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Behavioural activation: a role in treating depression after traumatic brain injury?
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Rudi Coetzer, Neuropsychologist North Wales Brain Injury Service
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Rudi.Coetzer{at}cd-tr.wales.nhs.uk Rudi Coetzer
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Traumatic brain injury (TBI) is a major public health issue and can leave survivors with long-term cognitive impairment, physical difficulties and psychiatric problems. The long-term consequences of TBI are huge and affect individuals, families and society (Dikmen et al, 2003). Depression is common after traumatic brain injury (TBI) and in many instances negatively affects rehabilitation and outcome (Jorge et al, 2004). Depression after TBI often represents a complex interaction of biological, psychological and social factors. Psychotherapy (Coetzer, 2007), including cognitive behaviour therapy (Mateer & Sira, 2006), is sometimes included in the rehabilitation of individuals to address emotional difficulties, including depression and anxiety, after TBI. Veale (2008) outlines the utility of behavioural activation in the management of depression and asserts that complex problems often require therapists to perform simple interventions well. He highlights overcoming avoidance, setting goals and teaching patients to disengage with the content of thoughts, as effective strategies within behavioural activation. These points are of direct relevance to psychotherapeutic approaches to depression after TBI also, where patients may have cognitive impairment in addition to depression and other emotional or behavioural difficulties. Many patients with TBI, as a result of impairment and disability, present with profound changes in identity and role. This can underpin or at least contribute to the development and maintenance of depression and the associated lack of meaningful activity as spontaneous recovery after TBI slows down or ceases. Many brain injury rehabilitation programmes place a heavy emphasis on re- engaging persons at a more functional level within the communities where they live. However, the emotional difficulties following TBI, including depression, often pose significant obstacles to re-engagement with meaningful and pleasurable activities. While complex psychotherapeutic interventions may result in unsatisfactory outcomes or poor generalisation because of patients’ cognitive impairment behavioural activation, a relatively simple intervention, is potentially ideally suited to improve both emotional and functional outcomes, in this population. Research is needed to evaluate the cost-effectiveness of this psychotherapeutic approach with persons presenting with depression after TBI. Coetzer, R. (2007). Psychotherapy following traumatic brain injury: Integrating theory and practice. The Journal of Head Trauma Rehabilitation, 22 (1): 39 - 47. Dikmen, S. S., Machamer, J. E., Powell, J. M. & Temkin, N. R. (2003). Outcome 3 to 5 years after moderate to severe traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 84 (10): 1449 – 1457. Jorge, R. E., Robinson, R. G., Moser, D., Tateno, A., Crespo-Facorro, B. & Arndt, S. (2004). Major depression following traumatic brain injury. Archives of General Psychiatry, 61 (1): 42 – 50. Mateer, C. A. & Sira, C. S. (2006). Cognitive and emotional consequences of TBI: intervention strategies for vocational rehabilitation. NeuroRehabilitation, 21 (4): 315 – 326. Veale, D. (2008). Behavioural activation for depression. Advances in Psychiatric Treatment, 14 (1): 29 – 36. Rudi Coetzer Neuropsychologist North Wales Brain Injury Service Colwyn Bay Hospital Colwyn Bay LL29 8AY Tel: 01492-807770 Fax: 01492-807777 |
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