Development of a motivational interviewing programme as a prelude to CBT for anxiety following traumatic brain injury

Abstract

A brief preparatory programme, based on the principles of motivational interviewing (MI), was developed as a way of engaging clients with traumatic brain injury (TBI) and preparing them for a cognitive behaviour therapy (CBT) programme for anxiety. The MI + CBT programme was delivered to a male client in his early 40s with severe TBI at four months post-injury, using a single-subject design with repeated measures pre- and post-treatment. The client received three sessions of manualised MI, followed by nine sessions of CBT. The MI sessions focused on helping the client to develop more realistic goals and supporting his self-efficacy about his ability to cope with anxiety. Specific strategies were used to accommodate the client's cognitive limitations, such as the use of personally meaningful metaphors and role plays. Re-assessments were conducted at the end of MI, CBT and nine weeks post-treatment, using a semi-structured clinical interview and self-report measures of anxiety, mood and change expectancy. The client showed significant improvement in anxiety following treatment and a significant reduction in subjective units of distress (SUDS) between the MI and CBT phases. The results suggest the potential utility of MI in people with TBI, and the need to evaluate treatment protocols in a controlled trial.

Efficacy of motivational interviewing and cognitive behavioral therapy for anxiety and depression symptoms following traumatic brain injury

“…MI sessions were guided by Westra & Dozois (2003) using a study specific manual detailed elsewhere (Hsieh et al 2012 c ). Sessions were designed to facilitate treatment engagement and expectancy using core strategies and principles of MI.…”

Brief compassion focused imagery for treatment of severe head injury

“…Heart rate variability (HRV) was used because it is an indicator of central nervous system activity and can differentiate between an 'affiliative' state (high HRV) and a 'threatened' state (low HRV) (Porges, 2006), and because brief CFI can stimulate increased HRV in healthy individuals (Rockliff, Gilbert, McEwan, Lightman, & Glover, 2008). Second, by promoting engagement in therapy using video-based information on psychological therapy to reduce pre-therapy state anxiety and to promote engagement and adherence; there is evidence to support this strategy from studies in adult mental health (Deane, Spicer & Leathem, 1992) and on preparing people with head injury for CBT targeted at anxiety (Hsieh, Wong, Schönberger, McKay, & Haines, 2012). Video-based delivery allows psychoeducational issues to be addressed uniformly across participants and can include familiarisation with key concepts and terminology in a way that circumvents common cognitive deficits after SHI.…”

Interventions to increase engagement with rehabilitation in adults with acquired brain injury: A systematic review

“…Of those studies utilising this technique, MI was either found not to be more effective than goal setting alone (Corrigan et al, 2005) or its effects were not sufficiently measured (Hsieh, Ponsford, Wong, Schönberger, Taffe & Mckay, 2012;Hsieh, Ponsford, Wong, Schönberger, Mckay & Haines, 2012). This appears to contradict the suggestion of others (Medley & Powell, 2010;Holloway, 2012).…”

“…Eight studies reported interventions using predominantly behavioural modification techniques (Hegel, 1988Zencius, Wesolowski, Burke & McQuade, 1989;Yuen, 1996;Manchester, Hodgkinson, Pfaff & Nguyan, 1997;Newell, 1997;Sohlberg, Lemoncello & Lee, 2011;Hufford et al, 2012), 5 studies primarily cognitive techniques (Pegg et al, 2005;Lane-Brown & Tate, 2010;Skidmore et al, 2011;Hsieh, Ponsford, Wong, Schönberger, Taffe & Mckay, 2012;Hsieh, Ponsford, Wong, Schönberger, Mckay & Haines, 2012) and 2 studies reported a mixture of the two (Corrigan, Bogner, Lamb-Hart, Heinemann & Moore, 2005;Corrigan & Bogner, 2007).…”