Once again from the ISEP blog, we bring you a new article. This time, continuing with a new publication on psychotherapy in acquired brain injury (ABI).
Although it can be read autonomously, this is the third part of the article Psychotherapy in acquired brain injury (ABI) – part 2.
ABI through conventional and third-generation approaches
In addition to therapies from more conventional approaches such as behaviorist or cognitive-behavioral, in recent years, third-generation behavioral therapies are strongly emerging. Although studies on their effectiveness in patients with Acquired Brain Injury (ABI) are few and often represent single-case or poorly experimentally controlled studies, it is true that some results are promising and invite testing these techniques and trying to improve their application with people with brain injuries or other neurological diseases.
Thus, in recent years, some clinicians have experimented with mindfulness-based techniques to help the person better accept their situation and live their experiences without looking back at their previous life. In this sense, other authors have suggested Acceptance and Commitment Therapy (ACT) as a valid therapeutic resource to face the usual grieving processes in people with ABI when there is total or partial awareness of the loss, especially at a functional and autonomy level, as it often leads to associated psychological problems. On another occasion, we will review the importance of taking into account specific intervention, if possible, on the lack of awareness of the illness.
A study by Kangas and McDonald conducted in 2011 found that ACT seems to help people accept their cognitive and psychological changes, and also appears to have the potential to improve psychological and cognitive flexibility, a capacity closely related to resilience and adaptation. Onsworth published an article in 2014 reviewing the application by some professionals of Compassion-Focused Therapy (CFT), which explains psychological imbalance as the result of an inadequate interaction between a self-protection system, another linked to motivation to achieve goals, and a final system linked to the sensation of calm and security. In this sense, and according to the author’s conclusions, CFT seems to have the potential to promote a correct interaction between these three systems that contributes to generating a balanced psychological state.
Acquired Brain Injury (ABI) and new technologies
When we talk about adapting psychotherapy in ABI, we are talking, in part, about adopting measures that facilitate intervention and overcome certain cognitive problems at the level of attention, concentration, verbal comprehension, or memory, among others. Therefore, new technologies offer us a good opportunity for this.
Thus, for example, through virtual reality, we can train in certain control techniques of activation such as diaphragmatic breathing, Jacobson’s progressive muscle relaxation, and even specific mindfulness exercises to train attention or reduce certain anxiety states.
Virtual reality therefore becomes a useful tool in many cases where it is possible to work at a psychotherapy level with the patient. The immersion achieved with this tool allows creating a pleasant environment for working while reducing distracting elements and channeling their attention towards the exercise that is developed visually and audibly.
As in the case of third-generation therapies, their application in ABI is still very recent, and currently there are few well-designed studies recommending their use. However, we should not overlook the opportunity it represents.
Psychological intervention with the direct social environment
If we return to the basic scheme we proposed a few paragraphs ago, in relation to the social environment of the person with ABI, so far we have seen the role it can play in addressing the emotional and behavioral problems of the person with brain injury themselves. However, intervention with caregivers, especially family members but also professional assistants, often requires us to go beyond counseling and psychoeducation to resolve or alleviate the problems of the person they care for or live with.
Family members and assistants, as individuals, are susceptible to emotional alterations, even more so when we talk about a situation – that of caring for a person in a dependent situation – which can easily lead to emotional exhaustion and associated emotional-behavioral alterations.
Let’s not forget that changes in the life of a person with acquired brain injury (ABI) extend beyond the person themselves, directly affecting their most direct social system. In this sense, the abrupt change in reality requires not only that the person with the injury readapt their life and life goals, but also that their family members do so. Therefore, it is important to offer the necessary resources to promote this process and their general well-being.
Therefore, it seems evident that offering guidelines to promote a good psychological state is important, as well as to prevent overload. Thus, adapting the degree of task facilitation by caregivers, attending to the real needs of the person with ABI in the different daily life activities and the potential dangers implicit in these activities, helps to avoid over-care, hyper-responsibility, and over-involvement, all of which are factors that usually contribute to the appearance of burnout syndrome. In the same way as in the previous example, we can adopt several measures and convert them into guidelines and action directives for certain situations and/or problems.
However, it often becomes essential not only to offer this type of support but also to provide psychological support oriented to the family member/assistant, based on active listening and understanding of their problems, with the aim of helping and accompanying them to resolve their personal doubts, fears, and concerns not only about the present but also about the future.
Undoubtedly, this is one of the key points to achieve an adequate environment to facilitate the process of “return home” and the progressive reintegration of the person with acquired brain injury into the community, minimizing the impact and interference that this process has on the personal lives of their family members.
As we can see, psychological intervention in ABI must take many factors into account, but above all, the environment should never be overlooked; moreover, it must be involved and given a leading role as a fundamental piece to ensure that the entire system – including the person, family, and caregivers – is capable of overcoming the vital change that ABI entails and developing the greatest possible degree of well-being.
The interdisciplinary nature of Neurorehabilitation
In the approach to a neurological injury such as Acquired Brain Injury, a multitude of professionals intervene (neuropsychologists, physiotherapists, occupational therapists, speech therapists, social workers, clinical psychologists, nurses, psychiatrists, neurologists, rehabilitation doctors, etc.). However, it is impossible to face a therapeutic approach without a holistic, person-centered, and transdisciplinary approach like the one offered by the ISEP Master’s in Neurorehabilitation, a pioneer due to its interdisciplinary nature.