Acceptance and Commitment therapy to facilitate psychological adjustment after a severe traumatic brain injury: A randomised controlled trial

Diane L. Whiting,^1,2 Frank P. Deane,² Grahame K. Simpson,^1,3 Hamish J. McLeod,⁴ and J. Ciarrochi⁵

¹Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Liverpool, Australia

²School of Psychology, University of Wollongong, Australia

³John Walsh Centre for Rehabilitation Research, University of Sydney, Australia

⁴Institute of Health and Wellbeing, University of Glasgow, Scotland

⁵Institute of Positive Psychology & Education, Australian Catholic University, Australia

Background and aims: The adjustment process after a traumatic brain injury (TBI) is complex, unique to each individual and often results in high levels of psychological distress as the individual comes to accept their post injury self. This study compared Acceptance and Commitment Therapy (ACT) to an active control, for people with a severe TBI, in order to facilitate post injury adjustment.

Method: A single centre, two armed, Phase II Randomised Control Trial (RCT) was undertaken with 19 participants with a very severe TBI (PTA>7 days) and met a clinical threshold for psychological distress (DASS>9). Participants were randomly allocated to either ACT or an active control (Befriending). Primary (psychological flexibility) and secondary (depression, stress, participation) outcomes were measured at three time points (pre, post and follow-up).

Results: Significant decreases were found for DASS-depression (group by time interaction, F _1,14 = 6.97, p = .02) and DASS-stress (group by time interaction, F _1,14 = 6.66, p = .02) in comparison to the Befriending group, but not for the primary outcome measures of participation or psychological flexibility. The changes in both depression and stress were also clinically significant with reductions in severity category demonstrated.

Conclusions: To the best of our knowledge, this is the first trial of ACT in severe TBI. The results indicate that ACT can decrease psychological distress for this group. Though no significant change was evident in the psychological flexibility, these results suggest a larger clinical trial is warranted.

Correspondence: Diane Whiting; [email protected]

Why do some friendships succeed following traumatic brain injury (TBI)?

Tennille Thomasz,^1,2,4 Leanne Togher^1,4 Emma Power^1,4 and Jacinta Douglas^3,4

¹University of Sydney, Sydney, Australia

²Royal Rehab, Sydney, Australia

³La Trobe University, Melbourne, Australia

⁴NHMRC Centre of Research Excellence in Brain Recovery

Background and aims: Friendships change in a number of ways post TBI. Both the amount that friends see one another, as well as the quality of the friendship can deteriorate, leading to social isolation. Despite this, there is little known about friendship following TBI from the perspective of friends. The aim of this study was to develop a preliminary model to explain why some friendships succeed post TBI.

Method: Nine friends of those who had sustained a TBI were identified and interviewed using semi-structured interviews. Data were transcribed and analysed using a grounded theory methodology.

Results: A preliminary theory was developed: Actively placing self within the friendship. In this sample, friends found a place in the friendship. They were able to do this by finding out about the consequences of TBI and maintaining normality. Friends could identify consequences of the TBI. To find out about such consequences, the participants responded directly to changes, thought deeply about these changes and gained support from family. Friends maintained normality in the friendship by helping the person with TBI. They also continued to engage with the person with TBI by socialising, sharing, providing advice and participating in activities of shared interest. Participants were able to use strategies to manage changes, which allowed them to maintain normality in the friendship.

Conclusions: This preliminary model may provide insight into how friendships can be maintained or developed. It appears that some friends have an innate ability to develop ways to find a place in the friendship.

Correspondence: Tennille Thomasz; [email protected]

The use of electronic assistive technology for social networking by people with disability living in supported accommodation

Rebecca Jamwal,^1,2 Libby Callaway,¹ Louise Farnworth,¹ Di Winkler,² and Joanne Enticott³

¹Department of Occupational Therapy, School of Primary Health Care, Monash University, Frankston, Australia

²Summer Foundation Ltd, Blackburn, Australia

³Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Dandenong, Australia

Background and aims: Social participation plays a key role in the community integration of people with disability. Electronic social networking (ESN) platforms present users with an accessible method of social participation. This study aimed to compare the relative risk of reduced ESN integration for people with acquired brain disorders and other disabilities living in shared supported accommodation, when compared to the general Australian population.

Method: Data collected via the ESN subscale of the Community Integration Questionnaire – Revised in previous studies examining (a) technology users with disability (N = 91, 60.5% with acquired brain disorders) living in shared supported accommodation in Victoria, Australia and (b) a normative sample of Australians (N = 1973), were matched on demographic variables including age, gender, living location, co-residency status and income range. A matching analysis (one person with disability to four matched normative ESN data sets) was applied using conditional Poisson regression to calculate the relative risk of reduced ESN integration.

Results: Preliminary results indicate large effects favouring the normative sample (F (1358) = 44.8, p < .001), with relative risk ratios demonstrating that people with disability are 2.1 times more likely to report reduced ESN integration compared to a matched sample from the general population.

Conclusions: Despite access to electronic assistive technology, people with disability living in supported accommodation still experience significant disadvantage integrating ESN in to daily life. Further examination of factors that influence effective ESN by people with disability is necessary to support social participation, and work to bridge the current divide.

Correspondence: Rebecca Jamwal, [email protected]