Maximizing Psychotherapeutic Process Following Traumatic Brain Injury


  • Angelle M Sander
  • Jennie Ponsford


  • Describe valued living and how it can be targeted in psychotherapy with persons with TBI.
  • Describe 2 obstacles to homework engagement and compliance in psychotherapy following TBI.
  • Describe 2 techniques to maximize benefit from psychotherapy in persons with TBI.


Clinically significant emotional distress occurs in a substantial number of persons with traumatic brain injury (TBI). Unfortunately, there is minimal evidence regarding effective treatments to reduce emotional distress. Research indicates that persons with TBI prefer psychotherapy over psychotropic medication to treat emotional distress; however, cognitive difficulties associated with TBI can be obstacles to benefitting from psychotherapy. A greater understanding of the targets of psychotherapy for persons with TBI, as well as techniques to improve treatment benefit, can be useful for clinicians conducting psychotherapy with persons with TBI.

The current symposium will present lessons learned from two randomized controlled trials of psychotherapy for persons with TBI. First, Dr. Jennie Ponsford will present on the results of a study examining changes in Valued Living (VL) over the course of recovery (acute, sub-acute, and late) following moderate to severe TBI (n=70). Implications of VL as a target for psychotherapy will be discussed. Next, Angelle Sander will discuss goal setting for valued living in a RCT of Acceptance and Commitment Therapy (ACT) conducted with persons with complicated mild to severe TBI (n=49). The process of setting goals through a card sort and the types of goals chosen by participants will be discussed, as well as actions used to work toward them in therapy. TBI-related obstacles to achieving valued living goals will also be discussed. Next, Dr. Ponsford will present data on working alliance and homework compliance gleaned from audio-recordings of sessions from a RCT of motivational interviewing as a prelude to cognitive-behavioral therapy for persons with TBI (n=31). The role of time since injury on working alliance will be discussed, as well as the impact of homework compliance/engagement on treatment response. Finally, Dr. Sander will discuss homework compliance for mindfulness exercises, cognitive diffusion exercises, and action toward valued living in the ACT trial. The role of memory impairment (mild/moderate versus severe) on successful homework completion will be discussed, as well as techniques for improving compliance. Throughout all presentations, emphasis will be made on implications of findings for the conduct of psychotherapy to reduce emotional distress following TBI.

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