New Approaches to Understanding and Treating Empathy Deficits Following Severe Head Injury

McLeod, H. , Gallagher, M., Campbell, I., O'Neil, B. and McMillan, T. (2016) New Approaches to Understanding and Treating Empathy Deficits Following Severe Head Injury. The International Brain Injury Association’s Eleventh World Congress on Brain Injury, The Hague, The Netherlands, 02-05 Mar 2016.

Abstract

Objectives: We set out to test psychological methods for improving empathy and emotional attunement in people with a severe head injury. There are very few effective psychological treatments for modifying empathy deficits following head injury and more data is needed to inform judgements about which techniques reliably produce benefits. We argue that there is a need to target specific emotional state factors that directly impede empathy and social functioning. For example, newer psychological interventions such as Compassion Focused Therapy (CFT) propose that response tendencies and information processing styles are substantially affected by the emotional state of the organism. These ‘social mentality’ systems can become dysregulated following head injury, resulting in an overactivation of threat-based processing. One aim of CFT is to train techniques that activate the affiliative and attachment based mental states that underpin more empathic modes of processing. Based on encouraging pilot data, we tested the effects of a single session compassionate imagery intervention and measured outcomes in psychological and physiological domains. Methods: Twenty-two people with severe head injury were recruited from community and inpatient rehabilitation settings and randomized to either a compassionate imagery or relaxation training intervention condition. All participants completed a preparatory video and information session specifically designed to address motivational and engagement issues. After preparation they completed a 50-minute intervention session involving either relaxation training or compassionate imagery training. Pre–post intervention measures assessed positive and negative affective state, anxiety, beliefs about compassion, treatment motivation, empathy and heart rate variability. Results: The main effect observed for both groups was a significant increase in treatment motivation (T = 149.0, z = 3.44, p = 0.001, r = 0.50) and there was a trend toward improved empathy across both groups (p = 0.06, dz = 0.40). However, neither intervention condition showed an effect on indices of compassion. The descriptive results indicate that the participants experienced higher levels of fear of compassion than the general population, but showed relatively normal levels of empathy. Conclusions: These results highlight the challenges of directly importing therapy techniques that have been used successfully with other populations and applying them with people with severe head injury. Our data point to the need to carefully analyse barriers to treatment uptake such as low psychological mindedness or fears about compassion. Importantly, it seems that some of these barriers may stem from pre-injury psychosocial and sub-cultural factors, not just the effects of head injury. Our success in improving treatment motivation points to the potential benefit of carefully adapting, testing and refining psychological interventions in a precise and targeted manner. This kind of data-driven approach should help to efficiently build up complex packages of intervention for post-head injury recovery that are tailored to the specific unmet treatment needs of this population.

• Item Type: Conference or Workshop Item
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Campbell, Dr Iain and McLeod, Professor Hamish and McMillan, Professor Tom
• Authors: McLeod, H., Gallagher, M., Campbell, I., O'Neil, B., and McMillan, T.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing