Social cognition and emotion regulation: a multifaceted treatment (T-ScEmo) for patients with traumatic brain injury

Abstract

Background: Many patients with moderate to severe traumatic brain injury have deficits in social cognition. Social cognition refers to the ability to perceive, interpret, and act upon social information. Few studies have investigated the effectiveness of treatment for impairments of social cognition in patients with traumatic brain injury. Moreover, these studies have targeted only a single aspect of the problem. They all reported improvements, but evidence for transfer of learned skills to daily life was scarce. We evaluated a multifaceted treatment protocol for poor social cognition and emotion regulation impairments (called T-ScEmo) in patients with traumatic brain injury and found evidence for transfer to participation and quality of life. Purpose: In the current paper, we describe the theoretical underpinning, the design, and the content of our treatment of social cognition and emotion regulation (T-ScEmo). Theory into practice: The multifaceted treatment that we describe is aimed at improving social cognition, regulation of social behavior and participation in everyday life. Some of the methods taught were already evidence-based and derived from existing studies. They were combined, modified, or extended with newly developed material. Protocol design: T-ScEmo consists of 20 one-hour individual sessions and incorporates three modules: (1) emotion perception, (2) perspective taking and theory of mind, and (3) regulation of social behavior. It includes goal-setting, psycho-education, function training, compensatory strategy training, self-monitoring, role-play with participation of a significant other, and homework assignments. Recommendations: It is strongly recommended to offer all three modules, as they build upon each other. However, therapists can vary the time spent per module, in line with the patients’ individual needs and goals. In future, development of e-learning modules and virtual reality sessions might shorten the treatment.

What is rehabilitation? An empirical investigation leading to an evidence-based description

“…68 Descriptions of other evaluated rehabilitation programmes illustrate the number and variety of actions that constitute a part of the patient's overall rehabilitation. 69,70 Thus rehabilitation is definitely a complex intervention, one in which cause-effect relationships are difficult to establish, are often non-linear, and often interact (not always beneficially). Table 1 illustrates its complexity of rehabilitation as assessed using one set of characteristics used to measure the spectrum of complexity.…”

“… 68 Descriptions of other evaluated rehabilitation programmes illustrate the number and variety of actions that constitute a part of the patient’s overall rehabilitation. 69 , 70 …”

Trajectories of Emotion Recognition Training in Virtual Reality and Predictors of Improvement for People with a Psychotic Disorder

“…DiSCoVR consisted of 16 individual 45–60 minutes, twice weekly one-on-one treatment sessions, guided by a trained therapist. The intervention was modeled after existing, effective SCT protocols (e.g., Roberts 23 and Westerhof-Evers et al 24 ) and was designed to gradually increase the complexity of training content. Sessions consisted of face-to-face discussion (e.g., about goals and strategies) and practice with social stimuli in VR.…”

Remediating impairments in social cognition

“…The T-ScEmo (Treatment of Social cognition and Emotion regulation) program, designed by Westerhof and colleagues (Westerhof-Evers et al, 2017;Westerhof-Evers, Visser-Keizer, Fasotti, & Spikman, 2019), is another multifaceted treatment for people with brain injury. This treatment combines many of the approaches that have been evaluated before as effective or promising, in a new set-up.…”