ABSTRACT
Background Stigma after Acquired Brain Injury (ABI) has been described as a significant obstacle for the recovery of survivors. Despite its theoretical and clinical relevance, studies dedicated to stigma after ABI are just starting to emerge. The goal of this systematic review was to integrate the existing scientific evidence and develop a model of stigma after brain injury that can guide interventions at different levels. Method Three electronic databases were employed. A search strategy was adapted for each database. Articles that explored stigma in adult ABI populations were included. All articles used quantitative, qualitative or mixed method designs and were published in English, Spanish or Portuguese. Results A total of 21 articles were selected. They considered three types of stigma after ABI: (1) self-stigma, (2) stigma-by-association and (3) public stigma. It was also found that information can be processed at implicit and explicit levels across all three forms of stigma. Definitions of each type of stigma used with ABIs are provided as well as related concepts and theoretical frameworks employed. Evidence emerging from different forms of stigma after ABI is summarised. Conclusion Research on stigma after ABI is heterogeneous, and existing studies have explored its impact at individual, family and public levels. A model of stigma after ABI should consider all these levels as well as the interactions that can occur between them. Future studies should explore how to incorporate stigma management as part of neuropsychological rehabilitation programs.
Subject(s)
Brain Injuries , Social Stigma , Humans , Brain Injuries/psychology , Brain Injuries/rehabilitationABSTRACT
Introduction: Group interventions are carried out routinely across neuropsychological rehabilitation services, to improve understanding of brain injury and aspects of impairment. Treatment provided in a group modality can bring additional perceived benefits, such as co-operative learning. However, there are very few studies which explore patient perceptions and experiences of such interventions. In the present study we investigated the experience of attending a group-based educational intervention for the consequences of acquired brain injury (ABI), which had a strong focus on emotion and emotion regulation. Methods: Using qualitative semi-structured interviews (approximately 20 minutes), the study explores the lived experience of participating in the seven-session programme, the better to identify the perceived efficacy, salience and value of individual elements. Twenty participants with ABI took part in individual interviews, after completion of the group programme (the Brain Injury Solutions and Emotions Programme, BISEP). The study adopted a descriptive phenomenological philosophy, which focuses on lived experience to explore a phenomenon (i.e. the experience of BISEP). As regards methods, the study employed thematic analysis to cluster experiences into themes of meaning. Results: Five themes were identified: (1) 'Long term consequences and psychological needs', which related to the persistent nature of direct consequences of injury and adjustment, and how these result in a need for interventions such as BISEP. (2) 'Positive experiences of participating in the programme', referred to participants' overall experience of the programme and valued elements within it. The remaining themes referred to the programme as (3) a social milieu; (4) a place to learn; and (5) a place to promote positive emotional experiences. Discussion: Similar to previous studies, many people reported high acceptability and perceived value of the group programme, and its role in facilitating adjustment and understanding of injury. Of particular importance was the opportunity to socialise with people who "can all relate", in line with a growing emphasis on social rehabilitation. The findings especially highlight the relevance of emotion-focused group programmes for ABI, promoting emotion regulation, and practical tools that are delivered optimistically. Further implications for practice and future research include to focus on long term rehabilitation, a social milieu, and strategies to support adjustment.
ABSTRACT
Aleksandr Luria repeatedly emphasised the importance of emotions and the right hemisphere in his neuropsychological writings. It is surprising, therefore, that Luria's most influential book, The Working Brain, appears to lack an explicit section on these topics. This is especially notable because of a comment in the book's English-language Introduction, by Karl Pribram, referencing Luria's thoughts about precisely this material. Remarkably, it seems that Luria did write such an explicit chapter, in the original Russian edition. However, in the English-language version, the relevant sections were separated, embedded elsewhere without chapter headings, and altered, presumably following an explicit translation decision. The present paper tracks the nature of these changes and, 50 years later, presents the material for the first time translated and reunited in English, as Luria intended. After the translation, we offer a brief commentary, on the ways in which Luria's ideas were in some respects prescient, and in other respects less well-informed about the brain basis of emotions and the right hemisphere. This reunification offers an interesting time capsule on the opinions of one of neuropsychology's greatest minds, on a topic which Luria admits had, at the time, only a modest empirical foundation.
ABSTRACT
Introduction: During the last decades, psychological interventions have become central components of rehabilitation programs for Traumatic Brain Injury (TBI). Nevertheless, due to a wide variability of therapeutic approaches there is little agreement regarding which approach is more suitable, or whether key elements from different psychotherapies should be integrated. This article critically reviews several contemporary approaches that are dominant in the literature. Methods: In order to accomplish such goal, an all-time search on Web of Science and Google Scholar was carried, using TBI and Psychotherapy as key words (n = 72). Results: The main finding of this paper is that theoretical and technical variability among psychotherapies reflects differences in the 'level of care' that is targeted: symptom reduction, behavioral problem reduction, quality of life and meaning reconstruction. Four contemporary approaches to psychotherapy [cognitive behavioral, third wave cognitive behavioral, narrative and psychodynamic] are then briefly described, by presenting their main theoretical tenets, the level of care they target, and the existing evidence that supports their efficacy. Finally, the implications of using a 'levels of care' perspective when addressing the 'effectiveness' debate is considered, as well as the need to familiarize future clinicians with more integrative models of psychological support after TBI.
Introducción: Durante las últimas décadas, las intervenciones psicológicas se han convertido en un elemento central de los programas de rehabilitación para personas que han adquirido un Trauma Cráneo Encefálico (TEC). Este artículo revisa críticamente los enfoques contemporáneos predominantes en la literatura a la luz del concepto de "niveles de cuidado". Método: Se realizó una revisión bibliográfica entre los años 1985 y 2014 utilizando los motores de búsqueda Web of Science y Google Scholar, usando TEC y Psicoterapia como palabras claves. 72 artículos fueron seleecionados para revisión. Resultados: Existe una amplia variabilidad teórico/técnica en los enfoques utilizados en esta población, reflejando diferencias en los niveles de cuidado: reducción de síntomas, reducción de problemas conductuales, calidad de vida y reconstrucción de sentido vital. Cuatro enfoques psicoterapéuticos contemporáneos (cognitivo-conductual, cognitivo-conductual de tercera generación, narrativo y psicodinámico) son brevemente descritos, presentando sus supuestos teóricos, el nivel de cuidado que consideran como objetivo, y la evidencia existente que apoya su efectividad. Finalmente, se discuten las implicancias de utilizar una perspectiva de 'niveles de cuidado' en el debate sobre efectividad de la psicoterapia en personas con TEC, así como la necesidad de familiarizar futuros neuropsicólogos clínicos con modelos genéricos de apoyo psicológico para esta población.
Subject(s)
Humans , Psychotherapy , Neurological Rehabilitation , Craniocerebral Trauma/rehabilitationABSTRACT
Abstract Recent studies have suggested that emotion regulation (ER) strategies, such as reappraisal and suppression, rely on the use of verbal thinking. Outside the field of ER, verbal thinking, particularly in the form of inner speech, has been largely linked to behavior and cognitive regulation. However, no article has yet directly addressed the potential role of inner speech in ER. In this study, 180 participants completed a survey that included measures of inner speech usage (Inner Speech Questionnaire), ER difficulties (Difficulties in Emotion Regulation Scale), ER strategy use (Emotion Regulation Questionnaire) and symptoms (HADS). Correlational analyses and hierarchical linear regression models were used to explore the potential relationship between inner speech and ER variables. A positive relationship was found between Inner Speech usage and the Difficulties in Emotion Regulation Scale overall score. This relationship was, however, heavily mediated by level of symptomatology. As for the ER strategies, only reappraisal presented a significant positive relationship, of medium size, with inner speech usage, which was independent of the level of symptoms. The results of this study are discussed in relation to the current conceptualization of reappraisal as well as its implications for clinical practice.
Resumen Estudios recientes han sugerido que estrategias de regulación emocional (RE) como la re-interpretación y supresión dependen del pensamiento verbal. Fuera del campo de la RE, el pensamiento verbal, como habla interna, ha sido vinculado con la regulación cognitivo/conductual. Sin embargo, a la fecha ningún estudio ha explorado el rol del habla interna en la RE. En esta investigación, 180 sujetos completaron cuestionarios de uso de habla interna (Inner Speech Questionnaire, ISQ), dificultades en la RE (Difficulties in Emotion Regulation Scale, DERS), uso de estrategias de RE (Emotion Regulation Questionnaire, ERQ) y sintomatología (HADS). Se realizaron análisis correlacionales y modelos de regresión lineal para explorar la relación entre habla interna y variables de RE. Una relación positiva fue encontrada entre frecuencia de uso de habla interna y la puntuación global de la escala de dificultades en RE -relación altamente mediada por el nivel de sintomatología. Respecto a las estrategias de RE, solo la reinterpretación presentó una relación positiva y significativa, de tamaño medio, con la frecuencia de uso de habla interna -con independencia del nivel de síntomas. Los resultados de este estudio son discutidos en relación a la conceptualización actual de la re-interpretación así como su relevancia para la práctica clínica.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Speech , Emotional Regulation , SuppressionABSTRACT
Barbara Wilson is a psychologist and researcher in neuropsychological rehabilitation from U.K. She is the founder of the Oliver Zangwill Centre, a place that has strongly contributed to the development of theoretical and technical approaches to rehabilitate cognitive and socio-emotional problems after brain injury. In this interview Barbara Wilson offers her personal perspective on the state of the art in neuropsychological rehabilitation, commenting on key topics such as the principles that guide holistic rehabilitation, the relevance of incorporating emotional problems after brain injury and the need to adopt research methodologies that are congruent with our object of study...
Subject(s)
Neuropsychology , Rehabilitation , Brain Injuries, TraumaticABSTRACT
La experiencia de tener una mente desorganiza es un fenómeno común luego de lesiones a la corteza frontal. Si bien en las últimas décadas existe un mayor conocimiento respecto a los mecanismos neuropsicológicos que colapsan en una mente desorganizada, las consecuencias emocionales de dicho problema han sido escasamente descritas. Este artículo sugiere que uno de los resultados más importantes de experimentar una mente desorganizada es la imposibilidad de utilizar dicha mente como fuente de autorregulación emocional. Además, propone que en situaciones de desorganización mental, los sobrevivientes de lesión cerebral tienden a utilizar las mentes-cerebros de otros como fuente de regulación afectiva, proceso conocido como regulación extrínseca. Por medio de la descripción de un caso clínico se intenta además demostrar como los procesos de regulación intrínseca y extrínseca se encuentran íntimamente relacionados...
The experience of a disorganized mind is a common phenomenon after pre-frontal cortex lesions. Even though during the last decades there has been a better understanding of the neuropsychological mechanisms that are often compromised in a disorganized mind, its emotional consequences have been scarcely described. This article suggests that a main problem of having a disorganized mind is the difficulty of using that same mind to self-regulate emotional states. In addition, this paper also proposes that in situations where the mind is in a state of disorganization, patients tend to use others peoples minds-brains as a source of affective regulation, a process commonly known as extrinsic regulation. Finally, the relationship between intrinsic and extrinsic regulatory processes is addressed through the description of a clinical case...
Subject(s)
Humans , Catastrophization , Prefrontal Cortex/physiopathology , Emotional Adjustment , Cognition Disorders/rehabilitation , Brain Injuries, Traumatic/rehabilitationABSTRACT
En los últimos años se ha observado un considerable aumento en el número de personas que sobreviven a lesiones medulares altas (tetraplejias). Si bien existe un adecuado conocimiento respecto a los cuidados médicos que un individuo con tetraplejia requiere, la comprensión de la experiencia subjetiva de vivir con una lesión medular alta, odel impacto de la inmovilización prolongada en la vida psíquica, es escasa. El siguiente trabajo describe las transformaciones psíquicas en una mujer con lesión cervical C6, durante los doce meses posteriores a su accidente. Se sugiere que la lesión medular alta impacta diversos ámbitos de la experiencia, generando: a) una hiper-activación de los procesos imaginativos por sobre los destinados a la resolución de problemas; b) un desacoplamiento del cuerpo virtual y material; c) cambios en las fronteras somáticas del Self.
In the last years there has been a significant increase in the number of people that survive from high-level spinal cord lesions (quadriplegia). Although there is an adequate understanding regarding the medical care these persons need, the comprehension of the subjective experience of living with quadriplegia, or the impact that chronic immobilization has on psychic life, is rare. This article describes psychic transformations in a woman who acquired a C6 spinal cord injury, during the following 12 months after her accident. It is suggested that a spinal cord lesion impacts different aspects of a patients experience, generating: a) an hyper-activation of imaginary life in contrast to processes related to real world problem solving; b) a decoupling between the virtual and material body; c) changes in the somatic borders of the Self.
Subject(s)
Humans , Female , Quadriplegia/physiopathology , Quadriplegia/psychology , Phantom Limb , Spinal Cord Injuries/physiopathology , Spinal Cord Injuries/psychology , Body Image , EmotionsABSTRACT
Debido al aumento de la población de pacientes con Lesión Cerebral Adquirida (LCA), la generación de programas efectivos de Rehabilitación Cognitiva (RC) se ha transformado en una necesidad pública. En nuestro país el desarrollo de esta área de la rehabilitación es reciente y principalmente se ha basado en intervenciones que intentan remediar los déficits cognitivos secuelares. Este abordaje es insuficiente ya que aísla artificialmente la esfera cognitiva, sin considerar los problemas emocionales, conductuales y psicosociales. Emerge así la necesidad de un enfoque comprensivo, que articule estas áreas y genere intervenciones que apunten a las múltiples necesidades de estos pacientes y sus familias.Delineamos en el siguiente articulo la descripción de un Enfoque Contextualizado de trabajo, que no se centra en la reparación exclusiva del déficit, sino también en la optimización funcional de los pacientes en sus actividades cotidianas y en el aumento de la participación social. Describimos los principios que guían este enfoque y los tipos de intervenciones que facilitan el logro de dicho objetivo. Señalamos, por último, las experiencias y dificultades de un equipo de neuro-rehabilitación en la implementación de dicho modelo.
Due to Acquired Brain Injury (ABI) patients population increase , the generation of effective programs for Cognitive Rehabilitation (CR) has become a public necessity .The development of this area of rehabilitation in our country is recent and it is mainly based on interventions that try to heal subsequent cognitive deficits. This approach is insufficient, because artificially isolates the cognitive sphere, regardless the emocional, behavioral , and psychosocial problems. Then comes the need for a comprehensive approach, that articulates these areas and generates interventions that aim to tthese patients and familias multiple needs. In the following article we outline the description of a Contextulaized Approach of work , that is not exclusively focused on the healing of the deficit, but also on the functional optimization of patients in their daily activitiesl and on the increase of social participation . We describe the principles that guide this approach, and the types of intervention that facilitate the achievement of taht objective. Finally , we note that, the experiences and difficulties of a team of neuro-rehabilitatio in implementing this model.