Comparison of a Cognitive-Behavioral Coping Skills Group to a Peer Support Group in a Brain Injury Population.

OBJECTIVE: To compare the efficacy of 2 group treatments for persons with brain injury (BI) and their caregivers in promoting perceived self-efficacy (PSE) and emotional and neurobehavioral functioning. DESIGN: Randomized controlled trial. SETTING: Outpatient BI rehabilitation. PARTICIPANTS: Subjects (N=38), including 19 with BI and 19 caregivers, participated in a BI coping skills group or a support group. INTERVENTIONS: BI coping skills is a manualized cognitive-behavioral treatment (CBT). CBT was compared with a structurally equivalent support group. MAIN OUTCOME MEASURES: Brain Injury Coping Skills Questionnaire (PSE), Brief Symptom Inventory-18 ([BSI-18]; emotional distress), and Frontal Systems Behavior Scale (neurobehavioral functions). RESULTS: There were no significant differences between survivors and caregivers on the Brain Injury Coping Skills Questionnaire and BSI-18; therefore, groups were combined during final analyses. Frontal Systems Behavior Scale caregiver data were used for analysis. Both groups showed significantly improved PSE between baseline and follow-up on repeated-measures analysis of variance, with the CBT group showing greater stabilization of change. There was no significant group by time interaction on measures of neurobehavioral functions, but the CBT group showed significant improvements at 3-month follow-up. No significant effects were found on the BSI-18. CONCLUSIONS: To our knowledge, no studies to date have been published comparing a CBT intervention with a support group in a BI population with caregiver participation. This study showed that given equivalent group structure, individuals with BI and caregivers may benefit from either type of intervention in enhancing PSE or maintaining emotional stability. However, there was a trend for individuals who received CBT to maintain the effects of improved PSE, whereas support group participants showed a trend for decline. This study offers a new conceptualization that with certain group dynamics and support, individuals with BI and caregivers may benefit similarly from either a support group or CBT intervention. However, because our sample did not include individuals in clinically significant emotional distress, we cannot rule out the possibility that those with more significant challenges in PSE or emotional functions may show greater benefits with a CBT group.