(PS6-D91) Adapting Cognitive-behavioral Therapy for Acquired Brain Injury: A Scoping Review

The disability that people experience after acquired brain injury (ABI) often necessitates their participation in mental health treatment, but contradictorily, also restricts their access to it. Cognitive, physical, communication, and sensory impairments are cited as reasons to exclude people with ABI from cognitive-behavioral therapy (CBT). At present, CBT has been preliminarily adapted for ABI using compensatory strategies for cognitive impairments. However, adaptations for other ABI impairments have yet to be considered, despite their standard application in ABI rehabilitation.

A scoping review of CBT for ABI was conducted following the JBI Manual for Evidence Synthesis. A comprehensive search strategy was developed for databases related to psychology, social work, occupational therapy, physiotherapy, speech-language pathology, and recreation therapy. Targeted website searches were completed to identify adaptations in grey literature. 659 academic articles and 236 grey literature documents met inclusion criteria. All documents were analysed using NVivo software and guided by qualitative content analysis. The a priori coding framework included ABI impairments and adaptations, CBT characteristics, and meaningful life activities relevant to behavioral activation.

Findings demonstrated the full range of ABI impairments in CBT and rehabilitation literature, including cognition, physical abilities, communication, and sensation. Participant samples in CBT studies were commonly limited to cognitive impairment, with other ABI subpopulations under-represented in the literature. Problematically, there was a pattern of intentional exclusion of people with communication impairments from CBT studies. In contrast, meaningful life activity interventions more consistently included a fulsome range of ABI impairments. ABI adaptations included external aids for cognitive and physical abilities, behavioural strategies and assistive technology for communication, and environmental modifications for sensation. While these adaptations were represented in rehabilitation disciplines and were often applied to meaningful life activities, they were under-represented and inadequately described in the CBT literature.

 


The range of ABI adaptations available in rehabilitation disciplines and their absence from CBT literature represent opportunities for their application to a comprehensive adaptation of both the cognitive and behavioral components of CBT. CBT adapted for the full range of ABI impairments would facilitate the inclusion of all people with ABI, rather than only those whose impairments allow for intuitive adaptation. The review offers recommendations for research and practice, including: the integration of adaptations into CBT for ABI, the inclusion of a range of ABI impairments in research sampling, the standard reporting and description of ABI adaptations in research, and greater cross-pollination across mental health and rehabilitation disciplines. This review serves as a call to action for equitable and accessible mental health treatment for all people, regardless of ability.