Online Aid Can Improve Emotional Regulation after Brain Injury

Recovery from a traumatic brain injury (TBI) frequently includes overcoming physical and mental impairments. Unfortunately, working through emotional issues often becomes one of the largest challenges as options for care, and access to care, may be limited.

These limitations have fueled innovative approaches to care for emotional deficits after TBI. New options includes the use of various forms of health information technology to provide training in emotional regulation skills.

The study is presented in a special issue of the Journal of Head Trauma Rehabilitation (JHTR). The official journal of the Brain Injury Association of America.

Many patients with TBI experience disruptions in emotional functioning, including problems in awareness, recognition, expression, and regulation of emotions.

“Of the vast array of consequences of TBI, emotional deficits are among the most prevalent, persistent, and difficult to treat,” according to Dawn Neuman, Ph.D., of Indiana University School of Medicine at Indianapolis.

Deficits in emotional regulation can affect patients’ lives in many ways, including a reduced ability to participate in and benefit from other rehabilitation treatments.

Yet emotional issues after TBI remain “grossly understudied,” especially in terms of treatment. The seven original research papers in the special issue evaluate innovative treatments for common emotional problems after TBI.

Theo Tsaousides, Ph.D., and colleagues of Icahn School of Medicine at Mount Sinai, New York, evaluated a web-based intervention to improve emotional regulation after TBI. The study included 91 adults with a history of TBI and current problems with emotional regulation, based on the “Difficulties in Emotional Regulation Scale” (DERS).

Average time since TBI was about 10 years. In nearly half of patients, the severity of TBI was rated mild.

Over 12 weeks, participants received 24 one-hour emotional regulation skills training sessions. The group sessions were delivered by videoconference, supervised by experienced rehabilitation neuropsychologists.

The program provided education on how TBI affects emotional functioning, followed by training, practice, and feedback on specific strategies for improving emotional regulation skills in everyday life.

At the end of the 12-week program, the participants showed meaningful improvements in emotional regulation, including “medium to large” effects on all aspects measured by the emotional regulation questionnaire. Follow-up assessment 12 weeks beyond the treatment period showed continued improvement.

Measures of positive emotions, satisfaction with life, and problem-solving skills also improved significantly. Participants felt they made substantial progress toward their personal goals. Nearly 90 percent reported moderate to large improvements in their capacity for emotional regulation skills.

The use of videoconferencing technology could help to overcome distance and travel barriers to treatment, while maintaining the benefits of group interventions.

The study recruited participants from 33 states and five countries. Tsaousides said, “This technology allowed us to create an online educational environment that, in addition to providing skill training, enabled people who were hundreds and thousands of miles apart — many of whom had been isolated from support communities — to connect, share, and learn from one another.”

Other papers in the special issue report on treatments targeting emotional self-awareness, social-emotional perception, anger and aggression, and depression after TBI. While the studies are an important step forward, “The state of the science for studying and treating emotional deficits in people with TBI is sorely lagging behind the needs,” Neumann writes.

“A lot more evidence-based research is needed to support more confident treatment recommendations.”

Source: Wolters Kluwer Health/EurekAlert