Efficacy of the Brain Injury Family Intervention: Impact on Family Members.

OBJECTIVE: Examine the effectiveness of an intervention (Brain Injury Family Intervention) for family caregivers after acquired brain injury. RESEARCH DESIGN: Prospective, controlled repeated-measures design. METHODS: The Brain Injury Family Intervention was designed as a whole family approach to addressing needs, emphasizing education, skill building, and psychological support. One hundred eight families of outpatients were assigned to either a treatment or wait list control group. The manualized treatment focused on highly relevant topics (eg, common injury effects, coping with loss and change, communication, and stress management) and was composed of five 2-hour sessions with outcome measurement pretreatment, posttreatment, and at 3 months following. Outcome measures included the Family Needs Questionnaire, the Service Obstacles Scale, and the Zarit Burden Interview. RESULTS: Treatment group caregivers showed an increase in met needs, greater satisfaction with services, and reduced burden relative to pretesting, whereas controls did not. Between-group differences for Professional Support needs were identified. CONCLUSIONS: Investigation provided evidence that a curriculum-based education, skill-building, and support intervention can benefit caregivers for up to 3 months. Additional research is needed to ascertain the longer-term benefits of intervention and the efficacy of alternative delivery methods (eg, via telephone and the Internet).

Relationship Between Resilience, Adjustment, and Psychological Functioning After Traumatic Brain Injury: A Preliminary Report.

OBJECTIVE: To examine the relationship between resilience, psychological distress, adjustment, and community participation after traumatic brain injury (TBI). SETTING: Large university health system. PARTICIPANTS: Adult survivors of mild to severe TBI (N = 96). DESIGN: Descriptive, preliminary. MAIN MEASURES: The Connor-Davidson Resilience Scale (10-item version) was used to assess resilience, the Brief Symptom Inventory (BSI-18) was used to characterize psychological distress, and the Mayo-Portland Adaptability Index (MPAI-4) was used to measure ability, adjustment, and participation. RESULTS: Resilience scores were substantially lower than those of the general population. Significant relationships were found between resilience, psychological distress, and adjustment. Partial correlations (adjusting for the other MPAI-4 indices) showed significant correlation (P < .05) between MPAI-4 Adjustment and resilience. Partial correlations (adjusting for the other BSI-18 scales) also showed significance for Depression (P < .01) and resilience. Resilience scores differed significantly (P < .001) between individuals meeting BSI-18 caseness criteria for psychological distress (n = 55) and those not meeting criteria (n = 41). CONCLUSIONS: Individuals with TBI are at risk for low resilience, which was found to correlate with psychological distress and psychosocial maladjustment. Developing interventions to strengthen resilience skills has the potential to improve postinjury psychosocial adjustment, an important area for future research.

Embracing a new path to emotional recovery: adopting resilience theory in post-TBI psychotherapy.

In this commentary, clinical researchers examine the potential benefits of adopting Resilience Theory in the practice of psychotherapy after brain injury. This commentary presents the development of the paradigmatic shift that has given rise to the resilience movement. Additionally, the primary tenets of resilience theory are explored and the utility of the theory in practice is explained. Finally, an argument for the match between the hallmarks of resilient populations and the post-TBI needs related to emotional recovery is presented.

Marriage after brain injury: review, analysis, and research recommendations.

This critical review of the literature examines marriage after traumatic brain injury. Studies reporting information on marital stability rates and studies examining the quality of marriages through the assessment of at least 1 relational domain have been included for review. Available findings are presented along with information on methodological limitations and knowledge gaps. A rationale for the adoption of a marriage and family therapy framework to clarify remaining inconsistencies is presented. Furthermore, specific marriage and family therapy relational models and corresponding measurement instruments are outlined. Finally, suggestions for future research and potential implications for brain injury rehabilitation outcomes are discussed.

A mixed methods evaluation of the Brain Injury Family Intervention.

OBJECTIVE: To describe and compare caregivers' and patients' helpfulness and goal attainment ratings of the Brain Injury Family Intervention (BIFI), and qualitatively evaluate their perceptions of most important things learned. METHODS: 76 caregivers and 76 patients with acquired brain injury participated in the BIFI, a structured family intervention program which includes educational, skill building, and psychological support components. Outcome measures were obtained following each of the five intervention sessions and following completion of the entire program. RESULTS: Session helpfulness ratings for caregivers and patients were uniformly high as were ratings of the extent to which session goals were met. Between group comparisons did not indicate differences for individual session helpfulness or goal attainment ratings. Qualitative analysis of most important things learned provided corroboratory evidence that BIFI topics were relevant and consistent with program goals. CONCLUSIONS: The present investigation provides evidence that the BIFI is perceived as helpful and that treatment methods facilitate achievement of goals. The investigation also suggests that investigators may benefit from using mixed methods to evaluate outcomes, complementing traditional quantitative methods with qualitative approaches.

Practical approaches to effective family intervention after brain injury.

Rehabilitation professionals have become increasingly aware that traumatic brain injury has a long-term adverse impact on family members as well as on survivors. Family members often have a critical supporting role in the recovery process, and researchers have identified a relationship between caregiver well-being and survivor outcome. Drawing from the fields of family therapy, cognitive-behavioral therapy, and individual psychotherapy, this article provides information to help clinicians effectively serve families. First, historically important and widely cited publications are reviewed and their implications for practice are discussed. Recommendations for developing successful therapeutic alliances are provided along with a rationale for their importance. Descriptions of common challenges and issues faced by families are presented along with corresponding therapeutic goals. Intervention principles and strategies, selectively chosen to help family members achieve therapeutic goals, are discussed. The article concludes with a presentation of ideas to help practitioners and systems of care more effectively help family members adjust and live fulfilling lives.