A complex and dynamic set of biological, psychological and social factors interact to determine the consequences of acquired brain injury (ABI). This has led to recognition of the need for an integrated biopsychosocial approach to assessment, formulation and rehabilitation after ABI, drawing on multiple methods and models. This presents a significant challenge for the development and evaluation of complex rehabilitation programmes that may involve multiple interventions. In psychotherapy research, such problems are addressed through an approach which emphasises theoretical modelling of the disorder from which treatment programmes are developed and then evaluated. The resulting outcome studies, in which theoretically grounded change processes are measured, thus provide not only a test of the efficacy of the intervention but also an empirical evaluation of the underpinning model. In this paper we advocate such an approach to ABI rehabilitation, and to this end propose a model of the change process in rehabilitation called the "Y-shaped" model. This integrates findings from research into psychosocial adjustment, awareness and well-being following brain injury. The notion of discrepant or threatened identity is central to the model. Specific interventions are identified from the model, along with processes and interactions that may be central to change in rehabilitation. In conclusion, we propose that development of integrated models of change in rehabilitation is required. We also note that outcome should focus not only on level of activity or social participation, but also on the personal meaning of this to the person with brain injury.

There is a growing body of literature on the nature of subjective changes experienced following brain injury. This study employs personal construct and qualitative research methods to address the question of how people make sense of, or construe, themselves after brain injury. Thirty-two individuals who had experienced acquired brain injury engaged in small group exercises based on a personal construct approach. Bipolar constructs were elicited through systematic comparison of pre-injury, current and ideal selves. The constructs elicited in this way were subjected to a thematic analysis. Nine themes were derived and an acceptable level of reliability of the definitions of these themes achieved. The highest proportion of constructs fell into the theme "experience of self in the world", followed by "basic skills" (cognitive, sensory, physical, social) and "experience of self in relation to self". It is concluded that following brain injury, people make sense of themselves in terms of the meanings and felt experiences of social and practical activity. This is consistent with social identity theory and stands in contrast to traditional neuropsychological sense making in terms of impairments and abilities alone, or activity or social participation alone. The implications of these findings for future research and rehabilitation are briefly considered.

Acquired brain injury (ABI) commonly results in a range of interacting difficulties including regulating emotion, managing social interactions and cognitive changes. Emotional adjustment to ABI can be difficult and requires adaptation of standard psychological therapies. This article outlines a case where cognitive– behavioural therapy (CBT) was of limited effectiveness but was significantly enhanced with compassion focused therapy (CFT). This article describes Jenny, a 23-year-old woman who suffered a traumatic brain injury 3 years prior to attending rehabilitation. Jenny presented with low self-esteem and mental health difficulties. Neuropsychological assessment revealed executive functioning difficulties. Jenny entered a holistic neuropsychological rehabilitation program aimed at improving complex interacting difficulties, receiving CBT as part of this. As CBT was of limited effectiveness, reformulation of Jenny's difficulties was presented to her based on CFT. The CFT intervention employed aimed to help Jenny develop self-validation and acceptance through producing feelings of kindness and warmth. Shifting the affective textures to the self is a key process for CFT. Self-report measures of mental health and self-esteem showed positive changes and the usefulness of CFT for Jenny. Adaptations in the context of Jenny's ABI are discussed. In conclusion, CFT may be useful in conceptualising emotional responses and developing intervention in rehabilitation after ABI, especially because CFT is based on a neurophysiological model of affect regulation that pays particular attention to the importance of affiliative emotions in the regulation of threat-focused emotion and self-construction.

The judgement of personality change following acquired brain injury (ABI) is a powerful subjective and social action, and has been shown to be associated with a range of serious psychosocial consequences. Traditional conceptualisations of personality change (e.g., Lishman, 1998) have largely derived from individualist concepts of personality (e.g., Eysenck, 1967). These assume a direct link between neurological damage and altered personhood, accounting predominantly for their judgements of change. This assumption is found as commonly in family accounts of change as in professional discourse. Recent studies and perspectives from the overlapping fields of social neuroscience, cognitive approaches to self and identity and psychosocial processes following ABI mount a serious challenge to this assumption. These collectively identify a range of direct and indirect factors that may influence the judgement or felt sense of change in personhood by survivors of ABI and their significant others. These perspectives are reviewed within a biopsychosocial framework: neurological and neuropsychological deficits, psychological mechanisms and psychosocial processes. Importantly, these perspectives are applied to generate a range of clinical interventions that were not identifiable within traditional conceptualisations of personality changes following ABI.