Evaluating a Novel Treatment Adapting a Cognitive Behaviour Therapy Approach for Sexuality Problems after Traumatic Brain Injury: A Single Case Design with Nonconcurrent Multiple Baselines

Abstract

There has been little progress in development of evidence-based interventions to improve sexuality outcomes for individuals with traumatic brain injury (TBI). This study aimed to evaluate the preliminary efficacy of an individualised intervention using a cognitive behaviour therapy (CBT) framework to treat sexuality problems after TBI. A nonconcurrent multiple baseline single-case design with 8-week follow-up and randomisation to multiple baseline lengths (3, 4, or 6 weeks) was repeated across nine participants (five female) with complicated mild–severe TBI (mean age = 46.44 years (SD = 12.67), mean post-traumatic amnesia = 29.14 days (SD = 29.76), mean time post-injury = 6.56 years (median = 2.50 years, SD = 10.11)). Treatment comprised eight weekly, individual sessions, combining behavioural, cognitive, and educational strategies to address diverse sexuality problems. Clinical psychologists adopted a flexible, patient-centred, and goal-orientated approach whilst following a treatment guide and accommodating TBI-related impairments. Target behaviour was subjective ratings of satisfaction with sexuality, measured three times weekly. Secondary outcomes included measures of sexuality, mood, self-esteem, and participation. Goal attainment scaling (GAS) was used to measure personally meaningful goals. Preliminary support was shown for intervention effectiveness, with most cases demonstrating sustained improvements in subjective sexuality satisfaction and GAS goal attainment. Based on the current findings, larger clinical trials are warranted.

Co-designing for behavioural change: understanding barriers and enablers to addressing sexuality after traumatic brain injury and mapping intervention strategies in a multi-disciplinary rehabilitation unit

“…There is also the 'You and Me' program by Simpson (1999), a 15-module education program designed for staff to educate clients and families on sex and sexuality after a TBI. Of greater significance, a novel cognitive behaviour therapy (CBT) approach for sexuality problems after TBI was developed by Fraser et al (2022) within the same TBI rehabilitation unit a year prior to this study. A couple of participants also indicated receiving sexuality training within the unit a few years earlier.…”

“…However, the persistent lack of clinical attention despite availability of resources and a growing body of research providing health professionals with clinical tools aligns with the notorious research-to-practice gap faced by clinical researchers (Morris et al 2011;Marier-Deschênes et al 2020;Fraser et al 2022). It further highlights the difficulty of achieving team-wide behavioural change and underscores the importance of interventions that target behavioural regulation at environmental and structural levels to ensure that meaningful and lasting changes can be made (Mark and Carl 2015).…”