Group psychotherapy for persons with traumatic brain injury: management of frustration and substance abuse

Residual emotional and behavioral difficulties in individuals who have sustained a traumatic brain injury (TBI) have been well documented in the literature. The issues are complex, interdependent, and often include substance abuse, depression, anxiety, chronic suicidal or homicidal ideation, poor impulse control, and significant degrees of frustration and anger. Often, preexisting psychological conditions and poor coping strategies are exacerbated by the trauma. Emotional and behavioral difficulties can interfere with the neurorehabilitation process at all levels. In acute rehabilitation, these issues have traditionally been addressed on an individual basis. However, in postacute settings, an interpersonal group format can be effectively implemented. The majority of individuals with TBI have minimal funding for long-term cognitive and behavioral remediation; often the only avenue available is support groups. This article will describe group psychotherapy models used with individuals with acute or postacute TBI within a comprehensive rehabilitation center. Interdisciplinary treatment of frustration and substance abuse and a continuum of care will be emphasized. Education, social support, skills development, interpersonal process, and cognitive-behavioral approaches will also be discussed. The psychotherapy groups focus on treatment of substance abuse and frustration management through education, social support, and development of interpersonal skills. Practical considerations of running such groups are presented.     

Measurement properties of the neurobehavioral cognitive status examination (Cognistat) in traumatic brain injury rehabilitation.

Objective: Evaluate measurement properties of the Neurobehavioral Cognitive Status Examination (Cognistat) using Rasch analysis. Design: Calibration of item responses from 120 individuals admitted to a rehabilitation medicine service for traumatic brain injury (TBI) and 296 community-dwelling adults with TBI. Results: Three strata of performance were differentiated despite a skewed distribution toward high performance among the community sample. Elimination of easier items created a better targeted instrument (i.e., generated more spread among individuals) without a significant increase in error. Memory and verbal reasoning were the most difficult domains for each sample; however, analyses indicated significant measurement error. Conclusions: As a screening instrument, the Cognistat reliably classifies multiple levels of cognitive status in both acute and postacute TBI settings; however, this measure is unsuitable for generating a profile of neurocognitive strengths and weaknesses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Driving, aging, and traumatic brain injury: Integrating findings from the literature.

Objective: In order to address the potential compounded risk in the population of aging traumatic brain injury (TBI) survivors who continue to drive, the authors synthesized literatures regarding the impact of aging or TBI on driving. Study Design: PubMed searches were conducted utilizing combinations of the following terms: driving, aging, elderly, TBI, cognition, seizures, vision, hearing, rehabilitation, sleep, fatigue, and assessment. Additional sources were also identified from the bibliographies of articles obtained and the Transportation Research Information Service electronic database. Clinically relevant human studies written in English were reviewed. Results: Using a conceptual framework developed by W. H. Brouwer and F. K. Withaar (1997), the authors of the current review highlight driving-related obstacles for TBI survivors and aging adults and suggest that individuals aging with TBI may be at increased risk for driving-related problems. Implications: Areas for clinical consideration include seizures, sleepiness and fatigue, vision, cognition, driving assessment, and caregiver involvement. The need for further study of postacute driving assessment and rehabilitation is highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of family focused therapy in rehabilitation for veterans with traumatic brain injury.

Objective: Military personnel returning from Iraq and Afghanistan with traumatic brain injury (TBI) present with a complex array of stressors encountered during combat as well as upon re-entry, often with additional physical and mental health comorbidities. This requires an intensive approach to treatment that includes family intervention as a part of rehabilitation. There is a small but growing literature addressing the needs of families when a family member has sustained a TBI. An established treatment intervention for individuals with serious mental illness, such as family focused therapy (FFT), is uniquely suited to address the complexity of issues presented by returning military personnel, and may be adapted for moderate to severe TBI populations. In this article, we discuss the rationale for adapting this family intervention for this population and present a case vignette illustrating adaptations for TBI. Conclusions: The adaptation of an existing family intervention for a chronic condition that focuses on enhancing both individual and family functioning is a useful starting point. With further research to modify FFT for this unique population and establish feasibility, this approach may supplement existing models of family intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Foreword to the special issue on long-term care.

This special issue on long-term care, guest edited by Carl and Susan Eisdorfer, addresses an issue that is rapidly becoming the most important health policy issue of the 1980s. The dilemma that we face as citizens and as rehabilitation professionals alike centers on our rapidly growing population of elderly citizens. While we have made unprecedented medical advances that have allowed for greater longevity, our health and social policies have not kept pace with these advances. We are therefore ill-equipped to deal with the myriad of economic, social, and health issues that confront our nation's elderly citizens. This issue of Rehabilitation Psychology is an attempt to address these questions by individuals who are leaders in the field of aging and long-term care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Care continuum in traumatic brain injury rehabilitation.

Discusses the range of services needed in traumatic brain injury (TBI) rehabilitation within the context of a services continuum owing to the nature of the recovery process. The TBI care continuum includes treatment during the following phases: injury onset, trauma center and emergency care, neurosurgery unit and acute hospitalization, coma stimulation, nursing home and long-term care programs, transitional living centers, day treatment and outpatient rehabilitation, supervised independent living center and support services, and vocational rehabilitation services. Obstacles to care continuity include funding concerns, lack of knowledge about TBI, the complex nature of TBI, and program accessibility issues. It is noted that major legislative, educational, and outreach efforts are under way to overcome these barriers to services provision. A comment by J. E. Sargent follows. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Jury instructions: Past, present, and future.

This introduction provides an overview of the relevant issues addressed in this special theme issue of Psychology, Public Policy, and Law, which is devoted to the topic of jury instructions. It begins with a brief history of jury instruction research. This is followed by a summary of the articles represented in this issue. Next, the strengths and weaknesses of the typical methodology used in jury instruction research are considered. Finally, the specific goals of this special issue are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to special issue: Rehabilitation psychology and persons with psychiatric disabilities: Are they mutually exclusive?

This guest-edited issue of the journal illustrates the relevance of psychiatric rehabilitation to rehabilitation psychologists. It demonstrates that the focus of psychiatric rehabilitation includes some areas of functioning typically identified with rehabilitation psychologists, for example, vocational, residential, and family functioning. Further, it shows that traditional assessment methodologies and treatment settings are beginning to reflect a psychiatric rehabilitation orientation. Finally, it illustrates the philosophy and treatment models that form the basis of physical rehabilitation as also underlying psychiatric rehabilitation. It is hoped that this issue of Rehabilitation Psychology will assist in the resolution of the debate over contextual issues by considering why psychologists working with psychiatrically impaired persons may be identified as rehabilitation psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction.

The current article introduces the special issue of Rehabilitaion Psychology. This issue is designed to explore a few of the many issues that have arisen in recent years. Several of the papers included are based upon an ethics symposium presented at the 1993 American Psychological Association annual convention, from which the impetus for this special issue arose. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response to "Psychotherapeutic interventions with traumatically brain-injured patients".

Comments on the original article "Psychotherapeutic interventions with traumatically brain-injured patients," by K. D. Cicerone (see record 1990-02095-001). The article by Cicerone presents a thoughtful and cogent rationale for the inclusion of psychotherapeutic intervention in the comprehensive rehabilitation of the brain-injured patient. The author's review of studies of emotional and personality disturbances following brain injury highlights the significance of overcoming the barriers of lack of self-awareness and acknowledgment of deficits. It can be argued that just as the end of posttraumatic amnesia represents a landmark or turning point in the recovery process during the acute phase of rehabilitation, similarly the process of achieving enhanced self-appraisal and awareness of deficits is a critical obstacle to overcome if postacute rehabilitation is to lead to successful community reentry. What Cicerone provides in this article is a practical framework encompassing the special problems of the head injured, which psychotherapists may use in their work with this population. It should be stressed that the psychotherapist working with the traumatically brain injured must be well versed with an understanding of the neuropathology, neurobehavioral correlates, and long-term consequences of head trauma to be truly effective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blame attribution in intentional and unintentional traumatic brain injury: Longitudinal changes and impact on subjective well-being.

Objective: Examine longitudinal changes in attribution of blame to self and others, and concern over cause of injury, in both intentional (violence-related) and unintentional (accidental) traumatic brain injury (TBI); investigate the relation of these factors to subjective well-being outcomes at 1 year post-TBI. Study Design: Prospective, multicenter, observational study with longitudinal component. Participants: 99 men with unintentional TBI and 25 men with intentional TBI who sustained moderate to severe injuries, received inpatient rehabilitation, and provided data in both acute rehabilitation and 1-year follow-up. Measures: Blame Attribution Questionnaire, General Health Questionnaire-30, Neurobehavioral Functioning Inventory-Revised Depression Scale, Satisfaction With Life Scale, community participation measures. Results: At both time points, participants with intentional TBI blamed others more while those with unintentional TBI blamed themselves more (trend). Other-blame at 1 year predicted depression but not life satisfaction. Self-blame was not a significant predictor of depression or life satisfaction. Increasing concern over cause/blame for injury from acute rehabilitation to follow-up was associated with high levels of emotional distress. Conclusion: Blame attribution issues may be markers of TBI-related emotional distress regardless of injury etiology, particularly when others are blamed for the injury and/or concerns over cause of injury do not resolve over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Misconceptions about traumatic brain injury among educators and rehabilitation staff: A comparative study.

This study compared the responses of 184 educators and 111 rehabilitation specialists on a measure of knowledge about childhood traumatic brain injury (TBI). Educators displayed more misconceptions about TBI overall compared to rehabilitation staff. They underestimated the effect of TBI on cognition, behavior, and continued development. More specifically, educators showed more misconceptions than the rehabilitation staff in the following areas: coma, memory and new learning, anger management, and factors affecting recovery. An important task for rehabilitation staff members is to clarify educator misconceptions about TBI as children transition to school. Information provided should increase the level of teacher preparation and help to maximize children's academic success and adaptation following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction.

Introduces this special issue of Rehabilitation Psychology. The purpose of this special issue is to present information about the status and utility of various treatment and rehabilitation programs that have been designed to maximize the functional outcomes of persons disabled with head injuries. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapeutic interventions with traumatically brain-injured patients.

Reviews personality disturbances that can occur after traumatic brain injury (TBI), including neuropsychologically based personality changes, emotional reactions to injury, and preexisting characterological styles. Denial, based in either psychological defensiveness or organic lack of awareness, presents a special rehabilitation problem that may be amenable to therapy. Psychotherapy following TBI is described, focusing on the use of the psychotherapeutic relationship, setting, rationale, and procedures. Psychotherapeutic techniques appropriate for working with TBI patients are noted, including cognitive-behavioral interventions, self-instructional training, dynamically oriented psychotherapies, and group psychotherapy. A comment by M. Rosenthal follows. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Counseling psychology research on sexual (orientation) minority issues: Conceptual and methodological challenges and opportunities.

This lead article of the special issue discusses conceptual and methodological considerations in studying sexual minority issues, particularly in research conducted by counseling psychologists (including the work represented in this special issue). First, the overarching challenge of conceptualizing and defining sexual minority populations is described. Second, the importance and value of scholarship about sexual minority issues are highlighted. Third, challenges in sexual minority research are outlined, using the articles in this special issue for illustrative purposes, and suggestions are offered for consideration in future research. Finally, the article concludes with a discussion of the ways in which counseling psychologists are uniquely positioned to advance knowledge, practice, and social justice through research on sexual minority issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special issue on the self and social identity.

This article describes the special issue of the Journal of Personality and Social Psychology (JPSP), which is the result of a joint undertaking by the three sections of JPSP. This makes it different from previous special sections or issues of the journal in that rather than relying on the generous services of a guest editor, the same editorial team that handles the regular journal issues has originated this special issue, as well, thus conveying a sense of "business as usual." Our major reason for the present initiative was to highlight the essential unity of personality and social psychology as a field of science. The topic choice for the present special issue was dictated by its relevance and interest to the field of personality and social psychology as a whole, across its various partitions and subdivisions. The articles in the special issue amply reflect the naturalness with which the self and social identity theme transcends the boundaries of JPSP sections. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Guest editor's introduction: Current issues in the assessment of marital and family systems.

Introduces the articles appearing in this issue of the Journal of Family Psychology, (1989[Dec], Vol 3[2]). This special issue on marital and family assessment grew out of a symposium presented at the meeting of the Southwestern Society for Research on Human Development, held in New Orleans in March, 1988. Because many members of this interdisciplinary organization were exploring new approaches to understanding the family, the focus of the symposium was on several assessment-related issues facing both researchers and clinicians. Participants were selected because of their special expertise concerning designated substantive issues in family measurement. Each panel member was asked to discuss the issue from a conceptual vantage point and to illustrate the discussion with data from his or her research program. The conference papers served as the starting point for this volume; subsequently, papers were exchanged among subsets of symposium participants and were refined for inclusion in this special issue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special issue: Psychology in the 21st century.

Introduces this special issue of Psychological Bulletin. When this journal was founded just after the turn of the century, the discipline of psychology was in its infancy. The knowledge base of the emerging discipline was quite limited, and the contributors to it were few. During the past century, research and theory on psychological issues have increased exponentially. This special issue of Psychological Bulletin includes articles on a select number of topics that are of broad interest and importance and that are likely to be viewed as fundamental issues for psychologists in the coming years. In these articles, scholars who are leaders in the field offer their insights into what is known about these topics and what issues are of central importance to address in the future. The articles in this issue offer compelling examples of behavioral research that integrates theory and methods within and outside of psychology. The topics discussed contribute to an understanding of a broad range of basic psychological processes, including issues related to positive adjustment and psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk mechanisms in development: Some conceptual and methodological considerations.

This commentary focuses on several issues concerning research on risk mechanisms that are raised in this special issue. First, we focus on what marks this special issue as distinctive in the ways in which risk research is conducted. Second, several general issues in research are highlighted, including sample characteristics, measurement strategies, specificity of risk factors and risk mechanisms, categorical vs. dimensional approaches to samples and measures, and definitions of development and transitions. Third, the challenges for integrating alternative models of risk are discussed, with special references to research on genetic and environmental influences on developmental psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)