kingdom
- The Disabilities Trust, Wakefield, United Kingdom
- Faculty of Medical, Life and Health Science, Swansea University, Swansea, United Kingdom
| | - Leanne Rowlands
- School of Psychology, Arden University, Coventry, United Kingdom
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Hart T, Maiuro RD, Fann JR, Vaccaro MJ, Chervoneva I. Predictors of Treatment Response to a Psychoeducational Intervention for Anger in Chronic Moderate-Severe Traumatic Brain Injury. J Neuropsychiatry Clin Neurosci 2022; 35:158-164. [PMID: 35989575 DOI: 10.1176/appi.neuropsych.21110279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The investigators examined predictors of treatment response to anger self-management training (ASMT) among patients with chronic moderate-severe traumatic brain injury (TBI). METHODS A multicenter randomized clinical trial comprising 90 participants with moderate-severe TBI was conducted. Fifty-four participants who were randomly assigned to receive active treatment and provided complete data were included in the current secondary analysis. Model averaging was used to examine the relative importance and significance of pretreatment variables for predicting change during treatment. Dependent variables were pre- to posttreatment changes in trait anger (TA) and anger expression-out (AX-O) subscale scores of the State-Trait Anger Expression Inventory-Revised. Predictors included demographic, injury-related, and neuropsychological variables, including both objective and self-reported measures of executive function, as well as readiness to change and participation of a significant other in treatment. RESULTS Change in both dependent variables was predicted by higher baseline anger. Greater change in TA was additionally predicted by White race, higher education, shorter posttraumatic amnesia, and worse self-reported (but not objectively measured) executive dysfunction; the latter predictor may have indicated better self-awareness. Greater change in AX-O was additionally predicted by better episodic memory and, paradoxically, lower readiness to change. CONCLUSIONS Further research should focus on adapting psychoeducational anger treatments to better serve the diverse populations affected by moderate-severe TBI. These findings suggest that providing memory aids to support the use of learned strategies after treatment cessation would be beneficial. Further research should also examine the construct of readiness to change and specific aspects of executive function that may affect treatment response in psychoeducational treatments. These findings were derived from only one model of anger intervention, and the relevance to other treatment approaches cannot be assumed.
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Affiliation(s)
- Tessa Hart
- Moss Rehabilitation Research Institute, Elkins Park, Pa. (Hart, Vaccaro); private practice, Seattle (Maiuro); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Fann); Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia (Chervoneva)
| | - Roland D Maiuro
- Moss Rehabilitation Research Institute, Elkins Park, Pa. (Hart, Vaccaro); private practice, Seattle (Maiuro); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Fann); Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia (Chervoneva)
| | - Jesse R Fann
- Moss Rehabilitation Research Institute, Elkins Park, Pa. (Hart, Vaccaro); private practice, Seattle (Maiuro); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Fann); Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia (Chervoneva)
| | - Monica J Vaccaro
- Moss Rehabilitation Research Institute, Elkins Park, Pa. (Hart, Vaccaro); private practice, Seattle (Maiuro); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Fann); Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia (Chervoneva)
| | - Inna Chervoneva
- Moss Rehabilitation Research Institute, Elkins Park, Pa. (Hart, Vaccaro); private practice, Seattle (Maiuro); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Fann); Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia (Chervoneva)
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8
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Emotional Disturbances After Traumatic Brain Injury: Prevalence, Assessment, and Treatment. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00311-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Mitchell T, du Preez E, Theadom A. An intervention to improve coping strategies in adult male prisoners with a history of traumatic brain injury: A pilot randomised clinical trial. Clin Rehabil 2021; 35:1185-1195. [PMID: 33706573 DOI: 10.1177/0269215521998535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether a psychological intervention improves coping, post-concussion symptoms and decreases in-prison infractions in adult males with a history of traumatic brain injury. DESIGN A single centre, randomised, wait-list, pilot study. SETTING A high security prison in New Zealand. SUBJECTS Fifty-five adult male participants who had experienced at least one traumatic brain injury in their lifetime (mean age 37.29 +/-9.81 years). INTERVENTION A manualised ten session, in-person, group based combined Cognitive Behavioural Therapy /Mindfulness Based Stress Reduction intervention versus wait list control. MAIN MEASURES The Negative Affect Repair Questionnaire and Rivermead Post-concussion Symptom Questionnaire were completed at baseline, post-intervention (five weeks) and at 12 week follow up. In-prison misconduct charges and negative file notes were reviewed for the previous five weeks at each assessment time point. RESULTS There was an improvement in the use of calming and distraction strategies in the intervention group from baseline (x̄ = 17.38, SD = 3.57) to post-intervention (x̄ = 18.67, SD = 3.84) and 12-week follow up (x̄ = 18.13, SD = 2.63). Participants in the intervention group had significantly higher negative affect repair on the calming and distractive strategies subscale following completion of the intervention, compared to wait-list controls (F = 4.69, P = 0.04) with a moderate effect size (ηp2 = 0.11). Improvements in use of calming and distractive strategies was not sustained at the twelve-week follow-up (F = 0.87, P = 0.36). There was no-significant improvement on other negative affect subscales or for post-concussion symptoms or decrease in-prison infractions. CONCLUSION A manualised psychological intervention may have the potential to facilitate the development of positive coping strategies in prisoners with a history of traumatic brain injury.
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Affiliation(s)
| | - Elizabeth du Preez
- Department of Psychology, School of Clinical Sciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Department of Psychology, School of Clinical Sciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand.,TBI Network, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
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10
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Di Vita A, Procacci MA, Bellagamba M, Jacomini M, Massicci R, Ciurli MP. Psychotherapy and Art Therapy: A pilot study of group treatment for patients with traumatic brain injury. J Health Psychol 2020; 27:836-846. [PMID: 33138657 DOI: 10.1177/1359105320967099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Here we investigated the efficacy of group Psychotherapy and Art Therapy in rebuilding self-identity after traumatic brain injury (TBI), assessing their effects on psychological aspects in twelve patients with severe TBI. Overall, the results show an increased ability to adapt to the experiences of life as well as a higher level of awareness, social functioning and emotional autoregulation. Furthermore, patients exhibited a reduction in depressive symptoms and in the perception of physical problems. Results highlight the importance of treatments focusing on the patients' emotional needs, in addition to the classic rehabilitation (i.e. physiotherapy, cognitive therapy).
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Affiliation(s)
- Antonella Di Vita
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Mario Augusto Procacci
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy.,Hairam Onlus Association, Rome, Italy.,SIFP - Scuola Italiana per la Formazione in Psicoterapia, Rome, Italy
| | - Martina Bellagamba
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Maria Jacomini
- Hairam Onlus Association, Rome, Italy.,Specialization in Arts for therapy, Accademia delle Belle Arti, Rome, Italy.,SIPEA - Scuola di Specializzazione in Artiterapie, Rome, Italy
| | - Roberta Massicci
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Maria Paola Ciurli
- Neuropsychological Diagnosis and Rehabilitation Unit, IRCCS Santa Lucia Foundation, Rome, Italy
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11
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Cicerone KD, Goldin Y, Ganci K, Rosenbaum A, Wethe JV, Langenbahn DM, Malec JF, Bergquist TF, Kingsley K, Nagele D, Trexler L, Fraas M, Bogdanova Y, Harley JP. Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014. Arch Phys Med Rehabil 2019; 100:1515-1533. [DOI: 10.1016/j.apmr.2019.02.011] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
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12
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Iruthayarajah J, Alibrahim F, Mehta S, Janzen S, McIntyre A, Teasell R. Cognitive behavioural therapy for aggression among individuals with moderate to severe acquired brain injury: a systematic review and meta-analysis. Brain Inj 2018; 32:1443-1449. [PMID: 29985654 DOI: 10.1080/02699052.2018.1496481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Aggression is common after an acquired brain injury (ABI). Cognitive behavioural therapy (CBT) is a form of psychotherapy, in which therapists help patients to identify their maladaptive behaviours. OBJECTIVE The objective of this systematic review and meta-analysis was to evaluate the effectiveness of CBT interventions in treating aggression in an ABI population. METHODS A systematic literature search was conducted using: PubMed/MEDLINE, CINAHL, EMBASE and PsycINFO from database inception to August 2016. English articles were included if: at least 50% of the study sample had a moderate to severe ABI, there were at least three adult human participants, and use of a CBT intervention for the treatment of aggression. RESULTS Seven articles met inclusion criteria: one RCT, an RCT crossover and five pre-post trials. Of these, four articles were included in a pre-post meta-analysis for treatment efficacy on subscales of the State Trait Anger Expression Inventory (STAXI) and STAXI-2 outcome measures. The meta-analysis found CBT was effective in moderating the external behaviours of aggression, but not internal anger. CONCLUSION The differences in outcomes may be related to the differential management of anger expression and anger suppression. CBT shows promise, but further studies with comparator groups are needed before conclusions about its efficacy can be made.
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Affiliation(s)
| | - Fatimah Alibrahim
- a Lawson Health Research Institute , Parkwood Institute , London , ON , Canada
| | - Swati Mehta
- a Lawson Health Research Institute , Parkwood Institute , London , ON , Canada
| | - Shannon Janzen
- a Lawson Health Research Institute , Parkwood Institute , London , ON , Canada
| | - Amanda McIntyre
- a Lawson Health Research Institute , Parkwood Institute , London , ON , Canada
| | - Robert Teasell
- a Lawson Health Research Institute , Parkwood Institute , London , ON , Canada.,b St. Joseph's Health Care , Parkwood Institute , London , ON , Canada.,c Schulich School of Medicine and Dentistry , University of Western Ontario , London , ON , Canada
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13
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Neumann D, Malec JF, Hammond FM. Reductions in Alexithymia and Emotion Dysregulation After Training Emotional Self-Awareness Following Traumatic Brain Injury: A Phase I Trial. J Head Trauma Rehabil 2018; 32:286-295. [PMID: 28060205 PMCID: PMC5498277 DOI: 10.1097/htr.0000000000000277] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the acceptability and initial efficacy of an emotional self-awareness treatment at reducing alexithymia and emotion dysregulation in participants with traumatic brain injury (TBI). SETTING An outpatient rehabilitation hospital. PARTICIPANTS Seventeen adults with moderate to severe TBI and alexithymia. Time postinjury ranged 1 to 33 years. DESIGN Within subject design, with 3 assessment times: baseline, posttest, and 2-month follow-up. INTERVENTION Eight lessons incorporated psychoeducational information and skill-building exercises teaching emotional vocabulary, labeling, and differentiating self-emotions; interoceptive awareness; and distinguishing emotions from thoughts, actions, and sensations. MEASURES Toronto Alexithymia Scale-20 (TAS-20); Levels of Emotional Awareness Scale (LEAS); Trait Anxiety Inventory (TAI); Patient Health Questionnaire-9 (PHQ-9); State-Trait Anger Expression Inventory (STAXI); Difficulty With Emotion Regulation Scale (DERS); and Positive and Negative Affect Scale (PANAS). RESULTS Thirteen participants completed the treatment. Repeated-measures analysis of variance revealed changes on the TAS-20 (P = .003), LEAS (P < .001), TAI (P = .014), STAXI (P = .015), DERS (P = .020), and positive affect (P < .005). Paired t tests indicated significant baseline to posttest improvements on these measures. Gains were maintained at follow-up for the TAS, LEAS, and positive affect. Treatment satisfaction was high. CONCLUSION This is the first study published on treating alexithymia post-TBI. Positive changes were identified for emotional self-awareness and emotion regulation; some changes were maintained several months posttreatment. Findings justify advancing to the next investigational phase for this novel intervention.
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Affiliation(s)
- Dawn Neumann
- Indiana University School of Medicine, Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital of Indiana, 4141 Shore Drive, Indianapolis, IN 46254, , Phone: 317-329-2188
| | - James F. Malec
- Indiana University School of Medicine, Department of Physical, Medicine and Rehabilitation, Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Flora M. Hammond
- Indiana University School of Medicine, Department of Physical, Medicine and Rehabilitation, Chief of Medical Affairs, Rehabilitation Hospital of Indiana, Indianapolis, IN
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14
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Anger Self-Management Training for Chronic Moderate to Severe Traumatic Brain Injury: Results of a Randomized Controlled Trial. J Head Trauma Rehabil 2018; 32:319-331. [PMID: 28520666 DOI: 10.1097/htr.0000000000000316] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
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.
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Kalkstein S, Scott JC, Vickers Smith R, Cruz J. Effectiveness of an anger control program among veterans with PTSD and other mental health issues: A comparative study. J Clin Psychol 2018; 74:1422-1430. [PMID: 29696635 DOI: 10.1002/jclp.22631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 02/20/2018] [Accepted: 02/21/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study examines the effectiveness of an anger management program among veterans with posttraumatic stress disorder (PTSD) and other mental health issues. METHOD Veterans with (n = 76) and without (n = 58) PTSD completed anger management groups at the Crescenz Veterans Affairs Medical Center. Self-rated checklists of anger and PTSD symptoms (for those with PTSD) were completed before and after the group. RESULTS Significant improvement in anger was observed in the overall sample (p < .001) but did not differ based on PTSD diagnosis. No significant PTSD symptom changes were observed. CONCLUSIONS Veterans with broad mental health concerns benefited significantly from this anger management program, consistent with prior research. Implications for program improvement and future research are discussed.
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Affiliation(s)
- Solomon Kalkstein
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James Cobb Scott
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Jourdan Cruz
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
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21st Century Cognitive Behavioural Therapy for Anger: A Systematic Review of Research Design, Methodology and Outcome. Behav Cogn Psychother 2018; 46:385-404. [DOI: 10.1017/s1352465818000048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background:Past reviews of cognitive behavioural therapy (CBT) for anger have focused on outcome in specific subpopulations, with few questions posed about research design and methodology. Since the turn of the century, there has been a surge of methodologically varied studies awaiting systematic review.Aims:The basic aim was to review this recent literature in terms of trends and patterns in research design, operationalization of anger, and covariates such as social desirability bias (SDB). Also of interest was clinical outcome.Method:After successive culling, 42 relevant studies were retained. These were subjected to a rapid evidence assessment (REA) with special attention to design (ranked on the Scientific Methods Scale) measurement methodology (self-monitored behaviour, anger questionnaires, and others’ ratings), SDB assessment, and statistical versus clinical significance.Results:The randomized controlled trial characterized 60% of the studies, and the State Trait Anger Expression Inventory was the dominant measure of anger. All but one of the studies reported statistically significant outcome, and all but one of the 21 studies evaluating clinical significance laid claim to it. The one study with neither statistical nor clinical significance was the only one that had assessed and corrected for SDB.Conclusions:Measures remain relatively narrow in scope, but study designs have improved, and the outcomes suggest efficacy and clinical effectiveness. In conjunction with previous findings of an inverse relationship between anger and SDB, the results raise the possibility that the favourable picture of CBT for anger may need closer scrutiny with SDB and other methodological details in mind.
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Verberne DPJ, Spauwen PJJ, van Heugten CM. Psychological interventions for treating neuropsychiatric consequences of acquired brain injury: A systematic review. Neuropsychol Rehabil 2018; 29:1509-1542. [DOI: 10.1080/09602011.2018.1433049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Daan P. J. Verberne
- Department of Acquired Brain Injury, GGZ Oost Brabant, Boekel, the Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Maastricht, the Netherlands
| | - Peggy J. J. Spauwen
- Department of Acquired Brain Injury, GGZ Oost Brabant, Boekel, the Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Caroline M. van Heugten
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Winter L, Moriarty HJ, Short TH. Beyond anger: emotion regulation and social connectedness in veterans with traumatic brain injury. Brain Inj 2018; 32:593-599. [DOI: 10.1080/02699052.2018.1432895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Laraine Winter
- Philadelphia Research and Education Foundation, Corporal Michael C. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Nursing Service, Corporal Michael C. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Helene J Moriarty
- Nursing Service, Corporal Michael C. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Villanova University College of Nursing, Villanova, PA, USA
| | - Thomas H Short
- Department of Mathematics, West Chester University of Pennsylvania, West Chester, PA, USA
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The Relations of Self-Reported Aggression to Alexithymia, Depression, and Anxiety After Traumatic Brain Injury. J Head Trauma Rehabil 2017; 32:205-213. [DOI: 10.1097/htr.0000000000000261] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mild traumatic brain injury and suicide risk among a clinical sample of deployed military personnel: Evidence for a serial mediation model of anger and depression. J Psychiatr Res 2017; 84:161-168. [PMID: 27743528 DOI: 10.1016/j.jpsychires.2016.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/29/2016] [Accepted: 10/06/2016] [Indexed: 11/20/2022]
Abstract
Research has demonstrated a robust link between traumatic brain injuries (TBIs) and suicide risk. Yet, few studies have investigated factors that account for this link. Utilizing a clinical sample of deployed military personnel, this study aimed to examine a serial meditation model of anger and depression in the association of mild TBI and suicide risk. A total of 149 military service members referred for evaluation/treatment of a suspected head injury at a military hospital participated in the present study (92.6% male; Mage = 27.9y). Self-report measures included the Suicidal Behaviors Questionnaire-Revised (SBQ-R), Automated Neuropsychological Assessment Metrics (ANAM) anger and depression subscales, and Behavioral Health Measure-20 depression subscale. A current mild TBI diagnosis was confirmed by a licensed clinical psychologist/physician. Overall, 84.6% (126/149) of participants met diagnostic criteria for a current mild TBI. Bootstrapped serial mediation analyses indicated that the association of mild TBI and suicide risk is serially mediated by anger and depression symptoms (bias-corrected 95% confidence interval [CI] for the indirect effect = 0.044, 0.576). An alternate serial mediation model in which depression symptoms precede anger was not statistically significant (bias-corrected 95% CI for the indirect effect = -0.405, 0.050). Among a clinical sample of military personnel, increased anger and depression statistically mediated the association of mild TBI and suicide risk, and anger appears to precede depression in this pathway. Findings suggest that therapeutically targeting anger may serve to thwart the trajectory to suicide risk among military personnel who experience a mild TBI. Future research should investigate this conjecture within a prospective design to establish temporality.
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Rochat L, Manolov R, Aboulafia-Brakha T, Berner-Burkard C, Van der Linden M. Reducing anger outbursts after a severe TBI: a single-case study. Neuropsychol Rehabil 2016; 29:107-130. [PMID: 28007000 DOI: 10.1080/09602011.2016.1270837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Anger outbursts constitute a frequent behavioural issue after a traumatic brain injury (TBI) and have a strong negative impact on the social outcomes resulting from the TBI. However, few studies have examined the efficacy of specific intervention strategies to reduce the frequency and intensity of anger outbursts. We therefore performed a single-case study on this topic by administering two successive and complementary psychological interventions with an AB design with maintenance (first intervention) and an AC design with maintenance plus a one-month follow-up (second intervention) to a patient with a severe TBI. Whereas the first intervention focused on improving the recognition and expression of basic emotions, the second consisted of a self-regulation programme, including various features such as psychoeducation about self-control strategies, relaxation and assertiveness training that aimed to establish adequate behaviours, which were further promoted by an implementation intentions strategy in the patient's daily life. The results indicated that all interventions resulted in a reduced frequency and intensity of anger outbursts, and the data upheld the specificity of these effects. In addition, a meta-analytic integration of the effects of both interventions on the outcomes indicated a medium effect size. Further research is needed on other patients who experience long-standing anger outbursts to examine whether the observed gains can be replicated, sustained on a longer-term basis and improved.
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Affiliation(s)
- Lucien Rochat
- a Cognitive Psychopathology and Neuropsychology Unit , University of Geneva , Geneva , Switzerland.,b Swiss Centre for Affective Sciences , University of Geneva , Geneva , Switzerland
| | - Rumen Manolov
- c Department of Behavioural Sciences Methods , University of Barcelona , Barcelona , Spain.,d Institute for Brain, Cognition and Behavior (IR3C), University of Barcelona , Barcelona , Spain
| | - Tatiana Aboulafia-Brakha
- e Division of Neurorehabilitation, Department of Clinical Neurosciences , Geneva University Hospitals , Geneva , Switzerland
| | - Christina Berner-Burkard
- a Cognitive Psychopathology and Neuropsychology Unit , University of Geneva , Geneva , Switzerland.,f Neuropsychology and Speech Therapy Unit , Institution of Lavigny , Geneva , Switzerland
| | - Martial Van der Linden
- a Cognitive Psychopathology and Neuropsychology Unit , University of Geneva , Geneva , Switzerland.,b Swiss Centre for Affective Sciences , University of Geneva , Geneva , Switzerland.,g Cognitive Psychopathology Unit , University of Liège , Liège , Belgium
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Byrne C, Coetzer R. The effectiveness of psychological interventions for aggressive behavior following acquired brain injury: A meta-analysis and systematic review. NeuroRehabilitation 2016; 39:205-21. [DOI: 10.3233/nre-161352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christopher Byrne
- North Wales Brain Injury Service, Betsi Cadwaladr University, Health Board NHS Wales, UK
- School of Psychology, Bangor University, Bangor, Wales, UK
| | - Rudi Coetzer
- North Wales Brain Injury Service, Betsi Cadwaladr University, Health Board NHS Wales, UK
- School of Psychology, Bangor University, Bangor, Wales, UK
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Winegardner J, Keohane C, Prince L, Neumann D. Perspective training to treat anger problems after brain injury: Two case studies. NeuroRehabilitation 2016; 39:153-62. [DOI: 10.3233/nre-161347] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jill Winegardner
- Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, UK
| | - Clare Keohane
- Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, UK
| | - Leyla Prince
- Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, UK
| | - Dawn Neumann
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
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Wheeler S, Acord-Vira A, Davis D. Effectiveness of Interventions to Improve Occupational Performance for People With Psychosocial, Behavioral, and Emotional Impairments After Brain Injury: A Systematic Review. Am J Occup Ther 2016; 70:7003180060p1-9. [PMID: 27089290 DOI: 10.5014/ajot.115.020677] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This systematic review evaluates the effectiveness of interventions to improve occupational performance for people with psychosocial, behavioral, or emotional impairments after traumatic brain injury (TBI). METHOD Medline, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews were searched. Of the 1,512 articles initially identified, 35 met the inclusion criteria. RESULTS Six types of interventions were identified: (1) education, (2) peer mentoring, (3) goal-directed therapy, (4) physical activity, (5) skills training, and (6) cognitive-behavioral therapy (CBT). Strong evidence from well-conducted research supports the use of CBT in individual and group settings. Moderate evidence supports goal-directed interventions, aquatic exercise, and functional skills training. Limited evidence supports peer mentoring, aerobic exercise, educational interventions, and various skills training. CONCLUSION An increasing body of evidence supports specific interventions to improve occupational performance and participation for people with psychosocial, behavioral, or emotional impairments after TBI.
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Affiliation(s)
- Steven Wheeler
- Steven Wheeler, PhD, OTR/L, CBIS, is Associate Professor and Associate Chair, Division of Occupational Therapy, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown;
| | - Amanda Acord-Vira
- Amanda Acord-Vira, MOT, OTR/L, CBIS, is Assistant Professor, Division of Occupational Therapy, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown
| | - Diana Davis
- Diana Davis, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown
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Aboulafia-Brakha T, Ptak R. Effects of group psychotherapy on anger management following acquired brain injury. Brain Inj 2016; 30:1121-30. [DOI: 10.1080/02699052.2016.1174784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Patterson F, Fleming J, Doig E. Group-based delivery of interventions in traumatic brain injury rehabilitation: a scoping review. Disabil Rehabil 2016; 38:1961-86. [DOI: 10.3109/09638288.2015.1111436] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Freyr Patterson
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Jennifer Fleming
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health District, Queensland Health, Brisbane, Australia
| | - Emmah Doig
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health District, Queensland Health, Brisbane, Australia
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Wiart L, Luauté J, Stefan A, Plantier D, Hamonet J. Non pharmacological treatments for psychological and behavioural disorders following traumatic brain injury (TBI). A systematic literature review and expert opinion leading to recommendations. Ann Phys Rehabil Med 2016; 59:31-41. [PMID: 26776320 DOI: 10.1016/j.rehab.2015.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The non pharmacological approach is an important issue in the treatment of psychological and behavioural disorders in traumatic brain injury (TBI) patients. It remains nevertheless insufficiently known and defined. The objective of this work was to develop precise recommendations for caregivers and relatives. METHOD The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement, involving a systematic, critical review of the literature and the expert opinions of the French Society of Physical Medicine and Rehabilitation (SOFMER) group. RESULTS 458 articles were identified, among which 98 were selected for their relevance to the theme of the research. None of the studies reached the highest level of evidence. Fifteen controlled studies reached a relatively high level of evidence (level 2); other studies were case series or expert opinions, and other articles again were reviews of the literature and theoretical points of view. The holistic approach structured into programmes, cognitive-behavioural therapy, and family and systemic therapy, despite the low levels of proof, are recommended in first intention at all stages in the evolution of TBI. Relational and adaptive approaches, rehabilitation and vocational approaches, and psychoanalytical therapies may be useful, provided that therapists are familiar with and trained in traumatic brain injury. CONCLUSION Despite the small number of publications and a low level of proof, a number of recommendations for the non-pharmacological approach to psychological and behavioural disorders in TBI is proposed by the consensus conference of experts. Scientific research in this domain is needed to confirm and complete these first recommendations.
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Affiliation(s)
- Laurent Wiart
- Service de MPR, CHU Pellegrin, 33076 Bordeaux Cedex, France.
| | - Jacques Luauté
- Service de MPR, Hôpital Henri-Gabrielle, 69230 Saint Genis Laval, France
| | | | - David Plantier
- Service de MPR, Hôpital René-Sabran, 83400 Giens, France
| | - Julia Hamonet
- Service de MPR, Hôpital Dupuytren, 87042 Limoges cedex, France
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Sanderfer M, Johnson K. Interprofessional Providers’ Perspectives on the Effectiveness of Anger Management Programs with Court-Mandated Clients. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2015. [DOI: 10.1080/00207411.2015.1035087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hart T, Brockway JA, Fann JR, Maiuro RD, Vaccaro MJ. Anger self-management in chronic traumatic brain injury: protocol for a psycho-educational treatment with a structurally equivalent control and an evaluation of treatment enactment. Contemp Clin Trials 2014; 40:180-92. [PMID: 25530306 DOI: 10.1016/j.cct.2014.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 12/09/2014] [Accepted: 12/12/2014] [Indexed: 11/19/2022]
Abstract
Anger and irritability are important and persistent clinical problems following traumatic brain injury (TBI). Treatment options include medications, behavioral modification, and psychotherapies, but some are impractical and none have proven efficacy with this population. We describe a randomized multi-center clinical trial testing a novel, one-on-one, 8-session psychoeducational treatment program, Anger Self-Management Training (ASMT), designed specifically for people with TBI who have significant cognitive impairment. The trial is notable for its use of a structurally equivalent comparison treatment, called Personal Readjustment and Education (PRE), which was created for the study and is intended to maximize equipoise for both participants and treaters. Fidelity assessment is conducted in real time and used in therapist supervision sessions. The primary outcome is change in self-reported anger on validated measures from pre-treatment to 1 week after the final session. Secondary outcomes include participant anger as reported by a significant other; emotional distress in domains other than anger/irritability; behavioral functioning; and quality of life. An interim assessment after the 4th session will allow examination of the trajectory of any observed treatment effects, and a follow-up assessment 2 months after the end of intervention will allow examination of persistence of effects. A treatment enactment phase, in which participants are interviewed several months after the last therapy session, is designed to provide qualitative data on whether and to what extent the principles and techniques learned in treatment are still carried out in daily life.
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Affiliation(s)
- Tessa Hart
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA; Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA, USA.
| | - Jo Ann Brockway
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jesse R Fann
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Roland D Maiuro
- Seattle Anger Management and Domestic Violence Programs, Seattle, WA, USA
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Prevalence, Comorbidities, and Correlates of Challenging Behavior Among Community-Dwelling Adults With Severe Traumatic Brain Injury. J Head Trauma Rehabil 2014; 29:E19-30. [DOI: 10.1097/htr.0b013e31828dc590] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Emotional and behavioral dyscontrol are relatively common neuropsychiatric sequelae of traumatic brain injury and present substantial challenges to recovery and community participation. Among the most problematic and functionally disruptive of these types of behaviors are pathologic laughing and crying, affective lability, irritability, disinhibition, and aggression. Managing these problems effectively requires an understanding of their phenomenology, epidemiology, and clinical evaluation. This article reviews these issues and provides clinicians with brief and practical suggestions for the management of emotional and behavioral dyscontrol.
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Affiliation(s)
- David B Arciniegas
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA; Neuropsychiatry Service, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Hal S Wortzel
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Neuropsychiatry Service, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA; VISN 19 MIRECC, Denver Veterans Medical Center, Denver, CO, USA
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Evaluation of the short-term executive plus intervention for executive dysfunction after traumatic brain injury: a randomized controlled trial with minimization. Arch Phys Med Rehabil 2013; 95:1-9.e3. [PMID: 23988395 DOI: 10.1016/j.apmr.2013.08.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/07/2013] [Accepted: 08/10/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether the Short-Term Executive Plus (STEP) cognitive rehabilitation program improves executive dysfunction after traumatic brain injury (TBI). DESIGN Randomized, waitlist controlled trial with minimization and blinded outcome assessment. SETTING Community. PARTICIPANTS Participants with TBI and executive dysfunction (N=98; TBI severity 50% moderate/severe; mean time since injury ± SD, 12±14y; mean age ± SD, 45±14y; 62% women; 76% white). INTERVENTION STEP program: 12 weeks (9h/wk) of group training in problem solving and emotional regulation and individual sessions of attention and compensatory strategies training. MAIN OUTCOME MEASURES Factor analysis was used to create a composite executive function measure using the Problem Solving Inventory, Frontal Systems Behavior Scale, Behavioral Assessment of the Dysexecutive Syndrome, and Self-Awareness of Deficits Interview. Emotional regulation was assessed with the Difficulties in Emotion Regulation Scale. The primary attention measure was the Attention Rating and Monitoring Scale. Secondary measures included neuropsychological measures of executive function, attention, and memory and measures of affective distress, self-efficacy, social participation, and quality of life. RESULTS Intention-to-treat mixed-effects analyses revealed significant treatment effects for the composite executive function measure (P=.008) and the Frontal Systems Behavior Scale (P=.049) and Problem Solving Inventory (P=.016). We found no between-group differences on the neuropsychological measures or on measures of attention, emotional regulation, self-awareness, affective distress, self-efficacy, participation, or quality of life. CONCLUSIONS The STEP program is efficacious in improving self-reported post-TBI executive function and problem solving. Further research is needed to identify the roles of the different components of the intervention and its effectiveness with different TBI populations.
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Rehabilitation Approaches to the Management of Aggressive Behaviour Disorders after Acquired Brain Injury. BRAIN IMPAIR 2013. [DOI: 10.1017/brimp.2013.7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Symptoms of neurobehavioural disability acquired through brain injury, especially aggression, are associated with severe social handicap. Differences in terminology have resulted in varying estimates, but aggressive behaviour disorder appears to be characteristic of survivors at some point in their recovery journey. This paper provides a brief review regarding the prevalence, development and causes of aggression associated with acquired brain injury (ABI), and what can be done to help manage them. The advantages of using standardised measures conceptualised for ABI in the assessment and formulation of aggressive behaviour disorders are especially highlighted. A range of treatment methods and the evidence base relating to these are described. The contribution of pharmacological therapies, cognitive behavioural therapy and behavioural interventions are explored. It is argued that the strongest evidence base is associated with behaviour therapy, especially when carried out in the context of neurobehavioural rehabilitation, and two case studies are described to illustrate the clinical advantages of interventions derived from operant theory. Comparative lack of ABI experts trained in the management of post-acute behaviour disorders remains a limiting factor.
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Aboulafia-Brakha T, Greber Buschbeck C, Rochat L, Annoni JM. Feasibility and initial efficacy of a cognitive-behavioural group programme for managing anger and aggressiveness after traumatic brain injury. Neuropsychol Rehabil 2013; 23:216-33. [DOI: 10.1080/09602011.2012.747443] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Anger self-management training for people with traumatic brain injury: a preliminary investigation. J Head Trauma Rehabil 2012; 27:113-22. [PMID: 21407088 DOI: 10.1097/htr.0b013e31820e686c] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE : To examine the feasibility and gather preliminary data on the efficacy of a fully manualized, 8-session, psychoeducational treatment for irritability and anger after traumatic brain injury (TBI), called anger self-management training (ASMT). PARTICIPANTS : A total of 10 persons with moderate to severe, chronic TBI with significant cognitive impairment and elevated levels of anger and irritability participated in the study; 8 had significant others (SOs) who participated in portions of the treatment and provided pre- and posttreatment measures; 1 SO provided only data. MAIN OUTCOME MEASURE : Two subscales of the State-Trait Anger Expression Scale-Revised and Brief Anger-Aggression Questionnaire. DESIGN : Pre- to posttreatment pilot study. RESULTS : There was significant improvement on all 3 measures of self-reported anger, with large effect sizes (>1.0), and on 1 of 3 SO-reported scales. Qualitative feedback from participants was positive and dropout rate was low (1 of 11). CONCLUSIONS : The treatment model represented by the ASMT appears worthy of further study in persons with TBI who have both problematic anger and cognitive impairment.
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Combining neuropsychological and cognitive-behavioral approaches for treating psychological sequelae of acquired brain injury. Curr Opin Psychiatry 2011; 24:156-61. [PMID: 21206272 DOI: 10.1097/yco.0b013e328343804e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Acquired brain injury (ABI) does not only result in physical and cognitive impairments, but may also entail behavioral-emotional difficulties and mental disorders. Although neuropsychological approaches target the rehabilitation of cognitive deficits, the treatment of emotional and behavioral sequelae has received less consideration. This review argues for the integration of cognitive-behavioral approaches into the rehabilitation process and examines respective recent research. RECENT FINDINGS Cognitive-behavioral interventions have been investigated in the treatment of behavioral disturbances and mental disorders after ABI. They have also been targeted at supporting adaptive coping with chronic injury-related impairments. Problem-solving approaches of cognitive behavioral therapy may work as meta-models or framework for the rehabilitative process. Unfortunately, most studies reviewed employed methodologically weak designs, which limit convincing conclusions. Still, positive intervention effects have been demonstrated concerning specific outcome measures. Whether these changes also translate into increased psychosocial functioning or quality of life remains unclear. SUMMARY Methodologically sound evidence for cognitive-behavioral interventions after ABI is limited, but preliminary results support the effectiveness of these interventions in the treatment of behavioral disorders and emotional disturbances after ABI. Integrating neuropsychological and cognitive-behavioral approaches may therefore prove beneficial to the rehabilitation process.
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