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.
Brain Injuries , Social Stigma , Humans , Brain Injuries/psychology , Brain Injuries/rehabilitation
Acquired brain injury (ABI) is a worldwide public health issue for its high prevalence rate and the disability it produces. The consequences of ABI, including cognitive deficits, may impact return to work. This review focuses on the association between executive functions (EFs) and return to work after ABI. A systematic review of the literature between 1998 and 2023 was conducted following PRISMA guidelines. The articles were retrieved from the Pubmed, Medline and Web of Science databases. A total of 49 studies were finally selected. Impairments of EF were consistently shown to have a negative impact on return to work after an ABI. There is evidence that specific executive functions and neurobehavioral variables may affect return to work Studies showed a significant theoretical and methodological heterogeneity, representing an important limitation to understand the relation between EFs and work. There is a robust association between EFs and return to work after brain injury. Findings in this systematic review raise the need for further research on the role of specific EF profiles in the process of returning to work after brain damage.
Emotion-based decision making (EBDM) is the capacity to make decisions based on prior emotional consequences of actions. Several neuropsychological tasks, using different gambling paradigms and with different levels of complexity, have been designed to assess EBDM. The Bangor Gambling Task (BGT) was created as a brief and simple card gambling-task to assess EBDM. BGT contains a single-card deck and requires participants to decide whether to gamble or not, which can result in wins or losses. Unknown to the participant, the winning probabilities decrease throughout the task (from 0.75 in the first block to 0.25 in the fifth block), requiring participants to reduce their gambling probability to avoid long-term losses. A few studies have offered evidence regarding the BGT convergent validity. However, there are no computerized versions of BGT available, thus slowing the process of gathering information to explore the EBDM mechanisms behind the task, its validity, and clinical usefulness. In this article, we present a computerized version of the BGT using the Matlab environment and make all our code available. We explore BGT's replicability and analyze its probabilistic structure, providing trial-level and block-level analyses. Eighty-one participants performed the computerized version, which followed the same structure as the original version. It took participants 8.5 ± 3.3 minutes to complete the task, which is faster than the paper version. Replicating previous studies, participants diminished their gambling probability throughout the task, learning to inhibit the initially rewarded gambling behavior. This change in gambling probability could be considered a proxy for EBDM. Our analyses suggest that the last blocks are especially sensitive to capturing deficits in EBDM, and we propose some modifications to BGT's original version to enhance the initial exploratory and learning phase. Our results show that the BGT constitutes a quick and simple task to evaluate EBDM capacities.
Intentional forgetting (IF) is an important adaptive mechanism necessary for correct memory functioning, optimal psychological wellbeing, and appropriate daily performance. Due to its complexity, the neuropsychological processes that give birth to successful intentional forgetting are not yet clearly known. In this study, we used two different meta-analytic algorithms, Activation Likelihood Estimation (ALE) & Latent Dirichlet Allocation (LDA) to quantitatively assess the neural correlates of IF and to evaluate the degree of compatibility between the proposed neurobiological models and the existing brain imaging data. We found that IF involves the interaction of two networks, the main "core regions" consisting of a primarily right-lateralized frontal-parietal circuit that is activated irrespective of the paradigm used and sample characteristics and a second less constrained "supportive network" that involves frontal-hippocampal interactions when IF takes place. Additionally, our results support the validity of the inhibitory or thought suppression hypothesis. The presence of a neural signature of IF that is stable regardless of experimental paradigms is a promising finding that may open new venues for the development of effective clinical interventions.
Patients with strokes to the Anterior Communicating Artery (ACoA) pose an important challenge to rehabilitation teams due to a particular mix of cognitive and behavioral impairments (anosognosia, anterograde amnesia, prospective memory problems, and executive dysfunction). These deficits often compromise engagement with rehabilitation, learning and generalization. The goal of this article is to describe the long-term presentation of a patient with an ACoA stroke (Mrs. B, a 60-year-old electric engineer) as well as her rehabilitation needs and the many challenges experienced by the rehabilitation team when attempting to facilitate functional, vocational and psychosocial recovery. Based on this case, and the existing literature, a neuropsychological rehabilitation framework to understand and address the specific problems and needs of this population is proposed. This framework demands rehabilitation teams to consider: the slow pattern of recovery of this population, the interaction between cognitive and behavioral impairments, the relevance of physical and social environments, the value of personal projects and the need to include psychological and relational interventions.
OBJECTIVE: To propose a set of internationally harmonized procedures and methods for assessing neurocognitive functions, smell, taste, mental, and psychosocial health, and other factors in adults formally diagnosed with COVID-19 (confirmed as SARS-CoV-2 + WHO definition). METHODS: We formed an international and cross-disciplinary NeuroCOVID Neuropsychology Taskforce in April 2020. Seven criteria were used to guide the selection of the recommendations' methods and procedures: (i) Relevance to all COVID-19 illness stages and longitudinal study design; (ii) Standard, cross-culturally valid or widely available instruments; (iii) Coverage of both direct and indirect causes of COVID-19-associated neurological and psychiatric symptoms; (iv) Control of factors specifically pertinent to COVID-19 that may affect neuropsychological performance; (v) Flexibility of administration (telehealth, computerized, remote/online, face to face); (vi) Harmonization for facilitating international research; (vii) Ease of translation to clinical practice. RESULTS: The three proposed levels of harmonization include a screening strategy with telehealth option, a medium-size computerized assessment with an online/remote option, and a comprehensive evaluation with flexible administration. The context in which each harmonization level might be used is described. Issues of assessment timelines, guidance for home/remote assessment to support data fidelity and telehealth considerations, cross-cultural adequacy, norms, and impairment definitions are also described. CONCLUSIONS: The proposed recommendations provide rationale and methodological guidance for neuropsychological research studies and clinical assessment in adults with COVID-19. We expect that the use of the recommendations will facilitate data harmonization and global research. Research implementing the recommendations will be crucial to determine their acceptability, usability, and validity.
COVID-19 , Adult , Humans , Longitudinal Studies , SARS-CoV-2 , Smell , Taste
Social isolation can be a consequence of acquired brain injury (ABI). Few studies have examined the relationship between social isolation and mental health after ABI. In this cross-sectional and case-control study, we compared 51 ABI survivors and 51 matched healthy controls on measures of social isolation (network size, social support and loneliness) mental health and mental health problems. We explored the relationship between structural, functional and subjective components of social isolation and examined whether they were associated with mental health outcomes. No group differences were found on size of the network and perceived social support. The ABI group exhibited marginally higher levels of loneliness. The ABI group presented higher levels of depression, lower levels of quality of life and emotional wellbeing. In both groups, perception of social support was inversely related to subjective experience of loneliness. The relationship between network size and loneliness was only significant in the ABI group. Only loneliness significantly predicted quality of life, emotional wellbeing, depression and anxiety in people with brain injury. The relationship between social isolation variables in ABI is discussed, as well as the theoretical and clinical implications of focusing on loneliness to improve mental health after brain injury.
Brain Injuries , Loneliness , Humans , Loneliness/psychology , Mental Health , Quality of Life , Cross-Sectional Studies , Case-Control Studies , Social Isolation/psychology , Social Support , Brain Injuries/complications , Brain Injuries/psychology
Couples' extrinsic emotion regulation strategies are associated with marital quality or dyadic adjustment. However, only the strategies employed according to the objective they are expected to achieve have been examined; it is not known if strategies on the bases of positive or negative extrinsic emotion regulation motivation would have the same consequences for the dyad. The purpose of this study was to examine if extrinsic emotion regulation (EER) predicts one's own and one's partner's dyadic adjustment and if this effect differs by gender and relationship length. Using the Actor-Partner Interdependence Model (a type of dyadic data analysis, which incorporates the scores of the two members of the relationship into the analyses), data from 103 Chilean couples who completed self-report scales on dyadic adjustment and EER were analyzed. The participants were between 22 and 78 years old (M men = 39.84, SD = 11.37; M women = 38.01, SD = 10.64), and the relationship lengths were between 1 and 50 years (M = 12.98, SD = 11.53). The motivation or the intention to make the partner feel good (positive) or bad (negative) respectively predict higher and lower dyadic adjustment in both the one who uses the strategy (actor) and the receiver of the strategy (partner). There was no difference by gender or by duration of the relationship in the dyads, but there was with children in common. It is important to consider the motivation underlying the emotional management of the couple, given its implication in marital quality and the need to broaden the understanding of other EERs related to healthy dyadic functioning.
Over the last few decades, work in affective neuroscience has increasingly investigated the neural basis of emotion. A central debate in the field, when studying individuals with brain damage, has been whether emotional processes are lateralized or not. This review aims to expand this debate, by considering the need to include a hierarchical dimension to the problem. The historical journey of the diverse literature is presented, particularly focusing on the need to develop a research program that explores the neural basis of a wide range of emotional processes (perception, expression, experience, regulation, decision making, etc.), and also its relation to lateralized cortical and deep-subcortical brain structures. Of especial interest is the study of the interaction between emotional components; for example, between emotion generation and emotion regulation. Finally, emerging evidence from lesion studies is presented regarding the neural basis of emotion-regulation strategies, for which the issue of laterality seems most relevant. It is proposed that, because emotion-regulation strategies are complex higher-order cognitive processes, the question appears to be not the lateralization of the entire emotional process, but the lateralization of the specific cognitive tools we use to manage our feelings, in a range of different ways.
The way couples regulate their emotions affects the quality of their relationship. Despite this, no evidence-based scales of validity and reliability can measure the intention to regulate emotions in the romantic dyad. In order to address this gap, we developed the Couples Extrinsic Emotion Regulation (CEER) questionnaire. First, we adapted the "Others" subscale from the Emotion Regulation of Others and Self questionnaire (EROS) for any close relationship to measure the intention to regulate emotions in couples; second, the psychometric properties of the CEER questionnaire were studied. For the content validity assessment, 23 experts (47.8% of whom worked in social and health psychology and the psychology of emotions, 17.4% in couples' therapy, and 34.8% in social science methodologies) participated. A total of 528 Chileans completed the online CEER questionnaire, the relationship satisfaction scale (RAS) and dyadic adjustment scale (DAS): 27.8% were male, age M = 38.7, SD = 10.05, and time of the relationships M = 11.27, SD = 9.82. The content-based validity study made it possible to determine which items to include in the final version. Two unrelated first-order factors structure of the original test fit (RMSEA = .052, GFI = .97, AGFI = .95; CFI = .99; NFI = .98; and NNFI = .98). The CEER+ and CEER- factors presented adequate internal consistency (α = .79; ω = .80 and α = .85; ω = .85, respectively). The discrimination index of the factors were excellent (CEER+ = .55 and CEER- = .63). Validity evidence based on the relations to other variables showed a direct positive relation between CEER+, RAS and overall DAS, as well as their factors; and a negative relation between CEER-, RAS overall DAS, as well as their factors. The use of this instrument is recommended for the identification of Chilean couples where at least one of the partners has a less favorable opinion of their relationship, providing relevant data for couple's therapy.
Adaptation, Psychological , Emotional Regulation/physiology , Psychometrics/methods , Sexual Partners/psychology , Stress, Psychological/epidemiology , Adult , Chile/epidemiology , Factor Analysis, Statistical , Female , Humans , Interpersonal Relations , Male , Reproducibility of Results , Surveys and Questionnaires
BACKGROUND: Social isolation and inactivity are highly problematic long-term consequences of Traumatic Brain Injury. They are rarely addressed by rehabilitation programmes, which focus on early phases of recovery. Day centres, or "drop-in" peer support groups, have emerged as an informal solution to social rehabilitation needs. However, there is a lack of knowledge regarding the therapeutic ingredients of these services. METHODS: Twelve survivors of Traumatic Brain Injury that attended a social rehabilitation service (Head Forward Centre, UK; HFC), were interviewed to explore the meanings attached to the service and its activities. Thematic analysis was used to describe emerging themes and build a model of social rehabilitation. RESULTS: Four therapeutic functions were attached to HFC: (a) HFC as a safe and predictable milieu; (b) HFC as a space where identity can be reconstructed; (c) HFC as a place where survivors can remain cognitive and socially active; (d) HFC as a network of continuous support. CONCLUSION: A model of long-term social rehabilitation should consider both psychological and practical/functional ingredients. Such a model can help informal rehabilitation services reflect upon their goals and activities, as well as articulate therapeutic actions along the rehabilitation path. The conceptualization of these four therapeutic ingredients in holistic rehabilitation models is described, and contrasted with its use in long-term social rehabilitation.IMPLICATIONS FOR REHABILITATIONSocial isolation and inactivity are important problems in the long-term rehabilitation of people with TBI. Both problems can be addressed by social rehabilitation services (day centres and peer support groups).Participation in social rehabilitation can promote a sense of normality and belongingness, which contribute to the long-term process of identity reconstruction.Social rehabilitation can help maintaining people with TBI cognitive and socially active, as well as developing a network of continuous support.
Brain Injuries, Traumatic , Counseling , Humans , Social Isolation , Social Networking , Survivors
Clinicians and researchers have become increasingly interested in the potential of technology in assisting persons with dementia (PwD). However, several issues have emerged in relation to how studies have conceptualized who the main technology user is (PwD/carer), how technology is used (as compensatory, environment modification, monitoring or retraining tool), why it is used (i.e., what impairments and/or disabilities are supported) and what variables have been considered as relevant to support engagement with technology. In this review we adopted a Neuropsychological Rehabilitation perspective to analyse 253 studies reporting on technological solutions for PwD. We analysed purposes/uses, supported impairments and disabilities and how engagement was considered. Findings showed that the most frequent purposes of technology use were compensation and monitoring, supporting orientation, sequencing complex actions and memory impairments in a wide range of activities. The few studies that addressed the issue of engagement with technology considered how the ease of use, social appropriateness, level of personalization, dynamic adaptation and carers' mediation allowed technology to adapt to PWD's and carers' preferences and performance. Conceptual and methodological tools emerged as outcomes of the analytical process, representing an important contribution to understanding the role of technologies to increase PwD's wellbeing and orient future research.
Dementia/rehabilitation , Neurological Rehabilitation/standards , Self-Help Devices/standards , Humans , Neurological Rehabilitation/instrumentation , Neurological Rehabilitation/methods
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.
Humans , Psychotherapy , Neurological Rehabilitation , Craniocerebral Trauma/rehabilitation
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.
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Speech , Emotional Regulation , Suppression
Social isolation has been described as a common problem among traumatic brain injury (TBI) survivors during the chronic phase. Due to physical, cognitive and behavioural changes, survivors become less socially active and experience a marked decrease in the number of friends. The goal of this investigation is to explore TBI survivors' subjective account of the challenges encountered in sustaining friendships, as well as gaining insight into their particular understanding of such difficulties. Using a thematic analysis approach, 11 survivors of TBI were interviewed in relation to their experience of social isolation and friendship during the chronic stage. Four main themes emerged from the interviews: (1) The impact of long-term cognitive and behavioural problems on relationships; (2) Loss of old friends; (3) Difficulties making new friends, and (4) Relating to other survivors in order to fight social isolation (sameness). Clinical implications of these findings, as well as their relevance in the design of long-term rehabilitation programmes, are discussed. Particular emphasis is placed on the need to acknowledge the value of relating to other survivors, as a way of resisting cultural discourses about disability, and as a source of self-cohesion in the process of identity re-construction.
Adaptation, Psychological , Brain Injuries, Traumatic/psychology , Friends/psychology , Social Isolation/psychology , Adult , Brain Injuries, Traumatic/complications , Chronic Disease/psychology , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Female , Humans , Male , Middle Aged , Neuropsychological Tests
Individuals with profound amnesia are markedly impaired in explicitly recalling new episodic events, but appear to preserve the capacity to use information from other sources. Amongst these preserved capacities is the ability to form new memories of an emotional nature - a skill at the heart of developing and sustaining interpersonal relationships. The psychoanalytic study of individuals with profound amnesia might contribute to the understanding the importance of each memory system, including effects on key analytic processes such as transference and countertransference. However, psychoanalytic work in the presence of profound amnesia might also require important technical modifications. In the first report of its kind, we describe observations from a long term psychoanalytic process (72 sessions) with an individual (JL) who has profound amnesia after an anoxic episode. The nature of therapy was shaped by JL's impairment in connecting elements that belong to distant (and even relatively close) moments in the therapeutic process. However, we were also able to document areas of preservation, in what appears to be a functioning therapeutic alliance. As regards transference, the relationship between JL and his analyst can be viewed as the evolution of a narcissistic transference, and case material is provided that maps this into three phases: (i) rejecting; (ii) starting to take in; and (iii) full use of the analytic space - where each phase exhibits differing degrees of permeability between JL and the analyst. This investigation appears to have important theoretical implications for psychoanalytic practice, and for psychotherapy in general - and not only with regard to brain injured populations. We especially note that it raises questions concerning the mechanism of therapeutic action in psychoanalysis and psychotherapy, and the apparent unimportance of episodic memory for many elements of therapeutic change.
Confabulations offer unique opportunities for establishing the neurobiological basis of delusional thinking. As regards causal factors, a review of the confabulation literature suggests that neither amnesia nor executive impairment can be the sole (or perhaps even the primary) cause of all delusional beliefs - though they may act in concert with other factors. A key perspective in the modern literature is that many delusions have an emotionally positive or 'wishful' element, that may serve to modulate or manage emotional experience. Some authors have referred to this perspective as the 'emotion dysregulation' hypothesis. In this article we review the theoretical underpinnings of this approach, and develop the idea by suggesting that the positive aspects of confabulatory states may have a role in perpetuating the imbalance between cognitive control and emotion. We draw on existing evidence from fields outside neuropsychology, to argue for three main causal factors: that positive emotions are related to more global or schematic forms of cognitive processing; that positive emotions influence the accuracy of memory recollection; and that positive emotions make people more susceptible to false memories. These findings suggest that the emotions that we want to feel (or do not want to feel) can influence the way we reconstruct past experiences and generate a sense of self - a proposition that bears on a unified theory of delusional belief states.
Emotions/physiology , Executive Function/physiology , Memory Disorders/psychology , Amnesia/psychology , Humans , Memory/physiology , Motivation/physiology , Neuropsychological Tests
The biodiversity-productivity relationship (BPR) is foundational to our understanding of the global extinction crisis and its impacts on ecosystem functioning. Understanding BPR is critical for the accurate valuation and effective conservation of biodiversity. Using ground-sourced data from 777,126 permanent plots, spanning 44 countries and most terrestrial biomes, we reveal a globally consistent positive concave-down BPR, showing that continued biodiversity loss would result in an accelerating decline in forest productivity worldwide. The value of biodiversity in maintaining commercial forest productivity alone-US$166 billion to 490 billion per year according to our estimation-is more than twice what it would cost to implement effective global conservation. This highlights the need for a worldwide reassessment of biodiversity values, forest management strategies, and conservation priorities.
Biodiversity , Conservation of Natural Resources , Forests , Trees/physiology , Climate Change , Extinction, Biological
