Advertisement

Role of Character Strengths in Outcome After Mild Complicated to Severe Traumatic Brain Injury: A Positive Psychology Study

      Abstract

      Objective

      To examine the effects of character strengths on psychosocial outcomes after mild complicated to severe traumatic brain injury (TBI).

      Design

      Prospective study with consecutive enrollment.

      Setting

      A Midwestern rehabilitation hospital.

      Participants

      Persons with mild complicated to severe TBI (N=65).

      Interventions

      Not applicable.

      Main Outcome Measures

      Community Integration Measure, Disability Rating Scale, Modified Cumulative Illness Rating Scale, Positive and Negative Affect Schedule, Satisfaction with Life Scale, Values in Action Inventory of Strengths, and Wechsler Test of Adult Reading.

      Results

      Character virtues and strengths were moderately associated with subjective outcomes, such that there were fewer and less strong associations between character virtues/strengths and objective outcomes than subjective outcomes. Specifically, positive attributes were associated with greater life satisfaction and perceived community integration. Fewer and less strong associations were observed for objective well-being; however, character strengths and virtues showed unique value in predicting physical health and disability. Positive affectivity was not meaningfully related to objective outcomes, but it was significantly related to subjective outcomes. In contrast, negative affectivity was related to objective but not subjective outcomes.

      Conclusions

      Given the strength of the associations between positive aspects of character or ways of perceiving the world and positive feelings about one's current life situation, treatments focused on facilitating these virtues and strengths in persons who have experienced TBI may result in better perceived outcomes and potentially subsequently lower comorbidities.

      Keywords

      List of abbreviations:

      CIM (Community Integration Measure), DRS (Disability Rating Scale), GCS (Glasgow Coma Scale), MCIRS (Modified Cumulative Illness Rating Scale), PANAS (Positive and Negative Affect Schedule), PANAS-NA (PANAS-Negative Affectivity), PANAS-PA (PANAS-Positive Affectivity), SWLS (Satisfaction With Life Scale), TBI (traumatic brain injury), VIA–IS (Values in Action Inventory of Strengths), WTAR (Wechsler Test of Adult Reading)
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gable S.L.
        • Haidt J.
        What (and why) is positive psychology?.
        Rev Gen Psychol. 2005; 9: 103-110
        • Dahlsgaard K.
        • Peterson C.
        • Seligman M.E.
        Shared virtue: the convergence of valued human strengths across culture and history.
        Rev Gen Psychol. 2005; 9: 203-213
        • Diener E.
        • Lucas R.E.
        • Scollon C.N.
        Beyond the hedonic treadmill: revising the adaptation theory of well-being.
        Am Psychol. 2006; 61: 305-314
        • Seligman M.E.
        • Csikszentmihalyi M.
        Positive psychology. An introduction.
        Am Psychol. 2000; 55: 5-14
        • Seligman M.E.
        • Rashid T.
        • Parks A.C.
        Positive psychotherapy.
        Am Psychol. 2006; 61: 774-788
        • Ryff C.D.
        • Dienberg Love G.
        • Urry H.L.
        • et al.
        Psychological well-being and ill-being: do they have distinct or mirrored biological correlates?.
        Psychother Psychosom. 2006; 75: 85-95
        • Peterson C.
        • Seligman M.E.
        Character strengths and virtues: a handbook and classification.
        Oxford Univ Pr, New York2004
        • Seligman M.E.
        • Steen T.A.
        • Park N.
        • Peterson C.
        Positive psychology progress: empirical validation of interventions.
        Am Psychol. 2005; 60: 410-421
      1. Costa PT Jr, McCrae RR. Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) manual. Odessa, FL: Psychological Assessment Resources; 1992.

        • Peterson C.
        • Park N.
        • Pole N.
        • D'Andrea W.
        • Seligman M.E.P.
        Strengths of character and posttraumatic growth.
        J Trauma Stress. 2008; 21: 214-217
        • Peterson C.
        • Park N.
        • Seligman M.E.
        Greater strengths of character and recovery from illness.
        J Posit Psychol. 2006; 1: 17-26
        • Park N.
        • Peterson C.
        • Seligman M.E.
        Strengths of character and well-being.
        J Soc Clin Psychol. 2004; 23: 603-619
      2. Peterson C. Positive psychology. Paper presented at: Michigan Psychological Association; March 31, 2006; Livonia, MI.

        • Levin H.S.
        • Amparo E.
        • Eisenberg H.M.
        • et al.
        Magnetic-resonance-imaging and computerized-tomography in relation to the neurobehavioral sequelae of mild and moderate head-injuries.
        J Neurosurg. 1987; 66: 706-713
        • Kashluba S.
        • Hanks R.A.
        • Casey J.E.
        • Millis S.R.
        Neuropsychologic and functional outcome after complicated mild traumatic brain injury.
        Arch Phys Med Rehabil. 2008; 89: 904-911
      3. Holdnack HA. Wechsler Test of Adult Reading: WTAR. San Antonio: The Psychological Corp; 2001.

        • Rappaport M.
        • Hall K.M.
        • Hopkins K.
        • Belleza T.
        • Cope D.N.
        Disability Rating-Scale for severe head trauma–coma to community.
        Arch Phys Med Rehabil. 1982; 63: 118-123
        • Linn B.
        • Linn M.
        • Gurel L.
        Cumulative illness rating scale.
        J Am Geriatr Soc. 1968; 16: 622-626
        • DiLibero F.
        • Fargnoli M.
        • Pittiglio S.
        • Mascio M.
        • Giaquinto S.
        Comorbidity and rehabilitation.
        Arch Gerontol Geriatr. 2001; 32: 15-22
        • Extermann M.
        Measuring comorbidity in older cancer patients.
        Eur J Cancer. 2000; 36: 453-471
        • Extermann M.
        Measurement and impact of comorbidity in older cancer patients.
        Crit Rev Oncol Hematol. 2000; 35: 181-200
        • Holcomb E.M.
        • Millis S.R.
        • Hanks R.A.
        Comorbid disease in persons with traumatic brain injury: descriptive findings using the Modified Cumulative Illness Rating Scale.
        Arch Phys Med Rehabil. 2012; 93: 1338-1342
        • Watson D.
        • Clark L.A.
        • Tellegen A.
        Development and validation of brief measures of positive and negative affect: the PANAS scales.
        J Pers Soc Psychol. 1988; 54: 1063-1070
        • Kercher K.
        Assessing subjective well-being in the old-old.
        Res Aging. 1992; 14: 131-168
        • Jones T.
        • Rapport L.
        • Hanks R.
        • Lichtenberg P.
        • Telmet K.
        Cognitive and psychosocial predictors of subjective well-being in urban older adults.
        Clin Neuropsychol. 2003; 17: 3-18
        • Pavot W.
        • Diener E.
        The affective and cognitive context of self-reported measures of subjective well-being.
        Soc Indic Res. 1993; 28: 1-20
        • Vangel S.J.
        • Rapport L.J.
        • Hanks R.A.
        Effects of family and caregiver psychosocial functioning on outcomes in persons with traumatic brain injury.
        J Head Trauma Rehabil. 2011; 26: 20-29
        • Hanks R.A.
        • Rapport L.J.
        • Wertheimer J.
        • Koviak C.
        Randomized controlled trial of peer mentoring for individuals with traumatic brain injury and their significant others.
        Arch Phys Med Rehabil. 2012; 93: 1297-1304
        • McColl M.A.
        • Davies D.
        • Carlson P.
        • Johnston J.
        • Minnes P.
        The Community Integration Measure: development and preliminary findings.
        Arch Phys Med Rehabil. 2001; 82: 429-434
        • Minnes P.
        • Carlson P.
        • McColl M.A.
        • Nolte M.L.
        • Johnston J.
        • Buell K.
        Community integration: a useful construct, but what does it really mean?.
        Brain Inj. 2003; 17: 149-159
        • Novack T.A.
        • Dowler R.N.
        • Bush B.A.
        • Glen T.
        • Schneider J.J.
        Validity of the Orientation Log, relative to the Galveston Orientation and Amnesia Test.
        J Head Trauma Rehabil. 2000; 15: 957-961
        • Kenny D.
        • Kashy D.
        • Bolger N.
        Data analysis in social psychology.
        in: Fiske S.T. Gilbert D.T. The handbook of social psychology, vol. 1. 4th ed. McGraw Hill, New York1998: 233-265
        • Sin N.L.
        • Lyubomirsky S.
        Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis.
        J Clin Psychol. 2009; 65: 467-487
        • Peterson J.C.
        • Charlson M.E.
        • Hoffman Z.
        • et al.
        A randomized controlled trial of positive-affect induction to promote physical activity after percutaneous coronary intervention.
        Arch Intern Med. 2012; 172: 329-336
        • Ogedegbe G.O.
        • Boutin-Foster C.
        • Wells M.T.
        • et al.
        A randomized controlled trial of positive-affect intervention and medication adherence in hypertensive African Americans.
        Arch Intern Med. 2012; 172: 322-326