Assonov Dmytro
Department of Medical Psychology, Psychosomatic Medicine and Psychotherapy, Bogomolets National Medical University, Kyiv, Ukraine.
Clin Neuropsychiatry. 2021 Oct;18(5):247-259. doi: 10.36131/cnfioritieditore20210503.
The present randomized parallel two-arm pilot study aimed to compare the efficacy of two-step resilience-oriented intervention with treatment as usual in veterans with mild to moderate traumatic brain injury.
Two-step Resilience-Oriented Intervention (TROI) is a brief psychological intervention that targets cognitive (step 1) and emotional (step 2) factors of resilience and consists of six 1-hour sessions. Overall, 70 Ukrainian veterans serviced in Anti-Terrorist Operation / Joint Forces Operation were randomly assigned to an intervention group (TROI group) or a control group that underwent treatment as usual (TAU group). For pre- (T1) and post-treatment (T2) assessment the Connor-Davidson Resilience Scale (CD-RISC), Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment Scale (MoCA), Neurobehavioral Symptom Inventory (NSI), Posttraumatic Stress Disorder Checklist 5 (PCL-5), Chaban Quality of Life Scale (CQLS), Positive and Negative Affect Scale (PANAS) were used.
Multivariable linear regression with the treatment group, gender, baseline cognitive performance level and TBI severity as the independent variables revealed statistically significant improvements in the TROI group in resilience (CD-RISC), cognitive performance (MoCA), postconcussive symptoms (NSI), posttraumatic symptoms (PCL-5), positive affect (PANAS) and quality of life (CQLS) comparing to such in TAU group. We found no statistically significant differences between groups in depression, anxiety (HADS) and negative affect (PANAS) outcomes. Additionally, Wilcoxon signed-rank test revealed that participants who completed two-step resilience-oriented intervention had significantly improved scores for all outcomes compared to the baseline (p < 0.05).
In summary, we can tentatively conclude that adding TROI to the standard treatment measures may improve the resilience and sustainable symptoms in veterans with TBI when compared with standard treatment. Targeting cognitive and emotional factors like problem-solving, decision-making, positive thinking can promote resilience in veterans with TBI and be useful in facilitating recovery from injury. Results of this pilot study are promising, but the intervention needs to be studied in a larger trial.
本随机平行双臂试点研究旨在比较针对轻度至中度创伤性脑损伤退伍军人的两步式复原力导向干预与常规治疗的疗效。
两步式复原力导向干预（TROI）是一种简短的心理干预，针对复原力的认知（第一步）和情感（第二步）因素，由六个1小时的疗程组成。总体而言，70名在反恐行动/联合部队行动中服役的乌克兰退伍军人被随机分配到干预组（TROI组）或接受常规治疗的对照组（常规治疗组）。在治疗前（T1）和治疗后（T2）评估中，使用了康纳-戴维森复原力量表（CD-RISC）、医院焦虑抑郁量表（HADS）、蒙特利尔认知评估量表（MoCA）、神经行为症状量表（NSI）、创伤后应激障碍检查表5（PCL-5）、查班生活质量量表（CQLS）、正负性情绪量表（PANAS）。
以治疗组、性别、基线认知表现水平和创伤性脑损伤严重程度作为自变量的多变量线性回归显示，与常规治疗组相比，TROI组在复原力（CD-RISC）、认知表现（MoCA）、脑震荡后症状（NSI）、创伤后症状（PCL-5）、积极情绪（PANAS）和生活质量（CQLS）方面有统计学上的显著改善。我们发现两组在抑郁、焦虑（HADS）和消极情绪（PANAS）结果方面没有统计学上的显著差异。此外，威尔科克森符号秩检验显示，完成两步式复原力导向干预的参与者与基线相比，所有结果的得分都有显著提高（p < 0.05）。
总之，我们可以初步得出结论，与标准治疗相比，在标准治疗措施中加入TROI可能会改善创伤性脑损伤退伍军人的复原力和持续性症状。针对解决问题、决策、积极思考等认知和情感因素可以促进创伤性脑损伤退伍军人的复原力，并有助于促进损伤恢复。这项试点研究的结果很有前景，但该干预措施需要在更大规模的试验中进行研究。
