MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK.
Department of Experimental Psychology, University of Oxford, Radcliffe Observatory Quarter, Anna Watts Building, Oxford, OX2 6GG, UK.
BMC Psychol. 2023 Jul 13;11(1):207. doi: 10.1186/s40359-023-01230-2.
Acquired brain injuries (ABI) from stroke, head injury, or resected brain tumours are associated with poor emotional wellbeing and heightened risk of mood disorder. Common sequalae of ABI, such as poor attention and memory, can create barriers to the efficacy of cognitively demanding mood interventions, such as Cognitive Behavioural Therapy (CBT). Behavioural Activation (BA), where individuals plan and engage in reinforcing activities, is a promising alternative due to lower cognitive demands. However, BA was initially developed in clinical populations without ABI where the primary barriers to activity engagement were low mood and anxious avoidance. Additionally, BA can incorporate a range of techniques (e.g., mood monitoring, activity scheduling, targeting avoidance, contingency management) and psychoeducational topics (e.g., mindfulness, managing uncertainty; social/communication skills). Exploring barriers and facilitators to adopting specific BA components in ABI is an important aim.
Semi-structured interviews were conducted with purposively selected ABI survivors (N = 16) with both low and high depressive symptoms, and family members (N = 7). Questions focused on routine and enjoyable activities, and feedback on 10 different BA techniques and associated psychoeducational topics. Transcripts were analysed using an interpretive description framework. Analysis was informed by field notes, reflexivity diaries, and peer debriefing.
The final constructed framework, Creating Sustainable Engagement, comprises a two-tier hierarchy. Higher-level themes concerned core perspectives of BA, regardless of BA component discussed. This included identifying optimal time windows for different BA components (Right Tool at the Right Time), that BA components should, at least initially, not be burdensome or fatiguing (Perceived Effort), that emotional readiness to confront activity-mood relationships should be addressed (Emotional Impact), and that planned BA activities be consistent with individual values (Relation to Values). Lower-level themes concerned specific BA components: Of these, activity scheduling, procedures targeting avoidance, managing uncertainty and social/communication skills were generally well-received, while mood monitoring, contingency management, and mindfulness had mixed feedback.
BA is a widely scalable intervention that can be adapted for ABI. This study provides a novel framework on implementing a range of BA components in ABI and adds to the limited evidence on which components may be particularly suitable.
脑卒中、头部损伤或切除的脑肿瘤引起的获得性脑损伤（ABI）与情绪健康状况不佳和情绪障碍风险增加有关。ABI 的常见后遗症，如注意力和记忆力差，可能会对认知要求高的情绪干预措施（如认知行为疗法（CBT））的疗效造成障碍。行为激活（BA），即个体计划和参与强化活动，是一种很有前途的替代方法，因为它的认知要求较低。然而，BA 最初是在没有 ABI 的临床人群中开发的，在这些人群中，活动参与的主要障碍是情绪低落和回避焦虑。此外，BA 可以采用多种技术（例如，情绪监测、活动安排、针对回避、应急管理）和心理教育主题（例如，正念、管理不确定性；社交/沟通技巧）。探索在 ABI 中采用特定 BA 成分的障碍和促进因素是一个重要目标。
对有和无抑郁症状的 ABI 幸存者（N=16）和家属（N=7）进行了有针对性的半结构式访谈。问题集中在日常和愉快的活动上，并对 10 种不同的 BA 技术和相关心理教育主题进行了反馈。使用解释性描述框架对转录本进行分析。分析受到现场记录、反思日记和同行审查的启发。
最终构建的框架“创造可持续参与”包括一个两级层次结构。较高层次的主题涉及 BA 的核心观点，无论讨论的 BA 成分如何。这包括确定不同 BA 成分的最佳时间窗口（在正确的时间使用正确的工具），BA 成分至少在最初阶段不应繁琐或疲劳（感知到的努力），应解决对活动情绪关系的情绪准备（情绪影响），以及计划的 BA 活动应与个人价值观一致（与价值观相关）。较低层次的主题涉及特定的 BA 成分：其中，活动安排、针对回避的程序、管理不确定性和社交/沟通技巧普遍受到好评，而情绪监测、应急管理和正念则有不同的反馈。
BA 是一种广泛可扩展的干预措施，可以针对 ABI 进行调整。本研究提供了一个关于在 ABI 中实施一系列 BA 成分的新框架，并为哪些成分可能特别合适增加了有限的证据。
