Coping after acquired brain injury Road to adaptation

164 Pages·2012·2.94 MB·English

by  Gisela Wolters Gregorio

Coping after acquired brain injury : road to adaptation
Citation for published version (APA):
Wolters Gregório, G. H. T. (2012). Coping after acquired brain injury : road to adaptation. [Doctoral
Thesis, Maastricht University]. NeuroPsych Publishers. https://doi.org/10.26481/dis.20121221gw
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Published: 01/01/2012
DOI:
10.26481/dis.20121221gw
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Coping after acquired brain injury
Road to adaptation
© G.H.T. Wolters Gregório, Maastricht 2012

Cover Pimalico, J. Arndt, Roermond
Print CPI Wöhrmann Print Service B.V.
Publisher NeuroPsych Publishers
ISBN 978 90 75579 642
Coping after acquired brain injury
Road to adaptation

Proefschrift

Ter verkrijging van de graad van doctor aan de Universiteit Maastricht,
op gezag van Rector Magnificus, Prof. dr. L.L.G. Soete,
volgens het besluit van het college van Decanen,
in het openbaar te verdedigen
op vrijdag 21 december 2012 om 16:00 uur

door

Gisela Hendrika Theresia Wolters Gregório

Geboren op 27 januari 1985 te Roermond
Promotores
Prof. dr. C.M. van Heugten
Prof. dr. F.R.J. Verhey
Copromotor
Dr. S.Z. Stapert
Beoordelingscommissie
Prof. dr. R.W.H.M. Ponds (voorzitter)
Dr. D. In de Braek
Prof. dr. M.L. Peters
Prof. dr. J.B. Prins (UMC St. Radboud, Nijmegen)
Dr. G. Ribbers (Rijndam revalidatiecentrum & Erasmus MC, Rotterdam)

The research described in this thesis was performed at the School for Mental Health and Neuroscience,
Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; and
Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia. The studies
were carried out in collaboration with Rehabilitation Centre Blixembosch, Eindhoven; de Hoogstraat,
Utrecht; Altrecht Vesalius, Den Dolder; GGZ Oost Brabant, Huize Padua; BAVO Europoort, Rotterdam;
and Pro Persona, Wolfheze.

Financial support by the Dutch Heart Foundation for the publication of this thesis is gratefully acknowl-
edged.
Furthermore, financial support for the publication of this thesis was kindly provided by Stichting Contusio
Cerebri Fonds, Lundbeck B.V., and Novartis Pharma B.V.
CONTENTS
Chapter 1 General Introduction 07
Chapter 2 Assessments of coping with acquired brain injury: A 13
systematic review of instrument conceptualization,
feasibility, and psychometric properties.
Chapter 3 Coping following acquired brain injury: Predictors and 31
correlates.
Chapter 4 Coping and executive functioning in patients with 45
neuropsychiatric symptoms due to acquired brain injury.
Chapter 5 Changes from pre- to post-injury coping styles in the first 59
three years after traumatic brain injury and the effects on
psychosocial and emotional functioning and quality of life.
Chapter 6 Coping styles in relation to cognitive rehabilitation and 75
quality of life after brain injury.
Chapter 7 Coping styles within the family system in the chronic 89
phase following acquired brain injury: its relation to
families’ and patients’ functioning.
Chapter 8 Changes in the coping styles of spouses and the influence 103
of these changes on their psychosocial functioning the first
year after a patient's stroke.
Chapter 9 General Discussion 117
References 131
Summary 143
Samenvatting 149
List of abbreviations 155
Dankwoord 157
Curriculum Vitae 161
Publications 163

CHAPTER 1
General Introduction

7
COPING AFTER ACQUIRED BRAIN INJURY
Acquired brain injury (ABI)
Acquired brain injury (ABI) includes any injury to the brain occurring during one’s
lifetime. The two most common forms of ABI are strokes in older people and trau-
matic brain injuries (TBI) in younger people. ABI is considered a chronic illness and
can lead to diverse, long-lasting consequences in several areas of functioning. The
consequences of such illnesses can be described in terms of the International
Classification of Functioning, Disability, and Health (ICF).1 ABI may influence all
three components of the ICF model: that is, brain functions or structures (e.g.,
memory), activities (e.g., remembering appointments), and participation level (e.g.,
meeting with friends). Environmental factors (e.g., social support) have been found
to influence psychosocial and emotional outcomes. Additionally, personal factors
(e.g., personality) have been suggested to mediate outcomes, although no specific
personal factors have yet been included in the model.
Insufficient adaptation to the consequences of ABI is an important and under-
estimated problem. Unfortunately, it is not yet understood why some people make
good recoveries or adjustments (e.g., returning to their social roles and to work,
reporting good quality of life) while others suffer from lasting detrimental changes in
their everyday lives. This phenomenon cannot be explained only by injury-related
factors, such as injury severity; there are large individual differences in emotional
and psychosocial functioning between patients with similar injuries. Brain injury and
the resulting impairments cannot be reversed when neurological recovery is no
longer possible. Accordingly, there is a growing interest in identifying which factors
determine whether patients will show resiliency following the consequences of ABI.
Furthermore, the importance of identifying factors that predict patient improvement
from natural recovery versus treatment programs has been recognised. Factors
that may be considered are awareness, motivation, availability of a social network,
and coping. This thesis focuses on ‘coping’, which is often mentioned in the litera-
ture as a promising factor for predicting outcomes after ABI, although it has scarce-
ly been investigated.
The importance of the concept of coping after ABI
Coping is a general concept and is difficult to define. In the literature, there is no
consensus on a single definition; however, we all seem to know what is meant by
the term. In general, people tend to define coping as managing one’s problems.
Because we encounter problems on a daily basis, we regularly rely on our coping
repertoire. Stressful situations can occur at home (e.g., noisy neighbours), at work
8
CHAPTER 1
(e.g., an argument with one’s boss), and in virtually any other situation. Folkman
and Lazarus are pioneers in the field of coping and have defined coping as ‘the
person’s cognitive and behavioural efforts to manage (reduce, minimise, master, or
tolerate) the internal and external demands of the person-environment transaction
that is appraised as taxing or exceeding the person’s resources’.2(p572)
They suggested that although some situations are considered more stressful
than others, no objectively stressful situations can be identified. That is, a situation
is stressful when a person appraises it as stressful. In these situations, coping
strategies are intended to have a stress-reducing effect. People rely on personal
(e.g., belief or traits), environmental (e.g., social support), and situational resources
when they encounter potentially stressful situations. Several coping styles are iden-
tified in the literature. Problem-focused and productive coping styles, for instance,
are actively focused on tackling the problem, attempting to search for different solu-
tions. Emotion-focused, or non-productive, coping styles are not aimed at solving
the problem but rather at regulating the emotional reaction that the problem elicits.
They include, among others, avoidance and passive reactions.
Examples of coping responses are provided hereafter. To our knowledge, pre-
paring for a doctoral dissertation defence is considered stressful for many Ph.D.
students. Ph.D. students may, however, each cope with such a situation quite dif-
ferently. Some persons may actively tackle the situation directly, studying and pre-
paring diligently. They may have reassuring thoughts that everything will work out,
or they may look for emotional or social support in dealing with the stressor. Others
may avoid the situation, for instance, by watching television or going out instead of
preparing, or they may worry about their performance. Of course, there are per-
sons who do not consider a defence to be stressful and do not employ coping
strategies.
Researchers have made several modifications to apply the model of Lazarus
and Folkman to patients with TBI.3-5 Godfrey et al.5 acknowledge that individuals
with TBI may experience additional stressors that are not experienced by persons
without TBI. Cognitive impairments, for instance, may limit the accomplishment of
pre-injury goals and values (e.g., partnership, employment). Moore et al.4 underline
the influences of cognitive beliefs concerning controllability and self-efficacy on the
selection of coping styles. Additionally, Kendall et al.3 recognise the important roles
of neurological impairment and cognitive dysfunction in outcomes and coping as
well as the influence of pre-injury functioning. All coping models suggest that cop-
ing largely mediates the influences of the symptoms on the final outcome.
These models are designed to explain outcomes in patients with ABI, but they
may also be used to describe the functioning of family members, whose lives also
change dramatically after the injury. Changes often occur in roles (e.g., from part-
ner to caregiver), future plans, and responsibilities. Family members may report
9