2016 Grant Recipients

Congratulations to our 2016 recipients!

Moving Ahead’s Small Seed Grant recipients are selected on the basis of project merit, the project’s consistency with the overall goals of Moving Ahead, and the project’s ability to progress our knowledge or understanding of psychosocial issues in TBI.

Every year the standard of applications is very high, with a significant number of applicants obtained.

The Moving Ahead NHMRC Centre for Research Excellence Small Seed Grant recipients for 2016 are:

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Anneli Cassel
UNSW
‘SIFT’ that social information! Feasibility of a novel social cognition treatment for people with acquired brain injury
Anneli Cassel, Professor Skye McDonald & Dr Michelle Kelly


What the study will be about:
People living with acquired brain injury (ABI) can experience an array of social cognitive deficits: ranging from difficulties perceiving emotions, difficulties perspective taking, to difficulties empathizing. All these skills interrelate with one another and have the potential to impact on these individuals’ competencies interacting with others’ socially. Despite this, awareness of social cognitive deficits in clinical practice is lacking. This may be partly due to the dearth of evidence-based treatments developed for people living with ABI: there are no ‘comprehensive’ treatments developed to date that target the multiple, and interrelated, processes of social cognition.

We are aiming, therefore, to explore the feasibility of a novel, ‘comprehensive’, social cognition treatment for people with ABI. Feasibility will be assessed through examining the demand for the treatment, implementation of the intervention, and initial efficacy outcomes related to social cognitive skills.

What we have done:
We have been reviewing the current evidence base of social cognition interventions in other clinical populations in order to understand “what works” when it comes to treating these difficulties. We have found that it is important to target the range of processes involved in social cognition, and to ensure these are contextualized into individuals’ everyday lives. This has informed our treatment development of ‘SIFT IT! The Social Thinking Therapy’.

Once the materials and resources for the treatment are finalized, we intend to conduct two studies examining the feasibility of the treatment. The first study will be a Randomized Controlled Trial comparing SIFT IT, delivered in a group program, to a waitlist control. The second study will be conducted as a Single-Case Experimental Design, with the treatment delivered via telehealth in individual therapy.

What we expect to find:
Through this research, we hope that we will learn more about whether social cognitive deficits can be treated following ABI: i.e. “can the treatment work”? We hope we will also find out some preliminary outcomes related to whether the treatment shows promise, which will then be able to inform a larger scale study. Broadly, this research will contribute to developing our understandings of ways we can potentially improve psychosocial outcomes for those living with brain injury.



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Freyr Patterson
The University of Queensland
Group therapy interventions in traumatic brain injury rehabilitation: processes, perceptions and effectiveness
Freyr Patterson, Associate Professor Jennifer Fleming & Dr Emmah Doig


What the study is about:
Increasingly rehabilitation services are required to deliver better and more intensive therapy services with fewer resources, and one strategy is to provide therapy to groups of patients. Benefits of group-based therapy include opportunities for peer support and learning, opportunities to receive feedback about capabilities, and to practice strategies in supportive ‘real world’ social and physical environments. It is important that group-based rehabilitation with people following traumatic brain injury (TBI) is informed by both the research literature and consumer perspectives, as well drawing upon the practice knowledge of clinicians who work in the area.

The overall aim of the study is to develop new knowledge about how to run effective group-based interventions in inpatient brain injury rehabilitation services. Specific aims are:

1. To investigate patient and clinician perceptions of the benefits, limitations and processes of group-based interventions in brain injury rehabilitation.
2. To examine group processes in brain injury rehabilitation including type of intervention, time on tasks, goal setting processes, and processes used to meet individual needs.
3. To evaluate the outcomes of patients with TBI following participation in group rehabilitation.

What we have done:
A scoping review was completed which highlighted that there is limited research evidence to guide clinicians in the delivery of group-based interventions for people following TBI. The current PhD study utilises a mixed-methods approach with data collected from patient questionnaires (n=83), patient interviews (n=15), videotaped recordings of therapy groups (n=4), and four clinician focus groups. A total of 35 patients participating in an inpatient occupational therapy groups program in the Brain Injury Rehabilitation Unit and 26 occupational therapists working in rehabilitation across brain injury, spinal injury and geriatric rehabilitation have participated in the study. Clinicians working in spinal and geriatric rehabilitation were included to explore group interventions across different rehabilitation populations in order to identify factors that may be uniquely important when working with people with TBI. So far, questionnaire data have been collated and analysed using descriptive statistics and focus group data have been analysed qualitatively using framework analysis. Patient interviews are being analysed using qualitative thematic analysis, guided by a phenomenological approach, and analysis of video-recordings of therapy groups will be conducted.

What we have found and expect to find:
Findings so far have highlighted that, from the perspective of clinicians, groups can create opportunities for support and learning between patients, and contribute positively to rehabilitation post TBI. Clinicians emphasised the importance of group facilitator skills and the processes to achieve a ‘good fit’ of patients in the group. Overall patient perspectives about participation in groups were positive. They agreed that working with others was enjoyable, that the groups provided feedback and individualised treatment, and were useful for them. Analysis of patient interview data will explore the perspectives of patients in more depth.

It is anticipated that the research findings will integrate patient preferences and experiences as well as clinician perceptions about provision of group therapy in inpatient TBI rehabilitation, to inform and enhance group rehabilitation practice to patients with TBI.



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Leah Zelencich
Monash University
Cognitive Behaviour Therapy following traumatic brain injury – role of working alliance and in/between-session interventions
Leah Zelencich, Professor Jennie Ponsford, Associate Professor Nikolaos Kazantzis & Dr Dana Wong


What the study will be about:
Psychopathology, particularly depression and anxiety (Gould et al., 2011; Osborn et al., 2014), are common following traumatic brain injury (TBI) and negatively impact quality of life (Bombardier et al., 2010). Preliminary evidence (Fann, Hart & Schomer, 2009) indicates that appropriately modified Cognitive Behaviour Therapy (CBT) is best placed to address the needs of people with TBI-associated cognitive impairment. However findings on the efficacy of CBT after TBI are mixed (e.g. Anson & Ponsford, 2006; Hsieh et al, 2012; Ashman, et al., 2014). Therefore, further investigation of the processes that underlie successful implementation of CBT in the TBI population is needed. This study will undertake CBT process research with brain-injured participants, specifically examining the role of the working alliance, between-session interventions (homework), therapist use of cognitive deficit compensatory strategies and client background factors, in relation to outcome.

What we have done:
A randomised controlled trial (RCT) has been conducted (Ponsford et al., 2016) which examined the efficacy of (1) CBT plus Motivational Interviewing (MI), compared to (2) CBT plus non-directive counselling and (3) treatment as usual. Patients with TBI were recruited via referral from rehabilitation centres or neuropsychologists between May 2008 and June 2013. Nine CBT sessions were provided to participants and were audio recorded. This project will utilise those CBT audio-recordings and outcome measures of 30 participants from the RCT. Depression and anxiety outcome measures were collected at baseline and 3, 12, 21 and 30 weeks post-baseline. Comprehensive training in the relevant observer-rated CBT process measures (Working Alliance-Short Form-Revised-Observer Scale, Kazantzis et al. 2012; Homework Adherence and Competence Scale, Kazantzis, Wedge & Dobson, 2004; Homework Rating Scale-Revised, Kazantzis, Deane, Ronan & L’Abate, 2005) has been undertaken. Data has been collected using these measures over 50 sessions so far with 54% of sessions currently co-rated. Additionally, a Cognitive Deficit Compensatory Strategy (CDCS) Checklist has been developed in order to measure therapist use of strategies throughout each CBT session. This checklist is currently being pilot tested.

What we expect to find:
As in the non-TBI population it is expected that stronger working alliance, higher rates of homework engagement and higher levels of therapist competence in reviewing and assigning homework will be associated with lower levels of anxiety and depression at post-treatment and follow-up. This project will also examine the factors that predict stronger working alliance and homework engagement, including the role of participant homework beliefs. Examination of the role of cognitive deficit compensatory strategies is exploratory. It is anticipated that this project will provide a preliminary psychometric evaluation of the CDCS Checklist to highlight the potential for compensatory strategies to be operationally defined and adequate inter-rater agreement achieved based on these definitions. Understanding the role of these psychotherapeutic processes in relation to outcome brings researchers and clinicians closer to identifying the crucial ingredients of CBT that effect change in the TBI population, in turn providing clinicians with the opportunity to increase the effectiveness of CBT for their brain-injured clients.