Compassion Focused Therapy After Traumatic Brain Injury: Theoretical Foundations and a Case Illustration

Abstract

Acquired brain injury (ABI) commonly results in a range of interacting difficulties including regulating emotion, managing social interactions and cognitive changes. Emotional adjustment to ABI can be difficult and requires adaptation of standard psychological therapies. This article outlines a case where cognitive– behavioural therapy (CBT) was of limited effectiveness but was significantly enhanced with compassion focused therapy (CFT). This article describes Jenny, a 23-year-old woman who suffered a traumatic brain injury 3 years prior to attending rehabilitation. Jenny presented with low self-esteem and mental health difficulties. Neuropsychological assessment revealed executive functioning difficulties. Jenny entered a holistic neuropsychological rehabilitation program aimed at improving complex interacting difficulties, receiving CBT as part of this. As CBT was of limited effectiveness, reformulation of Jenny's difficulties was presented to her based on CFT. The CFT intervention employed aimed to help Jenny develop self-validation and acceptance through producing feelings of kindness and warmth. Shifting the affective textures to the self is a key process for CFT. Self-report measures of mental health and self-esteem showed positive changes and the usefulness of CFT for Jenny. Adaptations in the context of Jenny's ABI are discussed. In conclusion, CFT may be useful in conceptualising emotional responses and developing intervention in rehabilitation after ABI, especially because CFT is based on a neurophysiological model of affect regulation that pays particular attention to the importance of affiliative emotions in the regulation of threat-focused emotion and self-construction.

Impact of rehabilitation on self-concept following traumatic brain injury: An exploratory systematic review of intervention methodology and efficacy

“…For activity-based interventions specifically, there was evidence from two RCTs (Blake & Batson, 2009;Driver et al, 2006), one pre-post group study (Fines & Nichols, 1994) and a case series (Schwandt et al, 2012) that exercise and active leisure were helpful in improving selfconcept after TBI. There was also some evidence of improvement in selfconcept in an RCT of family-based support (Sinnakaruppan et al, 2005), and a case study of psychotherapy (Ashworth et al, 2011). While another five RCTs found positive effects in the functional domain targeted by the intervention (Anson & Ponsford, 2006;Gemmell & Leathem, 2006;Hodgson et al, 2005;Medd & Tate, 2000;Simpson et al, 2011), this did not generalise to global self-concept.…”

An exploration of the experience of self in the social world for men following traumatic brain injury

“…Having a greater understanding of self-conscious emotions such as shame following brain injury and their role in the emotional adjustment process would be clinically useful in informing neuropsychological rehabilitation approaches (Ashworth, Gracey, & Gilbert, 2011). Specific approaches aimed at addressing shame and the response of self-criticism include compassion-focused therapy (Gilbert & Procter, 2006), although this has yet to be empirically tested in a TBI population.…”

“…For those individuals experiencing shame or guilt, using therapeutic approaches such as narrative therapy (Cloute, Mitchell, & Yates, 2008;Morgan, 2000) or a compassion-focused therapy approach (Gilbert, 2007;Ashworth et al, 2011), which are based on theoretical frameworks addressing issues of shame, social-construction and stigma, may be helpful.…”

Fears of Compassion in a Depressed Population Implication for Psychotherapy

“…CFT has been shown to be helpful for people with psychosis [18,19] and can significantly reduce paranoid ideation [20] and emotional difficulties for people with personality disorder difficulties [20]. Ashworth et al [21] found CFT to be a valuable addition to standard interventions in helping people with acquired brain injury. Kuyken et al [22] found that in a mindfulness trial, self-compassion was a significant mediator between mindfulness change and recovery from depression.…”