None listed
Conditions
Brief summary
Clinically significant levels of emotional distress and behavioural avoidance are quite frequent after a traumatic brain injury. Interventions with a traumatic brain injured (TBI) population have demonstrated general benefits of group programmes in addressing some of these issues but to date, programs have utilised cognitive behavioural therapy (CBT) as a treatment protocol. At this time, there appears to be no published studies using acceptance and commitment therapy (ACT) with a TBI population. Acceptance and Commitment Therapy (ACT) is one of the ‘third wave’ of behavioural therapies. It aims to change our relationship with internal experiences (thoughts, feelings, memories and physical sensations) so they no longer act as barriers to valued behaviour. The aim of the study is to implement a psychological treatment program to improve psychologically functioning following a traumatic brain injury utilising Acceptance and Commitment Therapy (ACT). With improved psychological functioning it is anticipated that participants will increase their participation in rehabilitation and movement towards a more valued life. The study will be a randomised controlled group treatment programme. Clients of the brain injury rehabilitation unit demonstrating clinically significantly levels of psychological distress will be randomly allocated to either the treatment group or the control group (consisting of an active control based on Befriending protocol). It is anticipated that the treatment will be offered over a two year period. The intervention will consist of six by two hour group treatment sessions offered weekly at the brain injury unit with a one month follow up session. Content of the sessions will be based on ACT theory including identification of values, defusing techniques, self as context and mindfulness. Testing will be undertaken prior to the commencement of treatment and after the one month follow up with brief measures being undertaken weekly at the beginning and conclusion of each treatment sessions relating to motivation and capacity to complete homework tasks. Demographic information will be collected and elicited from the existing brain injury unit database. Participants on the wait list control will be given the opportunity to participate in the intervention after the second outcome measures are undertaken. De-identified data form the outcome measures will be analysed statistically for changes pre and post intervention. De-identified demographic and medical information will provide descriptive data about the participants. Attendance at other therapy appointments in the brain injury unit will be reviewed to measure level of participation.
Interventions
Psychological intervention based on Acceptance and Commitment Therapy (ACT).
a) ACT is a behavour therapy that involves 6 core process: Defusion, acceptance, contact with present moment, self as context, values identification and committed action. Act focuses on helping clients to accept unpleasant thoughts and feelings when doing so promotes valued living. It incorporates visual metaphors and experiential role plays suggesting it maybe modifiable for use with a cognitively impaired population.
Psychological intervention based on Acceptance and Commitment Therapy (ACT). a) ACT is a behavour therapy that involves 6 core process: Defusion, acceptance, contact with present moment, self as context, values identification and committed action. Act focuses on helping clients to accept unpleasant thoughts and feelings when doing so promotes valued living. It incorporates visual metaphors and experiential role plays suggesting it maybe modifiable for use with a cognitively impaired population. b) Sessions will be undertaken weekly for 2 hours for a period of 6 weeks with a 7th session after a month (7 sessions in total) c) Duration of the intervention will therefore be 10 weeks d) Treatment will be administered by a clinical psychologist experienced in both ACT and traumatic brain injury (TBI) to groups of 2 clients. e) Summary of Treatment Protocol Session 1 Introduction to the group - Introductions & name tags - Administer measures - Icebreaker activity - Group guidelines including confidentiality - Reason for attending - Group aims - Program outline - Confronting the agenda - Identifying individual issues - Workability - Breathing mindfulness activity - Homework - Introduce concept of homework - Homework contract Session 2 Administer measures Review homework Review previous session Control is the problem Normalcy of control Human suffering Exercise – Let suffering get close Exercise – Passengers on the Bus Homework Valued activity Homework contract Session 3 Administer measures Review homework Review previous session Acceptance and Defusion Defusion exercise – milk milk milk Physicalise the thought Don’t get eaten machine Homework Physicalising thoughts Homework contract Session 4 Administer measures Review homework Review previous session The observing self Separating self from thoughts/feelings/actions Exercise: Observer The Observing Self Chessboard Metaphor Mindfulness – eating a sultana Homework Listing to mindfulness CD Homework contract Weekly diary Session 5 Administer measures Review homework Review previous session Introduction of values Difference between goals and values Exercise - Survey of Life Principles Exercise - Funeral Homework Principles and action Homework contract Session 6 Review homework Values and committed action Setting goals Committed action and goals Recap and review of each session Homework Weekly diary Homework contract Session 7 (one month later) Administer measures Review of homework and progress Review course content Exercise – Leaves on a Stream Certificates Contacts for further assistance f) Homework will be given every week and vary depending on the content of the session
Sponsors
Diane Whiting
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Severe Traumatic brain injury Experiencing at least a moderate level of psychological distress (as measured by any subscale of the Depression Anxiety Stress Scale - DASS) Sufficient cognitive capacity and English language skills ot complete questionnaires
Exclusion criteria
Pre morbid history of severe psychiatric illness (e.g. psychotic illness)
Outcome results
None listed