Treatments for Emotional Issues After Traumatic Brain Injury

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OF the vast array of consequences of traumatic brain injury (TBI), emotional deficits are among the most prevalent, persistent, and challenging to treat. However, they remain grossly understudied compared with other impairments, especially with respect to interventions. As emotional functioning is integral to well-being and quality of life, it is our obligation as rehabilitation researchers and clinicians to endeavor to narrow this gap. To enhance awareness of this void and inspire momentum needed to fill it, this Topical Issue presents empirical studies evaluating treatments for emotional deficits in people with TBI.
Emotional functioning pertains to the awareness, recognition, expression, and regulation of emotions, all of which are susceptible to disruption from a TBI. The articles in this issue describe clinical trials of interventions that target emotional functioning deficits frequently observed after a TBI, including poor emotional self-awareness, impaired recognition of emotional cues from others, anger and aggression, depression, and reduced emotional and behavioral self-control. With regard to emotional rehabilitation following a TBI, each article contributes information sorely needed to advance our knowledge of different treatment approaches, offer directions for future research, and provide evidence needed to inform clinical decision-making.
This Topical Issue contains the first clinical trial of a treatment option for people with TBI who have poor emotional self-awareness, a deficit known as alexithymia. It is alarming that some studies have found the incidence of alexithymia in the TBI population to be as high as 60%.1 The significance of this deficit lies in the fact that it has been associated with poor coping skills, substance abuse, suicidal ideation, somatization, reduced empathy, low relationship satisfaction, and poor quality of life.2–6 Notably, many studies show a link between alexithymia and poor emotional control, and it is believed that emotional awareness is a critical foundation for regulating emotions.7 This issue presents findings from a small phase I study trialing a computer-based training program to reduce alexithymia in participants with TBI. The outcomes from this study concern changes in emotional self-awareness as well as generalization to emotion regulation including anxiety, depression, anger, and affect.
Just as it is important to have awareness and recognition of self-emotions, the ability to recognize others' emotions (socioemotion perception) is also essential to overall emotional functioning and regulation. Others' emotions have an effect on our own affect and how we respond to others. If another person's emotions are misperceived, the result can be emotional responses (or lack thereof) that lead to unexpected and socially inappropriate behaviors. To date, a handful of treatment studies have successfully confronted emotion perception problems following TBI.8–10 However, the major caveat of these studies is that they failed to find changes in related outcomes such as empathic behavior and relationship satisfaction.11 This shortcoming has been attributed to the fact that past programs do not directly train these broader related skills. In this Special Issue, Dr Westerhof-Evers and colleagues describe an enhanced training program that they created to address some of the past study limitations. Their intervention incorporates both emotion perception training and lessons for acceptable behavioral responses to others' emotions. This level 1b randomized controlled trial represents an important advance in our knowledge and understanding of evidence-based treatment approaches for emotion perception deficits after TBI.
This Topical Issue also presents 2 randomized controlled trials addressing anger and aggression after TBI. We know that many challenges often accompany anger and aggression including interpersonal difficulties and relationship problems, caregiver burden, social isolation, violent criminal offenses, and decreased community reintegration (eg, employment failures).

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