journal blog

Third wave therapies for long-term neurological conditions: A systematic review to evaluate the status and quality of evidence

Authors
Paula Robinson, Ailsa Russell and Leon Dysch

What we did
This systematic review sought to summarise and appraise the quality of published empirical studies using third wave therapies such as: Compassion Focused Therapy (CFT); Acceptance and Commitment Therapy (ACT); and Mindfulness-Based Cognitive Therapy (MBCT) or Mindfulness-Based Stress Reduction (MBSR). Review procedures followed PRISMA guidelines, with 437 abstracts screened, 24 full-text articles retrieved and 19 studies found to meet inclusion criteria. Six out of seven randomised studies had unclear or high risk of bias, whilst the majority of non-randomised studies were considered moderate quality.

What we found
Overall, studies reported a statistically significant reduction in emotional distress. Of the 13 studies that used model-specific process measures, 10 found statistically significant improvements in transdiagnostic factors. The findings indicate that third wave therapies show promise in addressing transdiagnostic difficulties within neurological conditions. A number of methodological and conceptual issues for the included studies were highlighted during the quality appraisal process. Clinical implications include consideration of intervention length and use of outcome measures. Research implications are discussed by considering the progressive stages of development for behavioural treatments.

“If I knew what I was doing on Twitter then I would use it more”: Twitter experiences and networks of people with traumatic brain injury (TBI)

Authors
Melissa Brunner, Stuart Palmer, Leanne Togher, Stephen Dann and Bronwyn Hemsley

What the study is about
Addressing social communication and participation is a part of core business in rehabilitation after traumatic brain injury (TBI) given the devastating impacts a TBI can have on a person’s social communication and relationships. As yet, we have little information about how social media is used by people with TBI or how it can be addressed during rehabilitation to support social participation. Considering the high rate of TBI in young adults and the widespread use of Twitter by young adults generally, this study aimed to investigate the Twitter experiences and networks of six people with a TBI.

What we did
We recruited six people who self-identified as having a TBI who used Twitter. With their permission, we collected their tweets and analysed them. We then interviewed the participants about their experiences in using Twitter and their perspectives on using the platform. During the interviews, we showed them data visualisations of their tweet analysis to reflect on their use over time and who they connected with. The interview data was then analysed qualitatively.

What we found
Two males and four females took part in the study, ranging in age from 26 to 72 years. All the participants in this study used more than one social media platform (e.g., Twitter, Facebook, Instagram). With regards to Twitter, they reported diverse experiences, with two participants being experienced users and four being novice users. None had received any support to use it aside from setting up their account. All the participants used Twitter to feel connected and included; and reported both positive and negative experiences. Engaging in Twitter communities facilitated their higher frequency of tweeting and established feelings of enjoyment and connection. Novice and established users alike were keen to continue using Twitter and eager to learn more but had not received any rehabilitation support for their social media goals. However, they all learnt to use social media through ‘giving it a go’ and experimenting. They also reported difficulties with cognitive fatigue and understanding concepts around using Twitter, for example knowing how to use hashtags properly. People with TBI use Twitter for connection but approach the sometimes-confusing platform using trial-and-error to develop their skills. Considering their cognitive-communication disability and increased risk for social media safety incidents they are likely to require more active integration of social media if they wish to use it during rehabilitation and beyond for safe and enjoyable social connection. This will likely require individual tailored and explicit training and ongoing support in social media use during rehabilitation and in the community.

This research gives us great insights into the experiences of using Twitter by people with TBI – but what about health professionals? We followed this study up with focus groups with TBI rehabilitation professionals to find out what the experiences and perspectives were of health professionals working in TBI rehabilitation on the use of social media by people with TBI. You can read more about this focus group study in Disability and rehabilitation here: https://doi.org/10.1080/09638288.2019.1685604

Acknowledgements
The authors would like to acknowledge and thank the participants for their time and for sharing their experiences, Dr Lucy Bryant for acting as an independent consensus coder in tweet data analysis, and the University of Newcastle and the University of Technology Sydney for administration of funding and support in the conduction of this study. This research was funded through an Australian Government Research Training Program scholarship (Melissa Brunner) and a Discovery Early Career Research Award from the Australian Research Council (Bronwyn Hemsley). Melissa was also supported through ASSBI through a student conference travel grant in 2019 to present these findings at the ASSBI-NZRA Inaugural Trans-Tasman Conference.

Understanding Community ABI Therapists’ Preferences for Training in and Implementing Behaviour Interventions: A Focus on Positive Behaviour Support

Authors
Jai Jason Carmichael, Kate Gould, Amelia Hicks, Timothy Feeney, Jennie Ponsford

What the study is about
Following acquired brain injury (ABI), people may present with distressing and persistent challenging behaviours, such as aggression, inappropriate social behaviours and lack of initiation. These behaviours may place the person with brain injury and others at risk of harm and impede the person’s ability to reintegrate back into the community. Research suggests that not all individuals with ABI who present with challenging behaviours receive satisfactory behaviour support. Potentially, this results from barriers therapists face to being trained in and implementing behaviour interventions. Positive Behaviour Support (PBS) is one approach that aims to improve the person’s quality of life and proactively reduce challenging behaviours through environmental modification, skill-building and supporting engagement in meaningful relationships and activities. The intervention is designed and implemented in collaboration with the person and their natural supports (e.g., family, carers). Although there is a growing evidence base for PBS, it is not known how widely PBS or other intervention approaches are currently used by community ABI therapists to address challenging behaviours. This study aimed to investigate Australian community ABI therapists’ experiences of using, training in and implementing behaviour interventions, with a focus on PBS.

What we did
We designed and distributed an online survey asking 136 community ABI therapists about their experiences with behaviour interventions and PBS specifically. Participants included occupational therapists, clinical neuropsychologists, clinical psychologists, speech therapists, physiotherapists, case managers and coordinators. We used a modified version of the Organisational Readiness for Implementing Change Scale to measure participants’ readiness to learn and implement new behaviour interventions. Data were analysed by computing frequency and descriptive statistics and through content analysis, non-parametric group comparisons and multiple regression.

What we found
Participants identified a range of approaches as important in addressing challenging behaviours including teamwork and collaboration, person-centred practice, working with antecedents, environmental modification, improving quality of life and skill-building. These approaches were consistent with PBS. In general, participants expressed a high level of desire and readiness to learn and implement new behaviour interventions, preferring part-day face-to-face workshops, online courses/webinars and clinical supervision to train in this area. However, 80% reported facing one or more barriers to training and implementation. Major barriers were lack of time, organisational funding and confidence and disengagement of the individual’s support network. Participants with higher confidence in using behaviour interventions (b= 0.31, p = .002) and fewer barriers (b = –0.30, p = .002) were predicted to have greater readiness to learn and implement new behaviour interventions. Confidence, past training experiences and future training preferences did not appear to differ based on clinical role/discipline. The results suggest that community ABI therapists support PBS-consistent approaches to addressing challenging behaviours and would be receptive to training in PBS. Moreover, this study provides valuable information to tailor strategies for the clinical translation of behaviour interventions to specific barriers and preferences of community ABI therapists.

Acknowledgements
The authors would like to thank the participants for giving their time for this study and the Transport Accident Commission (through the Institute for Safety Compensation and Recovery Research) for their generous funding of the research.