The role of psychological flexibility in recovery following mild traumatic brain injury.

Abstract

Purpose and Objective: Psychological distress is known to contribute to recovery following mild traumatic brain injury (mTBI) and there is a need to understand the mechanisms that contribute to this relationship. The present study examined psychological flexibility, as a hypothesized psychological mechanism, in 169 treatment-seeking adults with mTBI. Research Method/Design: Participants completed self-report measures of postconcussion symptoms, psychological distress (anxiety, stress, and depression) and functional status within four weeks of entry to an mTBI outpatient clinic. A general measure (Acceptance and Action Questionnaire), as well as a context-specific (Acceptance and Action Questionnaire-Acquired Brain Injury) measure of psychological flexibility were administered. Results: Simple linear regression analysis showed that psychological flexibility made a significant contribution to the prediction of postconcussion symptoms and functional status. A series of multiple mediation analyses also found that psychological flexibility had a significant indirect effect on the relationships between psychological distress and postconcussion symptoms, and functional status. The context-specific, rather than the general measure of psychological flexibility, was consistently shown to contribute to these findings. Conclusions/Implications: These results suggest that psychological flexibility is a psychological mechanism that contributes to recovery outcomes in individuals with mTBI and could therefore be an important treatment target in mTBI interventions. Impact and ImplicationsThere is a growing need to identify the psychological mechanisms that explain the relationship between psychological factors and mild traumatic brain injury (mTBI) recovery outcomes; psychological flexibility may be one such mechanism. This study found that psychological flexibility significantly contributes to postconcussion symptoms and functional status in people after mTBI. Additionally, psychological flexibility partly mediated the relationship between psychological distress and postconcussion symptoms and functional status. The present study provides novel evidence that psychological flexibility may be an important psychological mechanism that contributes to recovery outcomes in individuals with mTBI. Psychological flexibility may be an important treatment target in mTBI interventions.

Depressive Symptoms in Individuals With Persistent Postconcussion Symptoms: A Systematic Review and Meta-Analysis

“…Publication year ranged from 2003 to 2021. With respect to geographic location, most studies were conducted in North America (Canada, 5 [27.8%]; United States, 8 [44.4%]), with the rest conducted in Europe (Finland, 1 [5.6%]; Netherlands, 1 [5.6%]; Sweden, 1 [5.6%]), China (1 [6%]), and New Zealand (1 [5.6%]) . The most frequently used questionnaires to assess PPCS was the Rivermead Post-Concussion Symptoms Questionnaire (6 [33.3%]) .…”

“…With respect to geographic location, most studies were conducted in North America (Canada, 5 [27.8%]; United States, 8 [44.4%]), with the rest conducted in Europe (Finland, 1 [5.6%]; Netherlands, 1 [5.6%]; Sweden, 1 [5.6%]), China (1 [6%]), and New Zealand (1 [5.6%]) . The most frequently used questionnaires to assess PPCS was the Rivermead Post-Concussion Symptoms Questionnaire (6 [33.3%]) . The most frequently used questionnaires to assess depressive symptoms included the Patient Health Questionnaire (5 [27.8%]), the Beck Depression Inventory-II (4 [22.2%]), and the Hospital Anxiety and Depression Scale (2 [22.2%]) (Table 1).…”

“…(1 [6%]), 43 and New Zealand (1 [5.6%]). 32 The most frequently used questionnaires to assess PPCS was the Rivermead Post-Concussion Symptoms Questionnaire (6 [33.3%]). 2,20,32,[36][37][38] The most frequently used questionnaires to assess depressive symptoms included the Patient Health Questionnaire (5 [27.8%]), 20,29,37,41,42 the Beck Depression Inventory-II (4 [22.2%]), 2,[33][34][35] and the Hospital Anxiety and Depression Scale (2 [22.2%]) 31,36 (Table 1).…”

Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW)

“…Third, future studies should continue to examine psychological flexibility as a key mechanism linking psychological and cognitive factors to behavioral outcomes, given its emerging importance within both chronic disease and neurological patient populations (Faulkner et al, 2020;Aytur et al, 2021;Faulkner et al, 2021). If empirically validated, the proposed framework would provide important data to guide personalized treatment approaches to enhance self-management behaviors in older adults.…”

Network analysis applied to post-concussion symptoms in two mild traumatic brain injury samples

“…Treatment seeking mTBI : this sample consisted of data collected as part of two studies using similar prospective observational methods. Participants were recruited from outpatient clinics providing rehabilitation services for mTBI across both the North and South Islands of New Zealand between February 2019 and October 2021, obtained independently across two different studies with similar recruitment methods and inclusion criteria ( 39 , 40 ). All participating clinics were funded by New Zealand’s government-funded injury insurance scheme.…”