Abstract
Objective
To compare the efficacy of 2 group treatments for persons with brain injury (BI) and
their caregivers in promoting perceived self-efficacy (PSE) and emotional and neurobehavioral
functioning.
Design
Randomized controlled trial.
Setting
Outpatient BI rehabilitation.
Participants
Subjects (N=38), including 19 with BI and 19 caregivers, participated in a BI coping
skills group or a support group.
Interventions
BI coping skills is a manualized cognitive-behavioral treatment (CBT). CBT was compared
with a structurally equivalent support group.
Main Outcome Measures
Brain Injury Coping Skills Questionnaire (PSE), Brief Symptom Inventory-18 ([BSI-18];
emotional distress), and Frontal Systems Behavior Scale (neurobehavioral functions).
Results
There were no significant differences between survivors and caregivers on the Brain
Injury Coping Skills Questionnaire and BSI-18; therefore, groups were combined during
final analyses. Frontal Systems Behavior Scale caregiver data were used for analysis.
Both groups showed significantly improved PSE between baseline and follow-up on repeated-measures
analysis of variance, with the CBT group showing greater stabilization of change.
There was no significant group by time interaction on measures of neurobehavioral
functions, but the CBT group showed significant improvements at 3-month follow-up.
No significant effects were found on the BSI-18.
Conclusions
To our knowledge, no studies to date have been published comparing a CBT intervention
with a support group in a BI population with caregiver participation. This study showed
that given equivalent group structure, individuals with BI and caregivers may benefit
from either type of intervention in enhancing PSE or maintaining emotional stability.
However, there was a trend for individuals who received CBT to maintain the effects
of improved PSE, whereas support group participants showed a trend for decline. This
study offers a new conceptualization that with certain group dynamics and support,
individuals with BI and caregivers may benefit similarly from either a support group
or CBT intervention. However, because our sample did not include individuals in clinically
significant emotional distress, we cannot rule out the possibility that those with
more significant challenges in PSE or emotional functions may show greater benefits
with a CBT group.
Keywords
List of abbreviations:
BI (brain injury), BSI-18 (Brief Symptom Inventory-18), CBT (cognitive-behavioral therapy), CI (confidence interval), FrSBe (Frontal Systems Behavioral Scale), PSE (perceived self-efficacy), TAU (treatment-as-usual)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Neurobehavioral symptoms and family functioning in traumatically brain-injured adults.Arch Clin Neuropsychol. 1998; 13: 695-711
- Primary caregivers’ psychological status and family functioning after traumatic brain injury.Brain Inj. 1994; 8: 197-210
- Predicting family functioning after TBI: impact of neurobehavioral factors.J Head Trauma Rehabil. 2006; 21: 236-247
- Who benefits? Outcome following a coping skills group intervention for traumatically brain injured individuals.Brain Inj. 2006; 20: 1-13
- Caregivers’ well-being after traumatic brain injury: a multicenter prospective investigation.Arch Phys Med Rehabil. 2009; 90: 934-946
- A longitudinal study of family functioning after TBI and relatives’ emotional status.Neuropsychol Rehabil. 2010; 20: 813-829
- The relationship between neurobehavioral problems of severe traumatic brain injury (TBI), family functioning and the psychological well-being of the spouse/caregiver: path model analysis.Brain Inj. 2001; 16: 743-757
- Predictors of caregiver depression among community-residing families living with traumatic brain injury.NeuroRehabilitation. 2007; 22: 3-8
- Pediatric traumatic brain injury: challenges and interventions for families.J Learn Disabil. 1996; 29: 662-669
- Personal needs of family members of critically ill patients with and without brain injury.J Neurosurg Nurs. 1984; 16: 36-44
- Long-term quality and family needs after traumatic brain injury.J Head Trauma Rehabil. 2001; 16: 374-385
- Family needs after brain injury: a quantitative analysis.J Head Trauma Rehabil. 1994; 9: 104-115
- Family stressors in traumatic brain injury: a two-year follow-up.Arch Phys Med Rehabil. 1994; 75: 876-884
- An interactive web-based intervention for persons with TBI and their families.J Head Trauma Rehabil. 2005; 20: 173-185
- Predictors of caregiver and family functioning following TBI: social support moderates caregiver distress.J Head Trauma Rehabil. 2002; 17: 242-250
- Caregiving appraisal after traumatic brain injury: the effects of functional status, coping style, social support and family functioning.NeuroRehabilitation. 2007; 22: 43-52
- Self-efficacy.Harv Ment Health Lett. 1997; 13: 4
- Self-efficacy as a resource factor in stress appraisal processes.in: Schwarzer R. Self-efficacy: thought control of action. Hemisphere, Washington (DC)1992: 195-213
- Causal attributions, self-efficacy cognitions, and coping with stress.J Soc Clin Psychol. 1992; 11: 377-400
- Perceived self-efficacy as a factor associated with the social participation of adults who who have sustained a traumatic brain injury.Can J Occup Ther. 2005; 72: 222-233
- Perceived self-efficacy and life satisfaction after traumatic brain injury.J Head Trauma Rehabil. 2007; 22: 257-266
- Brain injury coping skills group: a preventative intervention for patients with brain injury and their caregivers.Arch Phys Med Rehabil. 2010; 91: 840-848
- Improved self-awareness and coping strategies for patients with acquired brain injury–a group therapy programme.Brain Inj. 2010; 24: 823-832
- Evaluation of a coping skills group following traumatic brain injury.Brain Inj. 2006; 20: 167-178
- Comparison of individual, group and combined intervention formats in a randomized controlled trial for facilitating goal attainment and improving psychosocial function following acquired brain injury.J Rehabil Med. 2008; 40: 81-88
- Cognitive-behavioral group therapy versus group psychotherapy for social anxiety disorder among college students: a randomized controlled trial.Depress Anxiety. 2011; 28: 1034-1042
- The Orientation Log.The Center for Outcome Measurements in Brain Injury, 2000 (Available at: http://www.tbims.org/combi/olog. Accessed November 30, 2015.)
- The Cognitive Log.The Center for Outcome Measurements in Brain Injury, 2004 (Available at: http://www.tbims.org/combi/coglog. Accessed November 30, 2015.)
- Brief Symptom Inventory 18 (BSI-18): administration, scoring, and procedures manual.NCS Pearson, Minneapolis2001
- Frontal Systems Behavior Scale: professional manual.Psychological Assessment Resources, Lutz2001
- Advances in group psychotherapy: integrating research and practice.International Univ Pr, New York1983
- Guide for constructing self-efficacy scales.in: Pajares F. Urdan T. Self-efficacy beliefs of adolescents. Information Age Publishing, Inc., Atlanta2006: 307-337
- Efficacy of peer support interventions for depression: a meta-analysis.Gen Hosp Psychiatry. 2011; 33: 29-36
- The theory and practice of group psychotherapy.Basic Books, New York2005
- The great psychotherapy debate: models, methods, and findings.Lawrence Erlhbaum Associates, New Jersey2001
Article Info
Publication History
Published online: November 06, 2015
Footnotes
Supported by the Indiana Spinal Cord and Traumatic Brain Injury Research Fund and the Dr. Lisa Thompson Center for Family Education Fund, Rehabilitation Hospital of Indiana Foundation.
Disclosures: none.
Identification
Copyright
© 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
