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Comparison of a Cognitive-Behavioral Coping Skills Group to Peer Support in a Brain Injury Population.
OBJECTIVE: This study aims to compare the efficacy of two group treatments for persons with brain injury (BI) and their caregivers in promoting perceived self-efficacy (PSE), emotional, and neurobehavioral functioning.
DESIGN: Randomized-Controlled Trial.
SETTING: Outpatient BI rehabilitation.
INTERVENTIONS: The Brain Injury Coping Skills (BICS) is a manualized cognitive-behavioral treatment (CBT). CBT was compared to a structurally-equivalent support group (SG).
PARTICIPANTS: Thirty-eight subjects including 19 with BI and 19 caregivers participated in BICS or SG.
MAIN OUTCOME MEASURES: BICS-Questionnaire (PSE), Brief Symptom Inventory-18 (emotional distress; BSI-18), and Frontal Systems Behavior Scale (neurobehavioral functions).
RESULTS: There were no significant differences between survivors and caregivers on BICS-Questionnaire and BSI-18, so groups were combined during final analyses. FrSBe caregiver data were used for analysis. Both groups showed significantly improved PSE between baseline and follow-up on repeated measures ANOVA with CBT group showing greater stabilization of change. There was no significant group by time interaction on measures of neurobehavioral functions, but the CBT group showed significant improvements at 3-month follow-up. No significant effects were found on the BSI-18.
CONCLUSION: No studies to date have been published comparing a CBT intervention to a support group in a BI population, with caregiver participation. This study showed that given equivalent group structure, individuals with BI and caregivers may benefit from either type of intervention in enhancing PSE or maintaining emotional stability. However, there was a trend for individuals who received CBT to maintain the effects of improved PSE, while SG participants showed a trend for decline. This study offers a new conceptualization that with certain group dynamics and support, individuals with BI and caregivers may benefit similarly from either a SG or CBT intervention. However, since our sample did not include individuals in clinically significant emotional distress, we cannot rule out the possibility that those with more significant challenges in PSE or emotional functions may show greater benefits with a CBT group.
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