Social Rehabilitation for Military Veterans With Traumatic Brain Injury, Psychological Trauma, and Chronic Neuropsychiatric Symptoms: Intervention Development and Initial Outcomes

• Published in: Psychiatric rehabilitation journal 2019-09, Vol.42 (3), p.296-304
• Main Authors: McCarron, Kelly K, Dasgupta, Megan K, Campbell, Celeste A, Hull, Amanda E, Namazi, Salya, Adams, Alyssa H, Allen, Nathaniel J, Bloeser, Katharine J, Thomas, Laura A, Reinhard, Matthew J, Scholten, Joel D, Schwartz, Barbara L
• Format: Article
• Language: English
• Subjects: Adult; Armed forces; Brain; Brain Development; Brain Injuries, Traumatic - rehabilitation; Cognitive Rehabilitation; Emotional Trauma; Female; Human; Humans; Injuries; Intervention; Male; Mental depression; Middle Aged; Military Veterans; Outcome and Process Assessment, Health Care; Program Development; Psychiatric Rehabilitation - methods; Psychiatry; Psychological distress; Psychological Trauma - rehabilitation; Psychotherapy, Group - methods; Quality of life; Rehabilitation; Reintegration; Social integration; Social Participation; Social Perception; Social Skills; Symptoms; Test Construction; Trauma; Trauma care; Traumatic Brain Injury; Treatment Outcomes; United States; Veterans; Veterans - psychology
• ISSN: 1095-158X; 1559-3126
• DOI: 10.1037/prj0000361

Objective: A subset of military veterans who have experienced both traumatic brain injury and psychological trauma present with chronic neuropsychiatric symptoms and experience persistent obstacles to social reintegration. This project aimed to develop a novel treatment targeting the unmet social rehabilitation needs of these veterans. Initial intervention development, feasibility, and outcome data are explored. Method: Four treatment groups were conducted (n = 20). A treatment workbook was developed during Groups 1 and 2 (n = 10) and research data were collected from Groups 3 and 4 (n = 10). Results: There was a 0% attrition rate across all groups with unanimous requests for additional sessions. T test effect sizes were analyzed with bias-corrected Hedges' g. Improvements were observed on measures of depression (p = .026, g = 0.73), empathic perspective taking (p = .007, g = 0.94), social cognition (p = .002-.678, g = 0.27-1.30 across multiple measures), social relationships (p = .007, g = 1.50), traumatic brain injury-related quality of life (social: p = .014, g = 0.68, emotional: p = .009, g = 1.28) and nonsocial executive functioning (p = .006, g = 0.54). Conclusions and Implications for Practice: Preliminary evidence from this exploratory study suggests that targeting multiple layers of social competence using a combined psychotherapy and cognitive rehabilitation approach holds promise. Larger, controlled studies are needed to further evaluate the feasibility and efficacy of this intervention. Impact and Implications This study demonstrates that a yearlong social rehabilitation group for veterans with chronic neuropsychiatric symptoms following traumatic brain injury and psychological trauma may possibly result in improved social cognition, social participation, mood, and quality of life. Our preliminary findings highlight the importance of focusing on chronic care needs in polytrauma to optimize functioning and prevent further deterioration. This intervention targets co-occurring neuropsychiatric conditions simultaneously, rather than focusing on one condition at a time, to serve individuals who tend to fall outside of the scope of existing treatments.