Developmental levels of social cognition in head-injury patients

Changing goals and intentions among participants in a neuropsychological rehabilitation programme: an explorative case study evaluation

PRIMARY OBJECTIVE

The objective is to describe how persons with brain injury become aware of their difficulties and recreate their lives during a rehabilitation programme.

METHOD

Thirteen individuals with brain injuries were interviewed in a pre-post design, using a structured interview guide.

RESULTS

Two types of changes during rehabilitation were observed: First, a change has happened during the rehabilitation process from preserving the former self to self-autonomy or self-realization. Secondly, a change happened in the participants' perception of difficulties from attempts to handle critical situations to avoiding anticipated critical situations. Influential factors were identified as the settings in which the person is embedded, the emotional reactions, attributions and attitudes towards the injury and the future time perspective.

CONCLUSION

Self-presentation may be described as the ability to foresee critical situations and to intentionally choose not to get involved in that kind of situation. The way the persons present themselves has changed during the rehabilitation process.

Social Perception Deficits After Traumatic Brain Injury: Interaction Between Emotion Recognition, Mentalizing Ability, and Social Communication

Thirty-four adults with severe traumatic brain injuries (TBI) and 34 matched control participants were asked to interpret videotaped conversational exchanges. Study participants were asked to judge the speakers' emotions, the speakers' beliefs (first-order theory of mind), what the speakers intended their conversational partners to believe (second-order theory of mind), and what they meant by remarks that were sincere or literally untrue (i.e., a lie or sarcastic retort). The TBI group had marked difficulty judging most facets of social information. They could recognize speaker beliefs only when this information was explicitly provided. In general, emotion recognition and first-order theory of mind judgments were not related to the ability to understand social (conversational) inference, whereas second-order theory of mind judgments were related to that ability.

TASIT: A new clinical tool for assessing social perception after traumatic brain injury

OBJECTIVE

To develop a clinically sensitive test of social perception for people with traumatic brain injury (TBI).

DESIGN

An assessment tool comprising videotaped vignettes and response probes was developed in successive stages and tested on both normal participants and those with TBI.

SUBJECTS

A total of 169 normal adults and 7 adults with severe TBI (pilot studies), 283 normal adults, and 12 people with severe TBI (main studies).

MAIN OUTCOME MEASURES

"The Awareness of Social Inference Test" (TASIT) comprises videotaped vignettes of everyday social interactions and has three parts, each with alternate forms. The Emotion Evaluation Test (EET) assesses recognition of spontaneous emotional expression (happy, surprised, sad, anxious, angry, disgusted, and neutral). The Social Inference-Minimal (SI-M) test assesses comprehension of sincere versus sarcastic exchanges, whereas the Social Inference-Enriched test (SI-E) assesses lies versus sarcasm. In both SI-M and SI-E speaker demeanor (voice, facial expression) indicate the intended meaning of the exchange. In addition, the SI-E vignettes have other contextual clues that reveal the speakers' intentions. Performance on SI-E and SI-E is assessed via four standard questions per item probing for understanding of the emotions, intentions, beliefs, and meanings of the speakers and their exchanges.

RESULTS

Groups taken from the pool of 283 normal adults achieved a high level of performance on all aspects of the test with some influence from both education and intelligence. The 12 people with TBI were poorer at judging emotions than were matched controls, with particular difficulties recognizing neutral items, fear, and disgust. They were as capable as matched controls when understanding sincere exchanges and lies but had difficulty with sarcasm.

CONCLUSIONS

TASIT is straightforward for people with a normal range of social skills while being sensitive to social perception deficits after traumatic brain injury.

Rural versus urban social support seeking as a moderating variable in traumatic brain injury outcome

OBJECTIVE

To investigate personal beliefs about seeking social support following traumatic brain injury (TBI) and the relationship of these appraisals to demographic and injury variables, social integration, and quality of life ratings.

SETTING

The central region of a Midwest state.

PARTICIPANTS

Fifty-six adults with TBI who were more than 6 months postinjury and living in the community.

MAIN OUTCOME MEASURES

The Hesitation Scale, a 20-item survey that assesses reasons that people might hesitate to reach out to others in the community, and portions of the Living Life After Traumatic Brain Injury Scale.

RESULTS

Negative attitudes and beliefs about seeking social support were significantly related to lower perceptions of social support, lower ratings of quality of life, longer time since injury, being divorced or separated, and living in an urban area. Predictors of higher quality of life ratings included more positive appraisals about seeking social support, living in a rural area, and the ability to engage in productive activity.

CONCLUSIONS

Positive outcomes after TBI appear to be moderated by living in a rural area, which is associated with more openness to seeking social supports and contributes to better quality of life.

Empirically supported psychological and behavioral therapies in pediatric rehabilitation of TBI

This article examines the empirical support for psychological therapies for children with traumatic brain injury (TBI). Empirical support for psychological treatments of noninjured children provides a foundation upon and a framework in which to discuss applications to children with neurobehavioral dysfunction. Behavioral interventions to address externalizing behaviors have received the greatest focus, whereas there is a paucity of work that pertains to internalizing features and prosocial behavior such as assertiveness. Although the systematic study of psychological intervention lags far behind the rapidly increasing knowledge of neurobehavioral sequelae to TBI, there are promising directions that stem from initial findings.

Exploring the process of inference generation in sarcasm: a review of normal and clinical studies

This article evaluates two theoretical accounts of how sarcasm is understood; the traditional model, which asserts that listeners derive a counterfactual inference from the sarcastic comment, and relevance theory, which asserts that listeners recognize sarcasm as a scornful echo of a previous assertion. Evidence from normal speakers provides only partial support for both theories. Evidence from brain-injured populations suggests that aspects of the pragmatic process can be arrested in ways not predicted by either theory. It is concluded that sarcasm is more effortful to process than nonsarcastic comments and that inferences about the facts of the situation and the mental state of the speaker (e.g., attitudes, knowledge, and intentions) are important to comprehending sarcasm. It is questioned whether inferences about mental state are relatively more difficult for brain-injured subjects and, if so, whether this is a continuum of difficulty or reflects reliance upon different cognitive processes.

Developmental models of social cognition in assessing the role of family stress in relatives' predictions following traumatic brain injury

The present study extended the utilization of developmental models of social cognition to the investigation of stress and relatives' perception of traumatic brain injury (TBI) survivors. Structured interviews were conducted with 21 TBI survivors utilizing interpersonal negotiation strategies (INS) and self understanding (self) in the framework of Selman's model of social perspective-taking and Damon and Hart's multidimensional model of self understanding. A relative group composed of 21 participants was interviewed and their predictions of the responses of the TBI survivors to the action domain of the INS stories were obtained. The relative participant group was also administered the Beck Anxiety and Depression Inventories and Leeds Scales of Depression and Anxiety. The relationships among relative groups' predictive scores, INS and self domains and stress levels were analysed. The result of the survivor groups responses on INS and self were in agreement with the previous findings that TBI survivors respond at psychosocially immature levels. Comparison of INS action scores obtained by the survivor group and predicted by relative group were within one developmental level of each other in 87.4% of the cases. Fifty-two per cent of the relative group scored in mild to moderate or greater depression and 48% scored in the mild to moderate range of anxiety on the Beck scales. Person correlation coefficients indicated significant negative correlations between Beck scores and predictive INS scores. ANOVA indicated significantly higher Beck depression scores in relatives of TBI survivors living in residential facilities than relatives of TBI survivors in an outpatient treatment programme. The study supports the view that developmental social cognition methods appear to advance our understanding of psychosocial adjustments and relatives' perceptions of social cognition in TBI survivors.

Developmental models of social cognition in assessing psychosocial adjustments in head injury

This study compared the levels of conceptual responses involved in the processing of two parameters of social cognition in a group of 40 adult patients with closed-head injury (CHI) and a group of 26 normal controls. The two parameters, interpersonal negotiation strategies (INS) and self understanding (self) were examined in the framework of Selman's model of social perspective taking and Damon and Hart's multidimensional model of self understanding. Differences among the components of the INS conflict dilemmas and aspects of self descriptions were observed in a structure interview. Results supported the hypothesis that the CHI group would respond at lower levels on the development measures of social cognition. The results of the present study are in agreement with the conclusions in the initial study. This study also extended the study of social cognition to the Tennessee Self Concept Scale and the Neurobehavioral Rating Scale, in addition to incorporating a control group. These studies support the view that psychosocial adjustment is a multidimensional construct and developmental social cognition methods appear to advance our understanding of this concept in CHI patients.