Impaired awareness of deficits in individuals with neuropsychiatric symptoms after acquired brain injury: Associations with treatment motivation and depressive symptoms.

Abstract Background Following an acquired brain injury, individuals frequently experience anxiety and/or depressive symptoms. However, current treatments for these symptoms are not very effective. A promising treatment is acceptance and commitment therapy (ACT), which is a third-wave behavioural therapy. The primary goal of this therapy is not to reduce symptoms, but to improve psychological flexibility and general well-being, which may be accompanied by a reduction in symptom severity. The aim of this study is to investigate the effectiveness of an adapted ACT intervention (BrainACT) in people with acquired brain injury who experience anxiety and/or depressive symptoms. Methods The study is a multicenter, randomized, controlled, two-arm parallel trial. In total, 94 patients who survive a stroke or traumatic brain injury will be randomized into an ACT or control (i.e. psycho-education and relaxation) intervention. The primary outcome measures are the Hospital Anxiety and Depression Scale and the Depression Anxiety Stress Scale. Outcomes will be assessed by trained assessors, blinded to treatment condition, pre-treatment, during treatment, post-treatment, and at 7 and 12 months. Discussion This study will contribute to the existing knowledge on how to treat psychological distress following acquired brain injury. If effective, BrainACT could be implemented in clinical practice and potentially help a large number of patients with acquired brain injury. Trial registration Dutch Trial Register, NL691, NTR 7111. Registered on 26 March 2018. https://www.trialregister.nl/trial/6916.

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Feedback of brain-imaging findings: Effect on impaired awareness and mood in acquired brain injury

Brain Injury ◽

10.1080/02699050600664665 ◽

2006 ◽

Vol 20 (5) ◽

pp. 485-497 ◽

Cited By ~ 11

Author(s):

Craig B. Roberts ◽

Robert Rafal ◽

B. Rudi Coetzer

Keyword(s):

Brain Injury ◽

Brain Imaging ◽

Acquired Brain Injury ◽

Imaging Findings ◽

Impaired Awareness

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An Integrative Neuro-Psychotherapy Treatment to Foster the Adjustment in Acquired Brain Injury Patients—A Randomized Controlled Study

Journal of Clinical Medicine ◽

10.3390/jcm9061684 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1684

Author(s):

Antoine Urech ◽

Tobias Krieger ◽

Eveline Frischknecht ◽

Franziska Stalder-Lüthy ◽

Martin grosse Holtforth ◽

...

Keyword(s):

Depressive Symptoms ◽

Brain Injury ◽

Brain Injuries ◽

Controlled Trial ◽

Acquired Brain Injury ◽

Post Treatment ◽

Controlled Study ◽

Randomized Controlled ◽

Treatment Standard

Adjustment disorders (AjD) with depressive symptoms following an acquired brain injury (ABI) is a common phenomenon. Although brain injuries are increasing more and more, research on psychological therapies is comparably scarce. The present study compared, by means of a randomized controlled trial (RCT), a newly developed integrative treatment (Standard PLUS) to a standard neuropsychological treatment (Standard). Primary outcomes were depressive symptoms assessed with the Beck Depression Inventory (BDI-II) at post-treatment and 6-month follow-up assessment. In total, 25 patients (80% after a stroke) were randomized to one of the two conditions. Intention-to-treat analyses showed that the two groups did not significantly differ either at post-treatment nor at follow-up assessment regarding depressive symptoms. Both treatments showed large within-group effect sizes on depressive symptoms. Regarding secondary outcomes, patients in the Standard PLUS condition reported more emotion regulation skills at post-assessment than in the control condition. However, this difference was not present anymore at follow-up assessment. Both treatments showed medium to large within-group effects sizes on most measures for patients suffering from an AjD after ABI. More research with larger samples is needed to investigate who profits from which intervention.

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Physical activity levels, mood, and combat-related acquired brain injury: A cross-sectional examination of Operation Iraqi Freedom and Operation Enduring Freedom service members

American Journal of Recreation Therapy ◽

10.5055/ajrt.2014.0081 ◽

2017 ◽

Vol 13 (4) ◽

pp. 7

Author(s):

Julianne M. Hirst, MS, CTRS ◽

Heather Porter, PhD, CTRS

Keyword(s):

Physical Activity ◽

Depressive Symptoms ◽

Brain Injury ◽

Leisure Time Physical Activity ◽

Operation Iraqi Freedom ◽

Acquired Brain Injury ◽

Operation Enduring Freedom ◽

Service Members ◽

Cross Sectional ◽

Iraqi Freedom

A significant number of military service members are returning from Operation Iraqi Freedom and Operation Enduring Freedom with acquired brain injuries, and these injuries have been significantly linked with depression symptomology. The primary purpose of this study was to examine the relationship between current levels of participation in leisure-time physical activity (LTPA) and self-reported depressive symptoms in adults with a combat-related acquired brain injury. The study also examined if differences exist in reported levels of LTPA and depressive symptoms between demographic groups and the perceived psychosocial benefits of participation in LTPA for adults with a combat-related acquired brain injury. A cross-sectional survey design using self-reported measures was used; 33 participants completed the survey. Results indicate that there was no significant correlation between current level of participation in LTPA and self-reported depressive symptoms. A diagnosis of post-traumatic stress disorder was the only demographic variable significantly correlated with higher self-reported depressive symptoms. Participants ranked “improved mood” as the highest perceived benefit of LTPA and “decreased anxiety” the lowest. Additionally, the perceived benefits of “improved mood,” “decreased anger,” and “increased self-esteem” were significantly correlated with lower levels of self-reported depression.

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How Stable Is Coping in Patients with Neuropsychiatric Symptoms after Acquired Brain Injury? Changes in Coping Styles and Their Predictors in the Chronic Phase

Journal of Neurotrauma ◽

10.1089/neu.2015.3900 ◽

2016 ◽

Vol 33 (7) ◽

pp. 696-704 ◽

Cited By ~ 1

Author(s):

Gisela Wolters Gregório ◽

Rudolf W.H.M. Ponds ◽

Sanne M.J. Smeets ◽

Frank Jonker ◽

Climmy G.J.G. Pouwels ◽

...

Keyword(s):

Brain Injury ◽

Coping Styles ◽

Neuropsychiatric Symptoms ◽

Chronic Phase ◽

Acquired Brain Injury

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Prevalence and characteristics of neuropsychiatric symptoms, quality of life and psychotropics in people with acquired brain injury in long‐term care

Journal of Advanced Nursing ◽

10.1111/jan.14156 ◽

2019 ◽

Vol 75 (12) ◽

pp. 3715-3725

Author(s):

Roy Kohnen ◽

Jan Lavrijsen ◽

Odile Smals ◽

Debby Gerritsen ◽

Raymond Koopmans

Keyword(s):

Quality Of Life ◽

Brain Injury ◽

Long Term Care ◽

Neuropsychiatric Symptoms ◽

Acquired Brain Injury ◽

Term Care

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Enhanced Appreciation of Life Following Acquired Brain Injury: Posttraumatic Growth at 6 Months Postdischarge

Brain Impairment ◽

10.1375/brim.12.2.93 ◽

2011 ◽

Vol 12 (2) ◽

pp. 93-104 ◽

Cited By ~ 14

Author(s):

Jennifer Silva ◽

Tamara Ownsworth ◽

Cassandra Shields ◽

Jennifer Fleming

Keyword(s):

Depressive Symptoms ◽

Brain Injury ◽

Posttraumatic Growth ◽

Interpersonal Relationships ◽

Acquired Brain Injury ◽

Inpatient Rehabilitation ◽

Small Degree ◽

Moderate Degree ◽

Psychological Changes ◽

Post Traumatic Growth

AbstractPreliminary research supports that acquired brain injury (ABI) can act as a catalyst for positive psychological changes, and that such posttraumatic growth (PTG) increases with time since injury. In this study, posttraumatic growth refers to positive psychological changes in domains including interpersonal relationships, new possibilities, personal strength, spirituality and appreciation for life. This study aimed to identify associations between levels of subjective impairment and depressive symptoms at discharge, and PTG at 6-months postdischarge following ABI. Sixty participants (73% male) with ABI (Mean days of hospitalisation = 32.92, SD = 40.74) were consecutively recruited from an inpatient rehabilitation unit at discharge and were administered measures of subjective impairment (Mayo-Portland Adaptability Index–4; MPAI-4) and depression (Depression, Anxiety Stress Scales; DASS). Participants were followed up at 6-months postdischarge and administered the Post-Traumatic Growth Inventory, DASS and MPAI-4. The results indicated that levels of PTG reported at six months postdischarge were relatively modest and ranged between no to very small degree of change (‘spirituality’) and a small to moderate degree of change (‘a greater appreciation of life’). Level of subjective impairment at discharge significantly predicted overall level of PTG at 6-months follow-up (β =.40, p < .05, sr2 = .28). Further, at 6-months postdischarge, individuals with a greater appreciation for life reported significantly higher levels of subjective impairment (r = .35; p < .01) and depressive symptoms (r = .34, p < .01) at that time point. These findings indicate that individuals who perceive greater functional consequences of their ABI are more likely to experience PTG. Further, the process of reevaluating priorities and values in life after ABI may be associated with emotional distress during the early stages of community reintegration.

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Impaired awareness of deficits and cognitive strategy use in occupational performance of persons with acquired brain injury (ABI)

Irish Journal of Occupational Therapy ◽

10.1108/ijot-10-2019-0012 ◽

2020 ◽

Vol 48 (2) ◽

pp. 101-115

Author(s):

Sabine van Erp ◽

Esther Steultjens

Keyword(s):

Brain Injury ◽

Self Regulation ◽

Cognitive Strategy ◽

Acquired Brain Injury ◽

Strategy Use ◽

Strategy Training ◽

Occupational Performance ◽

Content Type ◽

Impaired Awareness ◽

Assessment Results

Purpose This study aims to explore the difference in cognitive strategy use during observed occupational performance between and within different levels of impaired awareness of deficits of individuals with acquired brain injury (ABI). Design/methodology/approach A cross-sectional study (N = 24) of individuals with ABI receiving rehabilitation and with the capacity to demonstrate goal-directed behaviour (Allen cognitive level screen score = 4.0) was undertaken. Cognitive strategy use during occupational performance of daily activities (measured with the perceive, recall, plan and perform [PRPP]) was evaluated between and within different awareness levels (awareness levels measured by the self-regulation skill interview). Statistical analyses, using independent t-test, Mann Whitney U test, ANOVA and Friedman test, were executed. Findings Significant differences were shown for both strengths and weaknesses in cognitive strategy use between emergent (n = 13) and anticipatory awareness (n = 11) groups on PRPP items “perceive”, “sensing” and “mapping”; and “searches”, “recall steps”, “identify obstacles”, “calibrates”, “stops”, “continues” and “persists”. Within emergent awareness group, participants scored lowest related to “perceive”, “plan”, “sensing”, “mapping”, “programming” and “evaluating”. Within anticipatory awareness group, participants scored lowest related to “plan”, “programming” and “evaluating”. Practical implications This study showed differences in cognitive strategy application during task performance in individuals with emergent or anticipatory awareness deficits that fit with theoretical expectations. It is recommended to make use of the PRPP assessment results (strengths and weaknesses in cognitive strategy application) to support the level of awareness determination. The PRPP assessment results and the level of awareness tailor the clinical reasoning process for personalised intervention planning and cognitive strategy training. Originality/value Because impaired awareness has so much impact on the course and outcome of rehabilitation (Rotenberg-Shpigelman et al., 2014), in clinical practice, it is of paramount importance to be aware of the level of awareness of the client (Smeets et al., 2017) and the effect on occupational performance.

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