CBT in the context of ABI

Helpful model for understanding self-concept post-ABI: name

• Y-shaped model

Top of the Y explained

• Post-ABI → experience stark personal + social discrepancies between their 'aspired self' (who they want to be) and their 'current self in context' (who they currently are)

• → gap triggers an immediate sense of threat to identity

How individuals tend to cope with this discrepancy (1), examples (3)

• Maladaptive coping cycles + safety-seeking responses which may lower anxiety + challenging feelings in the short-term but compromise long-term wellbeing + community participation

• E.g. denial, activity avoidance + social withdrawal

The stem of the Y + key phrase

• Breaks maladaptive coping cycle by providing safe + empathetic environment

• Structured exploration of possibilities

  • Behavioural experiments

  • Metacognitive approaches

Final section of Y name (1) + description (1)

• Reconstruction + connection

• Build self-efficacy + learn new skills to develop new identity + reconnect w self + others

2 domains to consider when adapting CBT for ABI

• Adapting conceptual focus

• Adapting practical session delivery

How is the conceptual focus adapted? Example?

• Frame self-monitoring around behavioural patterns rather than thought tracking

• E.g. notice moments of withdrawal + perceived self-discrepancy

How to adapt practical delivery (4)

• Shorter sessions to prevent fatigue (30-45 mins)

• Cognitive supports: e.g. written session summaries, visual maps

• Concrete metaphors: for abstract cognitive concepts (e.g. comparing cognitive flexibility to changing gears)

• Assistive technology: use alarms etc. to remind homework completion

Empirical evidence for CBT efficacy post-ABI (1)

• Effective for specific primary targeted outcomes (e.g. anxiety, stress, anger management), however these do not automatically transfer to secondary outcomes