cognitive behaviour therapy after acquired brain injury - University of

127 Pages·2009·8.3 MB·English

by  April Arundine

COGNITIVE BEHAVIOUR THERAPY AFTER ACQUIRED BRAIN INJURY:
AN INVESTIGATION OF THE BENEFITS FOR EMOTIONAL WELL-BEING,
COPING STRATEGY USE, AND COMMUNITY INTEGRATION
AT 6-MONTHS POST-TREATMENT

by

April Arundine

A thesis submitted in conformity with the requirements
for the degree of Masters of Science
Graduate Department of Rehabilitation Science
University of Toronto

© Copyright by April Arundine 2009
COGNITIVE BEHAVIOUR THERAPY AFTER ACQUIRED BRAIN INJURY:
AN INVESTIGATION OF THE BENEFITS FOR EMOTIONAL WELL-BEING,
COPING STRATEGY USE, AND COMMUNITY INTEGRATION
AT 6-MONTHS POST-TREATMENT

by

April Arundine

Masters of Science Degree
Graduate Department of Rehabilitation Science
University of Toronto
2009

Abstract
Objectives: To demonstrate that at 6-months post-cessation of cognitive behaviour therapy
(CBT) adapted for acquired brain injury (ABI), (1) patients maintain psychological benefits, (2)
coping strategy selection improves, (3) community integration is enhanced, and (4) benefits are
observed in both face-to-face and telephone administrations. Methods: Participants. Seventeen
ABI patients with elevated psychological distress. Outcome Measures. Pre-treatment, post-
treatment and 6-month follow-up performance on the Symptom Checklist-90-revised (SCL-90-
R), Depression, Anxiety Stress Scales (DASS-21), Community Integration Questionnaire (CIQ)
and the Ways of Coping-Revised Questionnaire (WOC-R). Procedures. Eleven CBT sessions
provided in group, face-to-face format or individually by telephone. Results: For face-to-face
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and telephone groups, psychological distress was significantly reduced from pre-treatment to
6-months follow-up: DASS-21 (t = 7.32, p <.000); SCL-90-R (t = 6.22, p <.000). Community
16 16
integration (t -6.15 p<.000) and problem-focused coping (t = -3.67, p<.01) were also
16= 16
significantly enhanced. Conclusion: CBT adapted for patients with ABI carries robust benefits
even 6-months after treatment.
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Acknowledgments

I am indebted to Robin Green and Cheryl Bradbury for providing me with the opportunity to do
my Masters thesis under their supervision. I would like to thank-you both for your continued
support, advice and “therapy” throughout this project. I have learned a lot over the past two
years and have developed my skills both professionally and academically. Perhaps most
importantly, I will carry these skills forward and continue to work towards improving the lives
of acquired brain injury survivors. I will make you both proud!

I would like to take this opportunity to express my gratitude to the participants of this study and
the PHABIS Senior Management team, Carol Williams, Scott Farraway, Colin Pryor and Al
McMullan for supporting this study. Without you, none of this would have been possible.

I would also like to acknowledge the support of the Ontario Neurotrauma Foundation, and the
Toronto Rehabilitation Institute who receives funding under the provincial rehabilitation
research program from the Ministry of Health and Long-Term Care in Ontario.

To my fellow lab members- Danielle, Diana, Kadeen, Lily, Brenda, Yuko, Alex and Ephrem - I
was so fortunate to have such great colleagues and friends to work with. I am thankful for all
your support and advice, and will forever cherish the friendships I’ve made.
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I would like to thank Deirdre Dawson for her support and advice, especially throughout the
final days of my thesis. You made me think outside the box and much contributed to the quality
of the thesis.

Last but not least, I want to thank my family and in particular my husband Mark who
encouraged me and stood by me every step of the way. You never stopped believing me and I
am forever grateful for your love and support. Thank-you for being the only “constant” in my
life.
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Table of Contents
Page
Title Page .......................................................................................................................... i
Abstract.............................................................................................................................. ii
Acknowledgements............................................................................................................ iv
Table of Contents............................................................................................................... vi
List of Tables...................................................................................................................... ix
List of Figures .................................................................................................................... x
List of Abbreviations.......................................................................................................... xi
List of Appendices.............................................................................................................. xiii
CHAPTER 1
Introduction and Rationale........................................................................................... 1
CHAPTER 2: Literature Review
Introduction.................................................................................................................. 3
Definition and Epidemiology of Acquired Brain Injury ............................................. 3
The Nature and Prevalence of Psychological Distress after Acquired Brain Injury.... 4
Etiology of Depression following Acquired Brain Injury............................................ 6
Prevalence of Emotional Distress after Traumatic Brain Injury.................................. 7
Prevalence of Emotional Distress after Stroke............................................................. 9
Prevalence of Emotional Distress in Tumor Survivors................................................. 10
Summary of the Prevalence of Emotional Distress after Brain Injury.......................... 11
Correlates of Emotional Distress after Acquired Brain Injury........................................ 12
The Relationship between Emotional Distress and Community
Integration after Brain Injury........................................................................................ 12
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Summary of Community Integration............................................................................ 14
Coping after Brain Injury.............................................................................................. 14
The Relationship between Coping and Emotional Distress
after Brain Injury........................................................................................................... 15
Coping Strategy Selection and Executive Function after Brain Injury......................... 17
Coping and Community Integration Outcomes after Brain Injury................................ 18
Summary of Coping and Brain Injury........................................................................... 19
Moore and Stambrook’s Conceptual Framework (1995).............................................. 19
Cognitive Behaviour Therapy....................................................................................... 21
Cognitive Behaviour Therapy for Acquired Brain Injury............................................. 23
Summary of Literature Review..................................................................................... 27
CHAPTER 3: MANUSCRIPT 1
Examining the Efficacy of a Cognitive Behaviour Therapy Protocol Adapted For
Acquired Brain Injury at 6-Months Post-Treatment
Abstract...................................................................................................................... 29
Introduction................................................................................................................ 30
Methods...................................................................................................................... 32
Results........................................................................................................................ 44
Discussion.................................................................................................................. 55
CHAPTER 4: MANUSCRIPT 2
Cognitive Behaviour Therapy After Acquired Brain Injury: An Investigation of the
Benefits for Coping Strategy Use and Community Integration at 6-Months
Post-Treatment
Abstract................................................................................................................... 61
vii
Introduction............................................................................................................. 62
Methods................................................................................................................... 66
Results..................................................................................................................... 73
Discussion................................................................................................................ 81
CHAPTER 5: DISCUSSION
Introduction............................................................................................................. 87
Summary of Findings.............................................................................................. 87
Major Contributions................................................................................................ 90
Methodological Issues............................................................................................. 92
Implications............................................................................................................. 94
Future Research....................................................................................................... 97
Summary and Conclusions...................................................................................... 98
References........................................................................................................................... 100
Appendices................................................................................................................. ......... 109

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List of Tables

CHAPTER 3: MANUSCRIPT 1

Table 1. Demographic and injury variables for the entire CBT group and for those drawn from
the Experimental and Waitlist control groups from Bradbury et al (2008).

Table 2: Mean SCL-90-R and DASS-21 scores at pre-treatment and post-treatment for cohorts
of treatment [Experimental (Cohort 1) and Waitlist (Cohort 2) subgroups]

Table 3: Mean DASS-21 subscale scores at pre-treatment, post-treatment and 6-months follow-
up (N=17)

CHAPTER 4: MANUSCRIPT 2

Table 1. Demographic and injury variables for the entire CBT group and the G-CBT and T-
CBT subgroups

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List of Figures

CHAPTER 3: MANUSCRIPT 1

Figure 1: Study procedure and participant flowchart

Figure 2: Mean changes (+ SE) over time on the SCL-90-R for all participants (N=17) and the
G-CBT (N=10) and T-CBT (N=7) subgroups

Figure 3: Mean changes (+ SE) over time on the DASS-21 for all participants (N=17) and the
G-CBT (N=10) and T-CBT (N=7) subgroups

CHAPTER 4: MANUSCRIPT 2
Figure 1: Mean Total CIQ scores from pre-treatment to post-treatment and 6-month follow-up
for the larger CBT group and G-CBT and T-CBT subgroups

Figure 2: Mean scores on the WOC-R, planful problem focused coping subscale from pre-
treatment to post-treatment and 6-month follow-up for the larger CBT group and G-CBT and T-
CBT subgroups.

Figure 3: Mean CIQ subscale scores from pre-treatment to 6-months follow-up for all
participants (N=17)
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