Compassion Focused Therapy After Traumatic Brain Injury: Theoretical Foundations and a Case Illustration

AbstractAcquired brain injury (ABI) commonly results in a range of interacting difficulties including regulating emotion, managing social interactions and cognitive changes. Emotional adjustment to ABI can be difficult and requires adaptation of standard psychological therapies. This article outlines a case where cognitive– behavioural therapy (CBT) was of limited effectiveness but was significantly enhanced with compassion focused therapy (CFT). This article describes Jenny, a 23-year-old woman who suffered a traumatic brain injury 3 years prior to attending rehabilitation. Jenny presented with low self-esteem and mental health difficulties. Neuropsychological assessment revealed executive functioning difficulties. Jenny entered a holistic neuropsychological rehabilitation program aimed at improving complex interacting difficulties, receiving CBT as part of this. As CBT was of limited effectiveness, reformulation of Jenny's difficulties was presented to her based on CFT. The CFT intervention employed aimed to help Jenny develop self-validation and acceptance through producing feelings of kindness and warmth. Shifting the affective textures to the self is a key process for CFT. Self-report measures of mental health and self-esteem showed positive changes and the usefulness of CFT for Jenny. Adaptations in the context of Jenny's ABI are discussed. In conclusion, CFT may be useful in conceptualising emotional responses and developing intervention in rehabilitation after ABI, especially because CFT is based on a neurophysiological model of affect regulation that pays particular attention to the importance of affiliative emotions in the regulation of threat-focused emotion and self-construction.

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Identifying the Needs of OEF/OIF Veterans with Traumatic Brain Injury (TBI) and Co-Occurring Behavioral Health Issues: A VA, Community Mental Health & State of Colorado Partnership

PsycEXTRA Dataset ◽

10.1037/e515432014-001 ◽

2014 ◽

Author(s):

Lisa A. Brenner ◽

Gina M. Signoracci ◽

Jennifer Olson-Madden ◽

Bridget B. Matarazzo

Keyword(s):

Mental Health ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Community Mental Health ◽

Behavioral Health ◽

Health State ◽

Health Issues

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Cervicovestibular rehabilitation in adult with mild traumatic brain injury: a randomised controlled trial protocol

BMC Sports Science Medicine and Rehabilitation ◽

10.1186/s13102-019-0139-3 ◽

2019 ◽

Vol 11 (1) ◽

Cited By ~ 1

Author(s):

Pierre Langevin ◽

Philippe Fait ◽

Pierre Frémont ◽

Jean-Sébastien Roy

Keyword(s):

Traumatic Brain Injury ◽

Cervical Spine ◽

Brain Injury ◽

Neck Pain ◽

Mild Traumatic Brain Injury ◽

Controlled Trial ◽

Rehabilitation Program ◽

Conventional Approach ◽

Persistent Symptoms ◽

Link Type

Abstract Background Mild traumatic brain injury (mTBI) is an acknowledged public health problem. Up to 25% of adult with mTBI present persistent symptoms. Headache, dizziness, nausea and neck pain are the most commonly reported symptoms and are frequently associated with cervical spine and vestibular impairments. The most recent international consensus statement (2017 Berlin consensus) recommends the addition of an individualized rehabilitation approach for mTBI with persistent symptoms. The addition of an individualized rehabilitation approach including the evaluation and treatment of cervical and vestibular impairments leading to symptoms such as neck pain, headache and dizziness is, however, recommended based only on limited scientific evidence. The benefit of such intervention should therefore be further investigated. Objective To compare the addition of a 6-week individualized cervicovestibular rehabilitation program to a conventional approach of gradual sub-threshold physical activation (SPA) alone in adults with persistent headache, neck pain and/or dizziness-related following a mTBI on the severity of symptoms and on other indicators of clinical recovery. We hypothesize that such a program will improve all outcomes faster than a conventional approach (between-group differences at 6-week and 12-week). Methods In this single-blind, parallel-group randomized controlled trial, 46 adults with subacute (3 to12 weeks post-injury) persistent mTBI symptoms will be randomly assigned to: 1) a 6-week SPA program or 2) SPA combined with a cervicovestibular rehabilitation program. The cervicovestibular rehabilitation program will include education, cervical spine manual therapy and exercises, vestibular rehabilitation and home exercises. All participants will take part in 4 evaluation sessions (baseline, week 6, 12 and 26) performed by a blinded evaluator. The primary outcome will be the Post-Concussion Symptoms Scale. The secondary outcomes will be time to clearance to return to function, number of recurrent episodes, Global Rating of Change, Numerical Pain Rating Scale, Neck Disability Index, Headache Disability Inventory and Dizziness Handicap Inventory. A 2-way ANOVA and an intention-to-treat analysis will be used. Discussion Controlled trials are needed to determine the best rehabilitation approach for mTBI with persistent symptoms such as neck pain, headache and dizziness. This RCT will be crucial to guide future clinical management recommendations. Trial registration ClinicalTrials.gov Identifier - NCT03677661, Registered on September, 15th 2018.

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Comparing Traumatic Brain Injury Symptoms Reported via Questionnaires Versus a Novel Structured Interview

Journal of the International Neuropsychological Society ◽

10.1017/s1355617721000278 ◽

2021 ◽

pp. 1-11

Author(s):

Natalie A. Emmert ◽

Georgia Ristow ◽

Michael A. McCrea ◽

Terri A. deRoon-Cassini ◽

Lindsay D. Nelson

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Response Bias ◽

Minnesota Multiphasic Personality Inventory ◽

Assessment Tool ◽

Symptom Burden ◽

Structured Interview ◽

Self Report ◽

Symptom Reporting ◽

Clinical Interviews

Abstract Objective: Mild traumatic brain injury (mTBI) symptoms are typically assessed via questionnaires in research, yet questionnaires may be more prone to biases than direct clinical interviews. We compared mTBI symptoms reported on two widely used self-report inventories and the novel Structured Interview of TBI Symptoms (SITS). Second, we explored the association between acquiescence response bias and symptom reporting across modes of assessment. Method: Level 1 trauma center patients with mTBI (N = 73) were recruited within 2 weeks of injury, assessed at 3 months post-TBI, and produced nonacquiescent profiles. Assessments collected included the SITS (comprising open-ended and closed-ended questions), Rivermead Post Concussion Symptoms Questionnaire (RPQ), Sport Concussion Assessment Tool-3 (SCAT-3) symptom checklist, and Minnesota Multiphasic Personality Inventory-2 Restructured Form True Response Inconsistency (TRIN-r) scale. Results: Current mTBI symptom burden and individual symptom endorsement were highly concordant between SITS closed-ended questions, the RPQ, and the SCAT-3. Within the SITS, participants reported significantly fewer mTBI symptoms to open-ended as compared to later closed-ended questions, and this difference was weakly correlated with TRIN-r. Symptom scales were weakly associated with TRIN-r. Conclusions: mTBI symptom reporting varies primarily by whether questioning is open- vs. closed-ended but not by mode of assessment (interview, questionnaire). Acquiescence response bias appears to play a measurable but small role in mTBI symptom reporting overall and the degree to which participants report more symptoms to closed- than open-ended questioning. These findings have important implications for mTBI research and support the validity of widely used TBI symptom inventories.

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Traumatic Brain Injury: Effect of Litigation Status on Executive Functioning—A Pilot Study

Indian Journal of Neurotrauma ◽

10.1055/s-0040-1717214 ◽

2020 ◽

Author(s):

Simi Prakash K. ◽

Rajakumari P. Reddy ◽

Anna R. Mathulla ◽

Jamuna Rajeswaran ◽

Dhaval P. Shukla

Keyword(s):

Traumatic Brain Injury ◽

Working Memory ◽

Depressive Symptoms ◽

Brain Injury ◽

Concept Formation ◽

Verbal Working Memory ◽

Self Report ◽

Semantic Fluency ◽

Set Shifting ◽

Wide Range

AbstractTraumatic brain injury (TBI) is associated with a wide range of physiological, behavioral, emotional, and cognitive sequelae. Litigation status is one of the many factors that has an impact on recovery. The aim of this study was to compare executive functions, postconcussion, and depressive symptoms in TBI patients with and without litigation. A sample of 30 patients with TBI, 15 patients with litigation (medicolegal case [MLC]), and 15 without litigation (non-MLC) was assessed. The tools used were sociodemographic and clinical proforma, executive function tests, Rivermead Post-Concussion Symptom Questionnaire, and Beck Depression Inventory. Assessment revealed that more than 50% of patients showed deficits in category fluency, set shifting, and concept formation. The MLC group showed significant impairment on verbal working memory in comparison to the non-MLC group. The performance of both groups was comparable on tests of semantic fluency, visuospatial working memory, concept formation, set shifting, planning, and response inhibition. The MLC group showed more verbal working memory deficits in the absence of significant postconcussion and depressive symptoms on self-report measures.

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Longitudinal Volumetric Changes following Traumatic Brain Injury: A Tensor-Based Morphometry Study

Journal of the International Neuropsychological Society ◽

10.1017/s1355617712000835 ◽

2012 ◽

Vol 18 (6) ◽

pp. 1006-1018 ◽

Cited By ~ 55

Author(s):

Kimberly D.M. Farbota ◽

Aparna Sodhi ◽

Barbara B. Bendlin ◽

Donald G. McLaren ◽

Guofan Xu ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

White Matter ◽

Degenerative Change ◽

Extended Period ◽

Spatiotemporal Pattern ◽

Volume Loss ◽

Post Injury ◽

Cognitive Changes ◽

Brain White Matter

AbstractAfter traumatic injury, the brain undergoes a prolonged period of degenerative change that is paradoxically accompanied by cognitive recovery. The spatiotemporal pattern of atrophy and the specific relationships of atrophy to cognitive changes are ill understood. The present study used tensor-based morphometry and neuropsychological testing to examine brain volume loss in 17 traumatic brain injury (TBI) patients and 13 controls over a 4-year period. Patients were scanned at 2 months, 1 year, and 4 years post-injury. High-dimensional warping procedures were used to create change maps of each subject's brain for each of the two intervals. TBI patients experienced volume loss in both cortical areas and white matter regions during the first interval. We also observed continuing volume loss in extensive regions of white matter during the second interval. Neuropsychological correlations indicated that cognitive tasks were associated with subsequent volume loss in task-relevant regions. The extensive volume loss in brain white matter observed well beyond the first year post-injury suggests that the injured brain remains malleable for an extended period, and the neuropsychological relationships suggest that this volume loss may be associated with subtle cognitive improvements. (JINS, 2012,18, 1–13)

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The Relationship Between the Self-Report BASC-2 Validity Indicators and Performance Validity Test Failure After Pediatric Mild Traumatic Brain Injury

Assessment ◽

10.1177/1073191114520626 ◽

2014 ◽

Vol 21 (5) ◽

pp. 562-569 ◽

Cited By ~ 10

Author(s):

John W. Kirk ◽

Christa F. Hutaff-Lee ◽

Amy K. Connery ◽

David A. Baker ◽

Michael W. Kirkwood

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

The Self ◽

Self Report ◽

Performance Validity ◽

Validity Indicators ◽

And Performance ◽

The Relationship ◽

Test Failure

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Mental health consequences of traumatic brain injury

Biological Psychiatry ◽

10.1016/j.biopsych.2021.09.024 ◽

2021 ◽

Author(s):

Jonathon R. Howlett ◽

Lindsay D. Nelson ◽

Murray B. Stein

Keyword(s):

Mental Health ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Health Consequences

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Cultivating the compassionate self against depression: An exploration of processes of change

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.344 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S356-S356 ◽

Cited By ~ 1

Author(s):

M. Matos ◽

J. Duarte ◽

C. Duarte ◽

J. Pinto-Gouveia ◽

P. Gilbert

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Longitudinal Design ◽

Self Report ◽

Processes Of Change ◽

Post Intervention ◽

Mediation Analyses ◽

Self Compassion ◽

Compassion Focused Therapy ◽

The Impact

IntroductionCompassion and self-compassion can be protective factors against mental health difficulties, in particular depression. The cultivation of the compassionate self, associated with a range of practices such as slow and deeper breathing, compassionate voice tones and facial expressions, and compassionate focusing, is central to compassion focused therapy (Gilbert, 2010). However, no study has examined the processes of change that mediate the impact of compassionate self-cultivation practices on depressive symptoms.AimsThe aim of this study is to investigate the impact of a brief compassionate self training (CST) intervention on depressive symptoms, and explore the psychological processes that mediate the change at post intervention.MethodsUsing a longitudinal design, participants (general population and college students) were randomly assigned to one of two conditions: Compassionate self training (n = 56) and wait-list control (n = 37). Participants in the CST condition were instructed to practice CST exercises for 15 minutes everyday or in moments of stress during two weeks. Self-report measures of depression, self-criticism, shame and compassion, were completed at pre and post in both conditions.ResultsResults showed that, at post-intervention, participants in the CST condition decreased depression, self-criticism and shame, and increased self-compassion and openness to receive compassion from others. Mediation analyses revealed that changes in depression from pre to post intervention were mediated by decreases in self-criticism and shame, and increases in self-compassion and openness to the compassion from others.ConclusionsThese findings support the efficacy of compassionate self training components on lessening depressive symptoms and promoting mental health.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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