Evidence-informed intervention ideas Psychosocial interventions for adults with traumatic brain injury

Many traumatic brain injury survivors experience difficulties related to emotional regulation and social participation. Occupational therapy practitioners should collaborate with clients to set goals related to these skills and delineate the steps to achieve them. Creating a plan for the client to practice new skills outside of therapy is an evidence-informed strategy to support learning. Practitioners are encouraged to use the evidence-informed intervention ideas included here as a guide for clinical decision making but should review the Systematic Review Briefs (Wheeler, Acord-Vira, & Davis, 2022a; Wheeler et al., 2022b; Wheeler et al., 2022c) for more specific information.

Evidence-Informed Intervention Ideas

• Emotional Regulation
  • Address self-monitoring and self-awareness skills early
  • Incorporate elements of cognitive-behavioral therapy during sessions to support occupational engagement (e.g., normalization, recognizing and reframing unhelpful thoughts, psychoeducation)
  • Create a supportive environment by providing encouragement and reassurance
  • Teach and incorporate mindfulness techniques
  • Collaborate with client to identify potential obstacles to goals and strategies to address them
• Education
  • In a group or individual setting, provide psychoeducation on the following topics:
    • Common problems and symptoms associated with TBI, including anger and depression
    • Potential psychosocial impacts of a brain injury (e.g., changes in professional or social life, misunderstandings, difficulties in relationships)
  • Use memory aids and organization strategies to support learning
  • Adjust the pacing of new information to match the client’s skills
  • Provide written handouts on new information and strategies
  • Provide training on problem-solving strategies and coping mechanisms
  • Provide training on self-management strategies for anger (e.g., self-monitoring skills, identifying emotions, active listening)
• Social Participation
  • Identify which effective communication strategies the client is using, and practice using those to replace non-productive communication strategies
  • Educate the client on new strategies to prevent communication breakdown (e.g., emotion recognition, perspective taking)
  • Educate the client on self-coaching strategies (e.g., rehearsing, creating personal scripts, using reminders, self-evaluation)
  • Provide opportunities to practice social-emotional skills, both during therapy and in the client’s natural environments
  • Plan and practice with the client how to address social situations that are challenging for them
  • Collaborate with the client’s care partners when appropriate, to support practicing new strategies in the natural context
  • Provide accurate and constructive feedback on communication
  • Design opportunities for the client to self-evaluate their performance in social situations
  • Connect the client with a therapeutic group led by a health care professional that can provide long-term support for learning and implementing psychosocial skills
• Habits and Routines
  • Establish ways to incorporate 30 minutes of moderate intensity exercise into the client’s routines to improve mood and decrease symptoms of depression
  • Set up regular external cues (e.g., smartphone notification) for self-prompting to use a mindfulness technique
  • Using the client’s own phrasing, set up reminders for steps to address goals
  • Create a plan prior to discharge to maintain new habits, routines, and skills
  • Use Motivational Interviewing techniques (e.g., express empathy, learn about and respect the client’s desires) to establish new routines or behaviors

References

Wheeler, S., Davis, D., Basch, J., James, G., Lehman, B., & Acord-Vira, A. (2022a). Self-regulation and relaxation-based interventions for adults with traumatic brain injury (2013–2020). American Journal of Occupational Therapy, 76(Suppl 2), 7613393150. doi: https://doi.org/10.5014/ajot.2022/76S2015

Wheeler, S., Davis, D., Basch, J., James, G., Lehman, B., & Acord-Vira, A. (2022b). Education and skills training interventions for adults with traumatic brain injury (TBI) (Dates of Review: 2013–2020). American Journal of Occupational Therapy, 76(Suppl 2), 7613393120. doi: https://doi.org/10.5014/ajot.2022/76S2012

Wheeler, S., Davis, D., Basch, J., James, G., Lehman, B., & Acord-Vira, A. (2022c). Physical activity interventions for adults with traumatic brain injury (2013–2020). American Journal of Occupational Therapy, 76(Suppl 2), 7613393140. doi: https://doi.org/10.5014/ajot.2022/76S2014

Checklist developed by Victoria Southwell, OTS