Role of CBT in Traumatic brain injury
by Dr Ascione
Traumatic brain injury (TBI) is a serious public health problem affecting around 1.5 – 2.0 million Americans each year. Cognitive deficits, particularly in the domains of memory and attention are frequently the source of persistent debility after TBI and a source of enormous distress to the injured individuals and their family. To date, interventions to ameliorate chronic cognitive deficits have been directed at either pharmacological interventions or cognitive rehabilitation.
Behavioral interventions for moderate to severe TBI typically include CBT delivered as components of comprehensive, multidisciplinary rehabilitation treatment. In general strong evidence supports the efficacy of CBT for treating panic and agoraphobia and social phobia following Traumatic brain Injury (TBI). Cognitive behavioral therapy is a specific form of psychotherapy that is concerned with how people’s behavior is shaped by their interpretation and perception of their experience (Alderman, 2003). It is also used for education and skills training to promote patients’ awareness of deficits and to increase positive coping following injury (Cattelani et al. 2010).
It is directed to assist the individual in analyzing and accepting the link between thoughts, feelings, belief and behavior. That is, there exist a belief (whether realistic or not), that triggers one’s thoughts and ultimately creates a pattern of behavior that is in lieu with that belief. Regardless of the fact, particular patterns of belief that existed prior to injury or those developed post-injury affect the treatment outcome of the rehabilitation process.
In cognitive behavioral therapy, the individual is asked to evaluate the maladaptive behavior in relation to the underlying beliefs that can cause hindrance in meeting basic needs. By altering the way an individual thinks will eventually result in modification of the behavior associated with the cause. For example, a teenager may be suspended multiple times for fighting in school. She reveals to her counselor that she has the following belief: “the way to deal with hostility is to be hostile in return — an eye for an eye and a tooth for a tooth.” Her counselor suggests alternative beliefs that would alter her emotional response and help her to avoid fights in school. In this case, alternative beliefs might include, “ignoring or walking away from another person’s hostility keeps me out of trouble” or “being hostile in return doesn’t improve the situation in the long run.” The process requires that an individual take an active role in the application of techniques.
Sufficient time and practice is required for self-monitoring, to achieve the success in changing belief and altering his/her own practices. Effectiveness of cognitive behavioral therapy with individuals who have a TBI is dependent upon the individual’s level of cognitive functioning. For example, the following personal characteristics are required to participate in Rational Emotive Behavioral Therapy (REBT) which is a form of cognitive behavioral therapy: self-direction, good ability to tolerate frustration, flexibility, acceptance of uncertainty, self-acceptance, and ability to take responsibility for one’s own emotional disturbances (Ellis & Dryden, 1997). Consequently, it has been suggested that a more flexible protocol of REBT be implemented for individuals with TBI. It should be more collaborative, less directive, and more flexible. They suggest that through procedural learning (repetition and structure), the likelihood will increase that cognitive behavioral therapy will be successful.