Search

Objective: To evaluate the efficacy of a psychological intervention to reduce moderate to severe hopelessness among Veterans with moderate to severe traumatic brain injury (TBI). Design: Two-arm parallel group, controlled, randomized crossover trial, with 3-month follow-up for those initially allocated to treatment. Participants were randomly allocated in blocks of 4 on a 1:1 ratio to treatment (n = 15) or waitlist (n = 20) groups. Setting: A Veterans Affairs Medical Center. Participants: Veterans between the ages of 26 and 65 years, with a history of moderate to severe TBI, and moderate to severe hopelessness. Interventions: A 20-hour manualized small group cognitive-behavioral intervention. Main Outcome Measures: Beck Hopelessness Scale (primary), Beck Depression Inventory, and Beck Scale for Suicide Ideation. Results: A significant difference between groups was found for postintervention scores on the Beck Hopelessness Scale (P = .03). Significant decreases were maintained at follow- up. For those initially allocated to the waitlist group who completed the intervention, treatment gains were noted in decreased hopelessness (P = .01) and depression (P = .003). Conclusions: Findings from this trial provide additional support for the efficacy of this method of psychological treatment of hopelessness among individuals with moderate to severe TBI. [ABSTRACT FROM AUTHOR]

Objective: Examine sleep-wake disturbance (SWD) characteristics, factors, consequences, and management strategies from the perspective of veterans with chronic stage, moderate/severe traumatic brain injury (TBI). Setting: VA Medical Center, Rocky Mountain. US Participants: Nineteen male veterans with post-acute TBI and SWD in the VA Health Administration. Design: Qualitative descriptive. Measures: Semistructured interviews, Ohio State University TBI-Identification Method, Insomnia Severity Index. Results: Two main dimensions emerged: "Messed up sleep" and Surviving and Managing SWD. Sleep-wake disturbance has long-term multidimensional features, etiology, consequences, and practice implications. Although SWD may not be consistently discussed with providers, the problem appears to be pervasive in many aspects of the lives of the informants. Difficulty falling asleep, frequent awakenings, and poor sleep quality were common symptoms that were described as intrusive, isolating, and difficult to self-manage. Veterans discussed a host of physical symptoms, mental health issues, environmental, and behavioral factors that contributed to SWD. Medications, sleep apnea treatment, and self-imposed isolation were frequent management strategies. Veterans expressed a willingness to try new approaches and work with providers. Conclusion: Sleep-wake disturbance among veterans with chronic stage TBI is a multidimensional phenomenon with interplay between comorbidities, contributing factors, effects on functioning, and sleep management strategies. Implications for practice include early and routine evaluation, monitoring, and treatment of SWD. Research is needed to test interventions that address SWD and common TBI comorbidities. [ABSTRACT FROM AUTHOR]