Affiliative and “self-as-doer” identities: Relationships between social identity,social support,and emotional status amongst survivors of acquired brain injury (ABI)

Social support is an important factor in rehabilitation following acquired brain injury (ABI). Research indicates that social identity makes social support possible and that social identity is made possible by social support. In order to further investigate the reciprocity between social identity and social support, the present research applied the concepts of affiliative and “self-as-doer” identities to an analysis of relationships between social identity, social support, and emotional status amongst a cohort of 53 adult survivors of ABI engaged in post-acute community neurorehabilitation. Path analysis was used to test a hypothesised mediated model whereby affiliative identities have a significant indirect relationship with emotional status via social support and self-as-doer identification. Results support the hypothesised model. Evidence supports an “upward spiral” between social identity and social support such that affiliative identity makes social support possible and social support drives self-as-doer identity. Our discussion emphasises the importance of identity characteristics to social support, and to emotional status, for those living with ABI.     

Art therapy interventions for active duty military service members with post-traumatic stress disorder and traumatic brain injury

This paper provides an overview of short and long-term art therapy treatment approaches, used in the USA, for military service members with post-traumatic stress disorder and traumatic brain injury. The described clinical approaches are based on the theoretical foundations and the art therapists’ experiences in providing individualised care for the unique needs of the patient population. The art therapy models and directives are designed to be more therapist-led in the short-term model, moving on to an increasingly patient-led format in the long-term treatment model. The overall objectives of art therapy are: to support identity integration, externalisation, and authentic self-expression; to promote group cohesion; and to process grief, loss, and trauma. In addition, programme evaluation is used in both settings as a means to understand participants’ experiences and the perceived value of art therapy.     

“Relating through sameness”: a qualitative study of friendship and social isolation in chronic traumatic brain injury

Social isolation has been described as a common problem among traumatic brain injury (TBI) survivors during the chronic phase. Due to physical, cognitive and behavioural changes, survivors become less socially active and experience a marked decrease in the number of friends. The goal of this investigation is to explore TBI survivors’ subjective account of the challenges encountered in sustaining friendships, as well as gaining insight into their particular understanding of such difficulties. Using a thematic analysis approach, 11 survivors of TBI were interviewed in relation to their experience of social isolation and friendship during the chronic stage. Four main themes emerged from the interviews: (1) The impact of long-term cognitive and behavioural problems on relationships; (2) Loss of old friends; (3) Difficulties making new friends, and (4) Relating to other survivors in order to fight social isolation (sameness). Clinical implications of these findings, as well as their relevance in the design of long-term rehabilitation programmes, are discussed. Particular emphasis is placed on the need to acknowledge the value of relating to other survivors, as a way of resisting cultural discourses about disability, and as a source of self-cohesion in the process of identity re-construction.     

Neurorehabilitation of behavioral disorders following lightning and electrical trauma

Neurobehavioral problems after lightning and electrical injuries are diverse. Commonly reported are decreased cognitive function, pain syndromes, depression, posttraumatic stress disorder, and significant alterations in social and work roles. While the problems resemble those following other kinds of accidents, the injury scenarios for lightning and electrical trauma are unique, and seem to invite more skepticism and controversy in medical and legal realms when the survivors seek help. Studies of lightning and electrical injuries have identified disabling neuropsychiatric changes for some survivors, often persistent and occasionally progressive, that appear weakly related to litigation status, inconsistently related to injury scenarios, and likely influenced by individual premorbid emotional and coping patterns. Standards of care in the fields of brain injury, behavioral medicine, and psychotherapy can inform rehabilitation strategies. Proper assessment is important, as well as an individualized approach to treatment. Multidisciplinary intervention focuses on managing symptoms, learning compensatory skills, providing psychosocial support, and preventing maladaptive behaviors. It has been therapeutic for some patients to become activists for better awareness and prevention.     

Measuring Identity Processes in Family Relational Empowerment

This paper outlines a procedure for measuring personal identity that uses self-characterisations to elicit and integrate ideographic data for fixed construct repertory grid nomothetic applications. There is a focus on how family members view their personal identities when they are recovering from the impacts of having a ‘loved one’ with a mental illness and/or substance used disorder. The unique nature of personal and relational empowerment journeys necessitates the use of an ideographic approach to capture changes in personal identity. A significant research implication for this procedure is that the consistent meaning generated through this initially ideographic approach can then be used to explore changes in identity across larger populations. The clinical implications include having a phenomenological framework upon which care plans that include a focus on identity processes can be individually tailored.     

Transcranial magnetic stimulation,deep brain stimulation and personal identity: Ethical questions,and neuroethical approaches for medical practice

Neurotechnology provides means to engage micro- and macrostructural networks of the brain to both mitigate the manifestations of several neurological and psychiatric disorders, and alter cognition and motoric activity. Such capacity also generates questions of how these interventions may affect personal identity. This paper discusses the ethical implications regarding changes to personal identity that arise from the therapeutic use of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) technologies. In addition, we raise the question of whether changes in personal identity, as a side effect of these interventions, are ethically acceptable and whether such alterations of personality foster patients’ sense of well-being and autonomy. First, we provide a series of case vignettes that afford an overview of the ways that various neurological interventions can affect personal identity. Second, we offer a brief working definition of personal identity in order to delineate an ethical framework that we deem necessary for the responsible use of neurostimulation technologies. In so doing, we argue that neurostimulation therapy, as a doctoring act, should be directed, and adherent to goals of restoring and/or preserving patients’ personal identity. To this end, we offer an ethical framework that we believe enables sound decisions about the right and good use of TMS and DBS.     

The Instrumented Fetal Sheep as a Model of Cerebral White Matter Injury in the Premature Infant

Despite advances in neonatal intensive care, survivors of premature birth remain highly susceptible to unique patterns of developmental brain injury that manifest as cerebral palsy and cognitive-learning disabilities. The developing brain is particularly susceptible to cerebral white matter injury related to hypoxia-ischemia. Cerebral white matter development in fetal sheep shares many anatomical and physiological similarities with humans. Thus, the fetal sheep has provided unique experimental access to the complex pathophysiological processes that contribute to injury to the human brain during successive periods in development. Recent refinements have resulted in models that replicate major features of acute and chronic human cerebral injury and have provided access to complex clinically relevant studies of cerebral blood flow and neuroimaging that are not feasible in smaller laboratory animals. Here, we focus on emerging insights and methodologies from studies in fetal sheep that have begun to define cellular and vascular factors that contribute to white matter injury. Recent advances include spatially defined measurements of cerebral blood flow in utero, the definition of cellular maturational factors that define the topography of injury and the application of high-field magnetic resonance imaging to define novel neuroimaging signatures for specific types of chronic white matter injury. Despite the higher costs and technical challenges of instrumented preterm fetal sheep models, they provide powerful access to clinically relevant studies that provide a more integrated analysis of the spectrum of insults that appear to contribute to cerebral injury in human preterm infants.     

Brain injury improves survival of mice following brain ischemia

Minor brain injury was inflicted with a small needle at 4 sites one week before the production of incomplete brain ischemia in the mouse. A bilateral carotid clamp was applied for 60 min under pentobarbital anesthesia, and the number of survivors at one week after the ischemic insult was compared with those in animals anesthetized only and those in a sham-operated group. The number of survivors in the brain-injured group was significantly higher than in the other two groups. The results suggest that anti-ischemic factors are released by the injured brain or that certain unknown protective mechanisms against ischemia become active following brain injury.     

Implicit Social Learning in Relation to Autistic-Like Traits

We investigated if variation in autistic traits in the typically-developed population (using the Autism-spectrum Quotient, AQ) influenced implicit learning of social information. In the learning phase, participants repeatedly observed two identities whose gaze and expression conveyed either a pro- or antisocial disposition. These identities were then employed in a gaze-cueing paradigm. Participants made speeded responses to a peripheral target that was spatially pre-cued by a non-predictive gaze direction. The low AQ group (n?=?50) showed a smaller gaze-cueing effect for the antisocial than for the prosocial identity. The high AQ group (n?=?48) showed equivalent gaze-cueing for both identities. Others’ intentions/dispositions can be learned implicitly and affect subsequent responses to their behavior. This ability is impaired with increasing levels of autistic traits.     

Early metabolic crisis-related brain atrophy and cognition in traumatic brain injury

Traumatic brain injury often results in acute metabolic crisis. We recently demonstrated that this is associated with chronic brain atrophy, which is most prominent in the frontal and temporal lobes. Interestingly, the neuropsychological profile of traumatic brain injury is often characterized as ‘frontal-temporal’ in nature, suggesting a possible link between acute metabolic crisis-related brain atrophy and neurocognitive impairment in this population. While focal lesions and diffuse axonal injury have a well-established role in the neuropsychological deficits observed following traumatic brain injury, no studies to date have examined the possible contribution of acute metabolic crisis-related atrophy in the neuropsychological sequelae of traumatic brain injury. In the current study we employed positron emission tomography, magnetic resonance imaging, and neuropsychological assessments to ascertain the relationship between acute metabolic crisis-related brain atrophy and neurocognitive outcome in a sample of 14 right-handed traumatic brain injury survivors. We found that acute metabolic crisis‐related atrophy in the frontal and temporal lobes was associated with poorer attention, executive functioning, and psychomotor abilities at 12 months post-injury. Furthermore, participants with gross frontal and/or temporal lobe atrophy exhibited numerous clinically significant neuropsychological deficits in contrast to participants with other patterns of brain atrophy. Our findings suggest that interventions that reduce acute metabolic crisis may lead to improved functional outcomes for traumatic brain injury survivors.     

Holistic neuro-rehabilitation in the community: is identity a key issue?

Many people experience identity change after brain injury. Impaired self-awareness after acquired brain injury is also common and can, along with other factors, affect the identity change a person may experience. Holistic rehabilitation programmes attempt to address both cognitive and emotional difficulties and specifically problems of self-awareness after brain injury. Does identity change require longer-term rehabilitation interventions? This paper describes a community-based neuro-rehabilitation service that has incorporated some principles from more traditional holistic programmes with a view to providing long-term, low-intensity brain injury rehabilitation. Specific reference is made to problems of identity and how these may be addressed during long-term psychotherapeutic follow-up. The potential relevance of the total duration of rehabilitation input rather than simply the number of sessions when working with adjustment and identity change after brain injury in community settings is discussed. The service model is compared to more traditional holistic rehabilitation programmes. A case study and early outcome data are presented to illustrate some of these points and to provide more information about the nature of the programme.     

Disaster response and group self-care

TOPIC: This article reports on group support using Psychological First Aid during Katrina relief work. It explores this issue from personal experience and a theoretical perspective. PURPOSE: Group support is useful for volunteers as well as refugees and makes it possible to deal with extraordinary events of disaster more successfully. CONCLUSIONS: The use of group work with disaster and trauma survivors can have an immediate positive impact and lasting consequences in preventing post-traumatic stress disorder. PRACTICE IMPLICATIONS: APRNs would benefit from group training in present centered therapy, acute debriefing, supportive, cognitive behavioral, and psychodynamic approaches. The ability to conduct groups with trauma survivors and professionals during disasters is a vital skill and service to provide immediate relief and constructive coping.     

Management of brain injury after resuscitation from cardiac arrest

The devastating neurologic injury in survivors of cardiac arrest has been recognized since the development of modern resuscitation techniques. After numerous failed clinical trials, two trials showed that induced mild hypothermia can ameliorate brain injury and improve survival and functional neurologic outcome in comatose survivors of out-of-hospital cardiac arrest. This article provides a comprehensive review of the advances in the care of brain injury after cardiac arrest, with updates on the process of prognostication, the use of therapeutic hypothermia and adjunctive intensive care unit care for cardiac arrest survivors.     

Deep Brain Stimulation and the Search for Identity

Ethical evaluation of deep brain stimulation as a treatment for Parkinson’s disease is complicated by results that can be described as involving changes in the patient’s identity. The risk of becoming another person following surgery is alarming for patients, caregivers and clinicians alike. It is one of the most urgent conceptual and ethical problems facing deep brain stimulation in Parkinson’s disease at this time. In our paper we take issue with this problem on two accounts. First, we elucidate what is meant by “becoming another person” from a conceptual point of view. After critically discussing two broad approaches we concentrate on the notion of “individual identity” which centers on the idea of “core attitudes”. Subsequently we discuss several approaches to determine what distinguishes core attitudes from those that are more peripheral. We argue for a “foundational-function model” highlighting the importance of specific dependency relations between these attitudes. Our second aim is to comment on the possibility to empirically measure changes in individual identity and argue that many of the instruments now commonly used in selecting and monitoring DBS-patients are inappropriate for this purpose. Future research in this area is advised combining a conceptual and an empirical approach as a basis of sound ethical appraisal.     

Managing Traumatic Stress Using a Mental Health Care Mobile App: A Pilot Study

This study aims to contribute to improving mental health services and establishing a direction for disaster survivors by verifying the effectiveness of the TLS (Training for Life Skills) app, a mental health management mobile application. Altogether, 22 disaster survivors received access to the app (with guidance) for eight weeks; we analyzed its effectiveness by examining each participant’s electroencephalography data, which were collected while they were utilizing the app. The results of this study show that the use of the TLS app had a significant positive effect on emotional quotient, basic rhythm quotient (left brain, right brain), alpha blocking rate (left brain, right brain), and brain quotient of disaster survivors. The TLS mobile app is expected to not only provide psychological first aid to disaster survivors but also to improve their life skills, which may allow them to gain information about their emotions; hence, it may provide the appropriate conditions needed to enable effective self-control and health management for disaster survivors.     

Personal narrative approaches in rehabilitation following traumatic brain injury: A synthesis of qualitative research

Although narrative storytelling has been found to assist identity construction, there is little direct research regarding its application in rehabilitation following traumatic brain injury (TBI). The aim of this review was to identify published evidence on the use of personal narrative approaches in rehabilitation following TBI and to synthesise the findings across this literature. A systematic search of four databases was conducted in December 2016. No limit was set on the start date of the search. Personal narrative approaches were defined as direct client participation in sharing personal stories using written, spoken or visual methods. The search retrieved 12 qualitative research articles on the use of personal narrative approaches in TBI rehabilitation. Thematic synthesis of the narrative data and authors’ reported findings of the 12 articles yielded an overall theme of building a strengths-based identity and four sub-themes: 1) expressing and communicating to others; 2) feeling validated by the act of someone listening; 3) reflecting and learning about oneself; and 4) being productive. The findings of this review support the use of personal narrative approaches in addressing loss of identity following TBI. Healthcare professionals and the community are encouraged to seek opportunities for survivors of TBI to share their stories.     

My life since my head injury

Nancy Bauser describes her experiences as a brain injury survivor and her quest to recover. After surviving an automobile accident in 1971, Bauser relearned how to walk, talk, and function independently. Despite her physical limitations, she completed undergraduate studies and her graduate degree in social work. Her current work includes peer counseling and conducting acceptance groups with survivors of brain injury and other traumatic disorders at outpatient treatment facilities.     

Using Interpretative Phenomenological Analysis to Assess Identity Formation Among Users of Synthetic Cannabinoids

Identity work and the perception and transformation of the addicted self are the most important processes during recovery from psychoactive substance addiction. While synthetic cannabinoids (SCs) have become increasingly popular among drug users in recent years, little is known about how the users of SCs perceive their identities. Semi-structured interviews were conducted with six male former SC users, and the transcribed interviews were analyzed using interpretative phenomenological analysis. Two master themes were identified: 1. The impact of SC use experience on self and identity formation, and 2. The transformed self and the user self. SCs users have difficulties organizing their experiences into definite meaning structures and constructing collective meanings. Their experiences are similar to traumatic experience; therefore, SC use may be treated as a particular type of trauma. As a result, the resources of SC users to change their self and construct a new non-addict identity are limited, which may mean a significant obstacle in recovery. Hence, treatment should focus on identity work more emphatically.