This study investigated the changes in coping styles of patients with acquired brain injury who underwent cognitive rehabilitation, and the effects of these changes on their quality of life. Participants were 110 patients in the chronic phase post-injury, who underwent outpatient cognitive rehabilitation according to current guidelines and standards. Coping style (Utrecht Coping List) was measured at the start of rehabilitation (T0) and repeated at least 5 months later (T1). Coping style was related to quality of life measured at T1 (Life Satisfaction Questionnaire and Stroke-Adapted Sickness Impact Profile). Results indicated that active problem-focused coping styles decreased and passive emotion-focused coping styles increased significantly between T0 and T1. Furthermore, the study showed that increases in active problem-focused coping styles and decreases in passive emotion-focused coping styles predicted a higher quality of life in the long term. These changes in coping styles are adaptive for the adjustment process in the chronic phase post-injury. Overall however, most participants showed maladaptive changes in coping styles. Implications for cognitive rehabilitation are therefore discussed.

This model additionally considers theories concerned with self-regulation of behaviour, self-awareness and self-efficacy, and with the setting and achievement of goals. THE TWO-DIMENSIONAL MODEL: Our model proposes the simultaneous and continuous interaction of two pathways; goal pursuit (short term and long term) or revision as a result of success and failure in reducing distance between current state and expected future state and an affective response that is generated by the experienced goal-performance discrepancies. This affective response, in turn, influences the goals set. This two-dimensional representation covers the processes mentioned above: restoration of function and consideration of long-term limitations. We propose that adaptation centres on readjustment of long-term goals to new achievable but desired and important goals, and that this adjustment underlies re-establishing emotional stability. We discuss how the proposed model is related to actual rehabilitation practice.

Cognitive functions do not influence coping style. Passive emotion-focused coping styles in the chronic phase after injury are maladaptive. These findings emphasize the importance of training of adaptive coping styles as rehabilitation targets in the chronic phase, especially for persons with lower educational attainment.

To optimise adaptation it seems appropriate to promote self-efficacy and both tenacity and flexibility during rehabilitation treatment.

Self-efficacy and coping predict long-term QOL but seem less important in long-term social participation. High self-efficacy protects against the negative effect of emotion-oriented coping. Enhancing self-efficacy in the early stage after ABI may have beneficial long-term effects.