Integrated neuropsychological and cognitive behavioural therapy after acquired brain injury: A pragmatic randomized clinical trial.

After acquired brain injury (ABI) many patients suffer from persistent cognitive and emotional disturbances. The aim of this study was to investigate the treatment outcome of an integrated intervention, combining neuropsychological and cognitive behavioural therapy (nCBT), against waitlist (WL) in outpatients with ABI. Individuals seeking outpatient treatment for cognitive and emotional problems after ABI were randomly allocated to nCBT (n = 27) or WL (n = 29) and completed assessments at baseline, post-treatment/WL and at six-month follow-up. The primary outcome measures were general psychopathology and functional activity in daily life. The nCBT group showed significant improvement for general psychopathology post-treatment when compared to WL. nCBT was also superior to WL regarding the secondary outcomes, i.e., the reduction of negative affect and the improvement of quality of life. No significant differences for functional activity and community integration were observed. Significant pre-post effect sizes ranged between small for functional activity and medium for quality of life. The positive effects were maintained at follow-up. The majority of patients with cognitive and emotional problems after ABI benefit from an integrated approach that offers cognitive remediation and psychotherapy. However, the heterogeneous sequelae of ABI and the moderate sample sizes in clinical trials present a methodological challenge to ABI research.

Quality of life in cancer rehabilitation: the role of life goal adjustment.

OBJECTIVE: A cancer diagnosis affects patients' quality of life (QOL) as well as their pursuit of life goals. However, numerous studies have shown surprisingly stable QOL measures in cancer patients over time. We propose that life goal adjustment can act as the missing link in explaining this response shift. Thus, the aim of this study was to examine associations between life goal adjustment and patients' QOL at baseline and over the course of 20 months. METHODS: Eighty-six cancer patients were recruited during rehabilitation and reassessed at follow-up 20 months later. Life goals were measured using the Life Goals Questionnaire and analyzed in relation to global QOL as assessed with the World Health Organization Quality of Life Questionnaire - Short Form. RESULTS: The overall attainment of life goals was associated with QOL. Moreover, over a period of 20 months, perceived QOL and goal attainment remained stable, whereas importance of life goals decreased. Lesser importance and improved goal attainment were predictors of increases in QOL. CONCLUSIONS: Results suggest that downgrading unattainable goals and making more progress in accomplishing attainable goals may be possible mechanisms of response shift as an adaption to illness. Thus, integrating life goal adjustment into rehabilitation services for cancer patients seems to be worthwhile to enhance an adaptive self-regulation and QOL.

Decline in attainability of communion and agency life goals over 2 years following acquired brain injury and the impact on subjective well-being.

Acquired brain injury (ABI) confronts patients with sudden and possibly permanent functional impairments which disrupt or block the attainment of important life goals and reduce subjective well-being (SWB). This longitudinal study aimed at investigating changes in the importance and the attainability of communion and agency life goals and their impact on SWB. Self-report measures of life goals, functional status and SWB were assessed in 42 patients during acute rehabilitation two months following ABI (baseline) and reassessed 19 months following discharge (follow up). Results indicate a significant longitudinal decrease of the general attainability of life goals and of the present success in achieving communal and agentic life goals. Life goal importance remained stable. After controlling for baseline SWB and follow up functional status the attainability of communal life goals significantly predicted SWB at follow up whereas agentic life goals failed to predict SWB. The present findings show long-term deterioration of life goal attainability. They highlight that more emphasis should be given to realistic attainability attributions during rehabilitation processes. Moreover, the results stress the need for outpatient treatment to promote disengagement from unobtainable life goals and to offer means for the engagement in alternative life goals in order to maintain or regain SWB.

Living with acquired brain injury: self-concept as mediating variable in the adjustment process.

Sequelae of acquired brain injury (ABI) require adjustment processes in which survivors must strive to regain subjective well-being (SWB) in the face of chronic impairment. The current study investigates whether the self-concept of achievement mediates this process. Thirty-five post-acute patients with ABI were assessed neuropsychologically for performance in memory, attention, concept formation and reasoning. Data concerning subjective complaints in applied cognition, self-concept, and SWB were collected. Patients rated their self-concept more negatively compared to a normative sample. Effects of subjective complaints in applied cognition on SWB were mediated by the self-concept of achievement. Contrary to expectations, objective cognitive deficits demonstrated no independent significant relationship to self-concept of achievement or SWB in multiple regression modelling when subjective complaints in applied cognition were considered simultaneously. The findings highlight the necessity of considering patients' subjective complaints and self-concepts to improve rehabilitative progress. Potential implications for neuropsychological rehabilitation are discussed.

Life goals after brain injury in the light of the dual process approach: empirical evidence and implications for neuropsychological rehabilitation.

Sequelae of acquired brain injury endanger the realisation of important life-goals. Discrepancies arise between the importance attached to a goal and the success in realising it. This study investigates goal discrepancies and their influence on patients' subjective well-being (SWB) in different rehabilitation stages. Life-goals, SWB and daily functioning were assessed in 130 neurological inpatients and 42 outpatients by self-report questionnaires. Both patient groups reported greater discrepancies between importance and success of life-goals than a normative sample of healthy controls. In multiple regression modelling, goal discrepancy predicted SWB in the inpatient sample even when controlling for the influence of ABI-related functional limitations. Of significant influence were the discrepancies in the domains of intimacy and achievement. In the respective analysis of the outpatient sample, goal discrepancy was not a significant predictor of SWB when accounting for functional limitations. A post-hoc analysis examined the inter-relation between functional limitations and goal discrepancy. Functional limitations influenced the ratings of successful goal realisation, yet they had less impact on the importance attached to a goal. The findings highlight the importance of patients' life-goals for successful neuropsychological rehabilitation. They indicate a need for further research considering goal adjustment processes in the face of chronic functional impairment.

Looking beyond the importance of life goals. The personal goal model of subjective well-being in neuropsychological rehabilitation.

OBJECTIVE: To identify subjective importance, attainability and success of life goals and their predictive value for subjective well-being in patients with acquired brain injury. DESIGN: Cross-sectional, descriptive. SETTING: Two inpatient neurological rehabilitation centres. PARTICIPANTS: Patients with non-progressive neurological disorders. INTERVENTIONS: Survey using questionnaires. MEASURES: Life goal characteristics were assessed using a life goal questionnaire (GOALS). Subjective well-being (composite score) was measured using the Center of the Epidemic Studies Depression Scale (CES-D), the Positive and Negative Affect Schedule (PANAS) and the Satisfaction With Life Scale (SWLS). RESULTS: Fifty-nine patients participated in the study. The most important life goals are intimacy (4.59/5), achievement (3.96/5) and altruism (3.89/5). The intimacy goals are considered most attainable (4.19/5) and patients feel most successful in this domain (3.98/5). Two important predictions of the personal goal model of subjective well-being could be confirmed. First, goal attainability moderates the relation between goal importance and goal success. Second, the influence of goal importance on subjective well-being is mediated by experienced success. The most powerful predictors for subjective well-being are success in the achievement domain (beta = 0.404) and discrepancy between importance and success in the intimacy domain (beta = -0.276). CONCLUSIONS: The subjective well-being of neurological patients depends not only on the appraised importance of life goals but also on their attainability and success.

Neuronal correlates of repetition priming of frequently presented objects: insights from induced gamma band responses.

The activation of cortical object representations requires the integration of dispersed cortical areas, signified by induced oscillatory bursts of activity > 20 Hz (induced Gamma Band Responses; iGBRs) at approximately 300 ms after stimulus onset. A well established marker of the functional dynamics within such cell assemblies is the suppression of iGBR amplitudes after the repetition of familiar stimuli. This effect is commonly interpreted as a signature of 'sharpening' processes within conceptual networks, which are behaviourally mirrored in repetition priming effects. Furthermore, it was demonstrated that the repetition of unfamiliar stimuli leads to iGBR increases indicating the 'formation' of a new cell assembly. A limitation of previous experiments was that only small numbers of repetitions were used. Thus, in the present EEG study we presented familiar and unfamiliar stimuli 10 times. We were able to replicate sharpening effects within conceptual networks representing familiar stimuli. Furthermore, we observed a gradual increase of iGBRs elicited by repeated unfamiliar stimuli. Interestingly, this formation effect did not turn into a sharpening effect after many repetitions (i.e. after an unfamiliar stimulus became familiar). Thus, we conclude that sharpening and formation effects rely on qualitatively different networks representing familiar and unfamiliar material.