This article first appeared in the Autumn 2014 Edition of Making Headway.
Individual wellbeing depends on many factors. Severe anxiety following brain injury creates a barrier to wellbeing that has been well researched. In this edition of Research Roundup, Headway Assistant Psychologist Niamh Lowe examines three recent pieces of research in the area.

Anxiety disorders following brain injury are widely reported in research literature.  People with severe anxiety can have recurring intrusive thoughts or worries. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat.  We don’t know exactly what causes anxiety, but one theory suggests that a combination of direct biological factors and indirect factors such as environment and personal history play a role. This is the so-called biopsychosocial model.

Soo, C., & Tate, R. (2012). Psychological treatment for anxiety in people with traumatic brain injury (review). Cochrane Database Syst Rev, 3.

This review discusses previous trials in the area of psychological treatments for anxiety after ABI. They argue that the use of pharmacological approaches in the management of anxiety, in this population, creates an increased risk of medical side effects (for example, nausea, dizziness and insomnia). Cognitive side effects of pharmacological treatments (for example, slowed information processing speed) have also been reported. These side effects may further reduce already weakened cognitive functioning. They propose that psychological treatments may be preferable during the initial phase of anxiety treatment.

In their review, the authors found evidence for the effectiveness of the following interventions: cognitive behavioural therapy (CBT) for treatment of acute stress disorder following mild TBI, and combining CBT and neurorehabilitation for treatment of general anxiety symptoms in individuals with mild to moderate TBI.

Hsieh, M. Y., Ponsford, J., Wong, D., Schönberger, M., McKay, A., & Haines, K. (2012). A cognitive behaviour therapy (CBT) programme for anxiety following moderate-severe traumatic brain injury (TBI): Two case studies. Brain Injury, 26(2), 126-138.

An argument for psychological treatments is also made in this article. The authors outline that psychological treatments teach adaptive coping skills which, if adopted, may produce longer-lasting effects than medication and promote self-efficacy and independence. They also highlight the potential benefits of psychological treatments by outlining that post-ABI anxiety is often maintained and worsened by psychosocial factors (e.g. ineffective coping and social isolation) which emerge during the process of community reintegration

The authors promote the use of cognitive behavioural therapy (CBT) in the treatment of anxiety in survivors of ABI. CBT is a well-researched and structured psychological therapy based on the idea that emotional problems can be effectively managed using adaptive thinking and behavioural strategies. An advantage of this therapy is that, given the highly structured content, it is open to adaptation for memory, attention and problem solving impairments, corresponding to common difficulties experienced by people with brain injury.

This study aimed to: (1) illustrate, through two client cases, CBT’s potential in addressing anxiety problems following ABI, and (2) document the process of implementing a CBT programme specifically adapted for this client group.

The two clients with ABI showed a reduction in measures of anxiety and of distress. The two client cases suggest that the structured yet flexible nature of CBT can lend itself well to alterations for an ABI population. This paper provided examples of how CBT could be changed to accommodate cognitive impairments, while also highlighting the need to consider the individual’s preferences and the characteristics of their personality.

Williams, W. H., Evans, J. J., and Fleminger, S. (2003). Neurorehabilitation and cognitive-behaviour therapy of anxiety disorders after brain injury: An overview and a case illustration of obsessive-compulsive disorder. Neuropsychological Rehabilitation, 13(1-2), 133-148.

Neurorehabilitation works with the skills and attributes of the person with a disability and supports them in achieving meaningful goals. Neurorehabilitation and CBT both have an emphasis on enabling survivors to gain skills, record progress, challenge pessimism, and promote self-efficacy.

This paper illustrates how Neurorehabilitation, in combination with CBT, provides strategies for understanding and managing cognitive and emotional disorders for brain injury survivors. The paper shows how strategies from each discipline can be developed to work together with the other. It reveals that this combination of techniques can help to reduce anxiety in survivors of ABI.


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