Moving Ahead CRE Small Seed Grants – Past Recipients
A trial of acceptance and commitment therapy to facilitate psychological adjustment after severe traumatic brain injury
By Diane Whiting, Frank Deane, Joseph Ciarrochi, Hamish McLeod and Grahame Simpson
What the study will be about:
Adjusting to the changes wrought by traumatic brain injury (TBI) often results in high levels of psychological distress and behavioural avoidance. These high levels of psychological distress may impair post-injury rehabilitation or engagement in meaningful activities for the person with the brain injury. The project involves the undertaking of a treatment intervention trial using Acceptance and Commitment Therapy (ACT) with an active control (Befriending) for the treatment of psychological distress after a severe traumatic brain injury. This project has three components: 1) explore the construct of psychological flexibility on a TBI population; 2) validate two measures of psychological flexibility on a TBI population for use in the clinical trial and; 3) to undertake a clinical trial using ACT to treat psychological distress.
What we have done:
The first two components of the study have finished data collection with 75 participants having completed a large battery of measures and an additional 75 participants completing a measure of psychological flexibility for the purposes of a factor analysis. The data is currently being analysed and written up for publication. With regard to the clinical trial, to date, 16 participants have been recruited with 14 completing the treatment, 7 in each group (ACT or Befriending). It is proposed to recruit an additional 4 participants in 2014 giving a total of 9 in each group for a final sample of 18.
What we expect to find:
It is hoped that this project will contribute to the empirical support for treatment of psychological distress after a traumatic brain injury. The seeding grant will be used to improve treatment fidelity in the area of standardisation of intervention delivery. Treatment adherence (fidelity) is a crucial element in the trial design and additional funds will allow independent review of treatment sessions to ensure they comply with both the treatment manual and that they are consistent with ACT and Befriending protocols.
To read more about the clinical trial, the protocol for the project has been published: Whiting DL, Simpson GK, McLeod HJ, Deane FP, Ciarrochi J (2012). Acceptance and Commitment Therapy (ACT) for psychological adjustment after traumatic brain injury: Reporting the protocol for a Randomised Controlled Trial. Brain Impairment, 13(3), 360-376.
Cognitive behaviour therapy to treat fatigue and sleep disturbance after traumatic brain injury
By Sylvia Nguyen, Jennie Ponsford, Adam McKay, Dana Wong and Shantha Rajaratnam
What this study is about:
Fatigue and sleep difficulties frequently occur after traumatic brain injury and can interfere significantly with everyday functioning and quality of life. Despite the prevalence and debilitating nature of these symptoms, there are no evidence-based treatments available in TBI. Past studies have shown that fatigue is strongly related to sleep disturbance, pain and mood. Cognitive Behavioural Therapy (CBT) is a promising treatment and may be able to address the factors that maintain these symptoms. The aim of this study is to be the first controlled trial to evaluate whether CBT is an effective intervention for fatigue and insomnia after adult TBI.
What we have done so far:
A CBT treatment manual has been developed specifically for this study and pilot data has been collected on participant’s response to the program. Pilot participants reported improved sleep and mood. The impact of fatigue on physical functioning and daily activities also decreased. Participants reported greater control over their symptoms and these gains were maintained over-time.
What we expect to find:
We are presently conducting the controlled trial and randomizing participants to therapy or treatment as usual. The two groups will be compared across 3 time points on measures of fatigue, sleep, mood, quality of life and self-efficacy in managing symptoms. We expect the trends found in the pilot group to continue in the controlled trial and for participants in therapy to report better outcomes relative to those not receiving treatment. This study will inform whether CBT is effective in treating fatigue and sleep symptoms in individuals with a TBI and associated cognitive impairment. If successful, it is hoped that the treatment program will be implemented into clinical practice to improve recovery outcomes for clients.
Communication recovery after TBI
By Elise Elbourn, Leanne Togher, Belinda Kenny and Emma Power
What is this study about?
Recovery of communication skills following severe traumatic brain injury is a largely unknown topic despite its key role in brain injury rehabilitation. The specific aims of this study are to explore the recovery of discourse impairments in the first year following injury.
What is the current progress on this study?
Our research team has obtained discourse samples from a cohort of 58 participants with TBI in the first 12 months following injury. We have used a newly developed and internationally recognised ‘TBI Bank’ discourse protocol which is currently being trialled for best practice in assessment and repeated assessment of discourse. The discourse samples will be analysed with a focus on the recovery trajectory. This CRE Seed grant will support the transcription and coding necessary for discourse analysis.
What will this study contribute?
This is the first study to trace discourse recovery in the sub-acute stage after TBI. It is anticipated that this information will be highly useful for rehabilitation providers, particularly with regard to timing and prioritisation of speech pathology services. The samples we have collected will also contribute to an international research database.
Using telehealth for improving the communication skills of people with traumatic brain injury and their carers
By Rachael Rietdijk, Leanne Togher and Emma Power
Many families have little access to support or training to deal with managing communication problems, particularly in rural and remote regions. A possible solution is the use of telehealth to provide communication training and support for families. This project will examine the use of telehealth to deliver social communication skills training to people with TBI and their carers. The study will evaluate whether social communication skills can be assessed as accurately over the Internet using Skype as compared to a face-to-face assessment. This will determine whether Skype is an appropriate and feasible medium for working with people with TBI and their carers on complex communication skills. The study will also use qualitative methods to explore the perceptions of people with TBI and their carers of telehealth services.
Serum biomarkers to predict fatigue outcome after pediatric traumatic brain injury
By Ali Crichton, Vicki Anderson, Franz Babl, Ed Oakley and Jamie Hutchison
Fatigue is one of the most commonly reported and challenging symptoms after traumatic brain injury. It significantly impacts on wellbeing and quality of life after injury. Post brain injury fatigue has been well documented in adult literature although this is not the case in paediatrics. It is currently unclear how many children experience fatigue after discharge from hospital, and what determines their recovery. The aim of this study is to establish the extent to which fatigue after paediatric brain injury is predicted by early biochemical markers (biomarkers).
Benefits of psychological treatment for depression after traumatic brain injury
By Paul Gertler, Robyn Tate and Ian Cameron
The current project fits into the broader scheme of a PhD program that aims to evaluate the benefits of psychological treatment for depression following traumatic brain injury (TBI). Depression is more common after TBI and this can be because damage to the brain affects the experience of emotions and the way emotions are managed. Depression can also be a secondary consequence of catastrophic injury and life changes. There are very few studies addressing the value of psychological treatment for depression following TBI. Practicing clinical psychologists and other health professionals are regularly called upon to provide non-pharmacological treatment for depression with little evidence of the effectiveness of these treatments when applied to people with cognitive impairments. The CRE grant is being used for the evaluation of behavioural and cognitive therapies by way of a single-case experimental design. The CRE funds will specifically be used for the independent evaluation of treatment outcomes by a clinical or neuro- psychologist not otherwise involved in the research. The independent psychologist will therefore be more likely to be impartial in their findings thereby making the outcomes more robust. It is hoped that this study, and the research program more broadly, will provide a clearer understanding of whether psychological treatments are effective and which components of treatment work best for people with TBI.