Is it time to act? The potential of acceptance and commitment therapy for psychological problems following acquired brain injury

Abstract

Behaviour therapies have a well-established, useful tradition in psychological treatments and have undergone several major revisions. Acceptance and Commitment Therapy (ACT) and mindfulness-based approaches are considered a third wave of behavioural therapies. Emerging evidence for ACT has demonstrated that this paradigm has promising effectiveness in improving functionality and well-being in a variety of populations that have psychological disturbances and/or medical problems. In this review we first evaluate traditional cognitive behavioural therapy (CBT) interventions used to manage psychological problems in distressed individuals who have sustained an acquired brain injury (ABI). We provide an overview of the ACT paradigm and the existent evidence base for this intervention. A rationale is outlined for why ACT-based interventions may have potential utility in assisting distressed individuals who have sustained a mild to moderate ABI to move forward with their lives. We also review emerging evidence that lends preliminary support to the implementation of acceptance and mindfulness-based interventions in the rehabilitation of ABI patient groups. On the basis of existent literature, we recommend that it is an opportune time for forthcoming research to rigorously test the efficacy of ACT-based interventions in facilitating ABI patient groups to re-engage in living a valued and meaningful life, in spite of their neurocognitive and physical limitations. The promising utility of testing the efficacy of the ACT paradigm in the context of multimodal rehabilitation programmes for ABI populations is also addressed.

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

“…The use of individual and group projects to apply new skills and gain feedback has been described by many authors (see Feeney & Capo, 2010;Wilson et al, 2009;Ylvisaker et al, 2008), but remains an important area for future controlled intervention studies. The emphasis of MIM and PBL on meaningful engagement and improving functionality is consistent with positive psychology principles and other values-based interventions which also have the potential to support identity reconstruction for this population (see reviews by Evans, 2011;Kangas & McDonald, 2011).…”

Goal pursuit, goal adjustment, and affective well‐being following lower limb amputation

“…Indeed, a recently developed cognitivebehavioural therapy intervention for rheumatic diseases, which is currently undergoing formal evaluation, was theoretically grounded in the dual-process model and included sessions specifically targeted at enhancing both assimilative and accommodative coping responses (Vriezekolk et al, 2012). Existing interventions such as Acceptance and Commitment Therapy (ACT: Hayes, Strosahl, & Wilson, 1999), which aims to facilitate individuals to live a purposeful and meaningful life by focusing on and engaging with their goals and values, while taking into account the limitations imposed by their situational constraints (Kangas & McDonald, 2011), may also prove effective in enhancing the use of these adaptive selfregulatory modes. Future research should investigate the efficacy of such interventions in enhancing TGP and FGA, and, concomitantly, psychosocial adjustment, following lower limb amputation and other forms of acquired disability.…”

Cognitive and psychological flexibility after a traumatic brain injury and the implications for treatment in acceptance-based therapies: A conceptual review

“…For example, ACT might facilitate adaptation and acceptance of changed functioning and life circumstances following a severe TBI (Kangas & McDonald, 2011). However, before utilising ACT to treat psychological distress in individuals with a TBI, the relationship between cognitive flexibility and psychological flexibility, both conceptually and empirically, should be clarified.…”

“…There is a growing interest in the potential application of ACT in assisting clients navigate the complex issues influencing recovery following a TBI (Kangas & McDonald, 2011;Soo, Tate, & Lane-Brown, 2011). For example, ACT might facilitate adaptation and acceptance of changed functioning and life circumstances following a severe TBI (Kangas & McDonald, 2011).…”