Window to Hope: A Randomized Controlled Trial of a Psychological Intervention for the Treatment of Hopelessness Among Veterans With Moderate to Severe Traumatic Brain Injury

Brenner, Lisa A.; Forster, Jeri E.; Hoffberg, Adam S.; Matarazzo, Bridget B.; Hostetter, Trisha A.; Signoracci, Gina M.; Simpson, Grahame

doi:10.1097/htr.0000000000000351

Cited by 28 publications

(25 citation statements)

References 21 publications

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“…Existing psychological treatments, predominantly CBT-based, have largely focused on reducing symptoms of psychological distress. Previous trials have suggested efficacy in reducing a range of psychological symptoms after TBI including depression (Fann et al, 2015), hopelessness (Brenner et al, 2018;Simpson, Tate, Whiting, & Cotter, 2011), anxiety (Hsieh et al, 2012) and anger (Medd & Tate, 2000). However, a Cochrane review found the evidence-base for the efficacy of traditional CBT with the TBI population is still slim (Gertler, Tate, & Cameron, 2015).…”

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confidence: 99%

“…To address these issues, the current study investigated psychological treatment efficacy for individuals with a severe TBI (i.e., post traumatic amnesia, PTA>7days), within five years post-injury. In addition, the intervention was compared to an active control, something that is not commonly used in treatment trials with participants who have had a TBI, rather than the more typically employed usual treatment or wait list control (Bédard et al, 2014;Bell et al, 2011;Brenner et al, 2012;Brenner et al, 2018;Simpson et al, 2011). The use of an active control allows for the control of a number of factors including therapist contact, the expectancy of the client, a therapeutic alliance, and replication of intervention time (Bendall et al, 2006).…”

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confidence: 99%

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Can acceptance and commitment therapy facilitate psychological adjustment after a severe traumatic brain injury? A pilot randomized controlled trial

Whiting

Deane

McLeod

et al. 2019

Neuropsychological Rehabilitation

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This study sought to determine if an Acceptance and Commitment Therapy (ACT) intervention (ACT-Adjust) can facilitate psychological adjustment and reduce psychological distress following a severe traumatic brain injury (TBI). The study design comprised a single centre, two-armed, Phase II pilot randomised controlled trial. Nineteen individuals with a severe TBI (PTA ≥7 days) who met a clinical threshold for psychological distress (Depression Anxiety Stress Scales 21; DASS>9) were randomly allocated to either ACT-Adjust (n =10) or an active control, Befriending Therapy (n = 9), in conjunction with a holistic rehabilitation programme. Primary (psychological flexibility, rehabilitation participation) and secondary (depression, anxiety & stress) outcomes were measured at three-time points (pre, post and follow up). Significant decreases were found for DASS-depression (group by time interaction, F1,17 = 5.35, p = .03) and DASS-stress (group by time interaction, F1,17 = 5.69, p = .03) in comparison to the Befriending group, but not for the primary outcome measures of rehabilitation participation or psychological flexibility. The reduction in stress post-treatment was classed as clinically significant, however the interaction differences for both stress and depression were not maintained at one month follow up. Preliminary investigations indicate some promise for ACT in decreasing psychological distress for individuals with a severe TBI with further sessions being required to maintain treatment gains. The pilot results suggest that further investigation is warranted in a larger scale clinical trial.

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confidence: 99%

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confidence: 99%

Can acceptance and commitment therapy facilitate psychological adjustment after a severe traumatic brain injury? A pilot randomized controlled trial

Whiting

Deane

McLeod

et al. 2019

Neuropsychological Rehabilitation

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“…The Windows to Hope (WtoH) program is a CBT-focused treatment that includes 10 group sessions utilizing traditional CBT techniques, such as behavioral activation, cognitive restructuring, problem solving skills, and relapse prevention. Results of a recent RCT found significant decreases in hopelessness and depressive symptoms among the WtoH condition compared with TAU and a trend-level difference on suicidal ideation (Brenner et al, 2017). The success of this group treatment suggests there are a variety of targets for impacting suicidal ideation, including hopelessness.…”

Section: Militarymentioning

confidence: 85%

Suicide prevention.

Mandel¹,

Jager‐Hyman²,

Brown³

2021

Handbook of Cognitive Behavioral Therapy: Applications (Vol. 2).

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Suicide PreventionS uicidal behavior is a significant public health problem. Although considered a rare event, suicide-death caused by self-directed injurious behavior with intent to die as a result of the behavior-is the 10th leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2017). Suicide attempts are even more common, with 25 suicide attempts for every 1 suicide (CDC, 2017). Even more widespread is suicidal ideation, or thinking about, considering, or planning suicide; over 10 million Americans reported experiencing suicidal thoughts in the past year (Center for Behavioral Health Statistics and Quality, 2016). Several characteristics put individuals at greater risk for suicide, including a history of mental disorders (particularly depression); a history of alcohol and substance abuse; a sense of hopelessness; impulsive or aggressive behavior; history of child maltreatment; a sense of isolation; physical illness; and social, relational, vocation, or financial loss (U.S. Public Health Service, 1999). Understanding contributing factors to the development or experience of suicidal thoughts or behavior provides a foundation for the effective implementation of strategies to prevent suicide. 1 Early intervention efforts focused on addressing underlying psychiatric disorders of which suicidal thoughts and behaviors were a symptom, such as depression, anxiety, bipolar disorder, schizophrenia, posttraumatic stress disorder, or personality disorders (Palmer et al., 2005;Sareen et al., 2005). Although addressing the underlying psychiatric condition is important, this approach was 1 Clinical examples are disguised to protect patient confidentiality.

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“…In treating the pervasive hopelessness expressed by participants, the Window to Hope program is an important resource. The program is an evidence-based psychological intervention that has been proven in two randomised controlled trials as being effective in reducing chronic hopelessness after moderate to severe TBI (60,61).…”

Section: Implications and Recommendations For Practicementioning

confidence: 99%

Living with suicidality following traumatic brain injury: a qualitative study

2020

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Numbers of traumatic brain injury (TBI) are increasing, and with suicidality post-injury presenting at 3-4 times higher than in the general population, understanding this is crucial in reducing a devastating outcome. Given the lack of literature, this study investigated the experiences of living with suicidality after TBI.Methods: Interview data from nineteen TBI participants with TBI from a Brain Injury Rehabilitation Unit (BIRU) in New South Wales (NSW), Australia wereas collected and thematically analysed. Findings: The participants (predominantly male) had sustained extremely severe injuries (median PTA 60 [IQR 81.0] days) and were in the chronic phase post-injury (median 8.0 [IQR 9.0] years). Six main themes were identified; Loss of sense of self, TBI as a hidden disability, Chronic but transient suicidality, Reliance, Protective factors, and Hope. Tentative relationships between themes and subthemes were identified. Conclusion:Chronic suicidality after TBI was demonstrated consistently regardless of receiving long-term support. However, their engagement with protective factors such as social support, spirituality and positive personal qualities was also identified.Implementing these as coping strategies during long-term rehabilitation may reduce the levels of suicidal distress. Implications, methodological considerations and future research were discussed, with the aim of improving experiences of individuals with TBI to reduce suicidality.

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Window to Hope: A Randomized Controlled Trial of a Psychological Intervention for the Treatment of Hopelessness Among Veterans With Moderate to Severe Traumatic Brain Injury

Abstract: Findings from this trial provide additional support for the efficacy of this method of psychological treatment of hopelessness among individuals with moderate to severe TBI.

Cited by 28 publications

References 21 publications

Can acceptance and commitment therapy facilitate psychological adjustment after a severe traumatic brain injury? A pilot randomized controlled trial

Can acceptance and commitment therapy facilitate psychological adjustment after a severe traumatic brain injury? A pilot randomized controlled trial

Suicide prevention.

Living with suicidality following traumatic brain injury: a qualitative study

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