The Feasibility of Using Acceptance and Commitment Therapy (ACT) to Promote Recovery Following Severe Head Injury

McLeod, H. , Moynan, C., O'Meara, N., White, R. , O'Neil, B., Patterson, N., Whiting, D. and McMillan, T. (2016) The Feasibility of Using Acceptance and Commitment Therapy (ACT) to Promote Recovery Following Severe Head Injury. The International Brain Injury Association’s Eleventh World Congress on Brain Injury, The Hague, The Netherlands, 02-05 Mar 2016.

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Objectives: Adjustment difficulties are a major source of distress and disability following head injury, but there are very few evidence-based treatment options available. Based on promising case study data, we set out to examine the feasibility of ACT as an adjunctive treatment for people with adjustment problems following severe head injury. Methods: We conducted this feasibility study in accordance with the 2015 MRC guidance on the development and evaluation of complex interventions. This involves a deliberate and planned approach to assessing processes relevant to understanding mechanisms of therapeutic change and implementation issues (e.g. is the treatment acceptable to recipients, can therapists be trained with fidelity). Our design was modelled on a cluster randomized trial format with one intervention site (Glasgow) and two control sites (Leeds and York). We applied a mixed-methods approach to data collection and analysis. Focus groups were used to assess the experience of the intervention (for therapists and patients), the effects of completing study measures and opinions about key RCT parameters such as being subjected to randomization to treatment condition. We also piloted the quantitative assessment of key outcome and process measures using self-report scales. This covered factors such as emotional adjustment (anxiety and depression), treatment motivation, awareness and insight, psychological flexibility and the acceptability of the intervention. Finally, measures of treatment implementation and feasibility were obtained from professional carers at each recruitment site. The intervention was a six-session manualized Acceptance and Commitment Therapy protocol developed specifically for people who were experiencing adjustment difficulties following a head injury. Treatment was delivered via 120-minute long group sessions provided by a trained therapist on a weekly basis. All other usual treatment parameters were free to vary across all study sites. Results: Twenty-one eligible participants consented and 17 provided complete post-intervention data that could be subjected to analysis. All participants had sustained a severe head injury and were rated as severely disabled on the GODS. The retention in treatment rate was very good (> 80%) and attrition was mostly due to discharge from the unit rather than dissatisfaction with the intervention. Themes that emerged from the focus groups included the importance of adjusting the therapy techniques to match the cognitive abilities of participants as well as pacing the therapy sessions to better match limitations in processing speed. Feedback from both patients and therapists suggest that some aspects of ACT such as cognitive defusion and the use of metaphor will require particular attention and refinement in future adaptations of ACT for people with severe head injury. Conclusions: ACT is a feasible and acceptable intervention for inpatients with severe head injuries, but there is a need for more work on therapy delivery techniques before testing in full scale effectiveness trials is warranted.

Item Type:Conference or Workshop Item
Glasgow Author(s) Enlighten ID:White, Dr Ross and McLeod, Professor Hamish and McMillan, Professor Tom
Authors: McLeod, H., Moynan, C., O'Meara, N., White, R., O'Neil, B., Patterson, N., Whiting, D., and McMillan, T.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing

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