Posts Tagged resilience

[WEB SITE] A Brief Program May Help People Build Resilience After a Traumatic Brain Injury


study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

A traumatic brain injury (TBI) is lasting brain damage resulting from an external force, such as a fall or a car accident. People with TBI may have challenges managing stress, thinking and remembering things, or communicating with others. Resilience is the ability to adapt positively to traumatic events and being resilient can help people manage these challenges and adjust to life changes after a TBI. Past research has found that people can become more resilient by learning and practicing coping skills.

In a recent NIDILRR-funded study, researchers tested a new program called the Resilience and Adjustment Intervention (RAI). The RAI program is designed to help build resilience for people with TBI. They wanted to find out if the program would lead to higher resilience, fewer emotional challenges, or lower stress for people with TBI. They also wanted to find out if the benefits of the program could last over a 3-month period.

Researchers at the Virginia Commonwealth University Traumatic Brain Injury Model System Center enrolled 160 people with TBI in a study. The participants were adults over the age of 18, and all had their TBI for at least three months before beginning the study. The participants were randomly divided into two groups: an experimental group who participated in the RAI Program and a comparison group who did not receive any services during the study (but were given the opportunity to receive the intervention after the study was complete).

Each participant in the experimental group had 7 one-hour sessions with a therapist in an outpatient clinic over a five-week period. Participants were also given worksheets and reading materials to complete at home between sessions and were asked to discuss these materials with family and friends. Each session covered a different topic related to resilience and TBI as follows:

  1. Learning about common life changes after a TBI;
  2. Discussing how to take an active role in TBI recovery;
  3. Goal setting and defining success in a flexible way;
  4. Learning how to solve problems and overcome challenges;
  5. Managing stress and difficult emotions;
  6. Communication skills, building relationships, and talking to others about TBI; and
  7. Having a positive outlook on life and overcoming negative thinking.

The participants in both the experimental and comparison groups completed questionnaires at the beginning of the study and either after the final session (experimental group) or about five weeks after starting the study (comparison group). The participants in the experimental group completed the questionnaires a third time about three months after the end of the program. The questionnaire included questions asking how often the participants felt resilient (e.g., “coping with stress can strengthen me”); how they rated themselves on problem-solving and communication skills; and how much they experienced emotional challenges (such as anxiety or depression) or feelings of being stressed or overwhelmed.

The researchers found that the participants in the experimental group reported feeling more resilient, improving their communication and problem-solving skills, and feeling fewer emotional challenges and less stress at the end of the study than at the beginning of the study. For example, the participants’ resilience scores increased by an average of 35%, and their stress scores decreased by an average of 33%. These improvements were maintained three months after the end of the study. In contrast, the participants in the comparison group showed only very small changes in their resilience, skills, emotional challenges, and stress levels.

The authors noted that resilience may play a key role in helping people adjust to challenges after a TBI. Although the stresses of having a TBI can challenge resilience, people can improve their resilience by learning and practicing specific skills. The participants in this study showed improvements in their emotional health and problem-solving skills after only seven brief sessions. Future research may be useful to explore other ways for people with TBI to build their resilience, including long-distance or group-based programs.

To Learn More

The Model Systems Knowledge Translation Center (MSKTC) develops and curates TBI resources from the Model Systems, including factsheets, video modules, and the innovative TBI InfoComics series. offers a wealth of resources on TBI for survivors, family members and caregivers, military personnel, and professionals, including articles from researchers, survivors, and supportive organizations. These include:

For professionals who work with individuals with TBI, the Resilience and Adjustment Intervention (RAI) is available through the National Resource Center for TBI. Learn more about its development and frequently asked questions, including how to receive training on using the RAI with clients with TBI.

To Learn More About This Study

Kreutzer, J.S., Marwitz, J.H., Sima, A.P., Mills, A., Hsu, N.H. & Lukow II, H.R., (2018) Efficacy of the resilience and adjustment intervention after traumatic brain injury: A randomized controlled trial. Brain Injury, 32(8), 963-971. This article is available from the NARIC collection under accession number J79743.

Date published:

via A Brief Program May Help People Build Resilience After a Traumatic Brain Injury | National Rehabilitation Information Center

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[ARTICLE] Psychological Resilience Is Associated With Participation Outcomes Following Mild to Severe Traumatic Brain Injury – Full Text

Traumatic brain injury (TBI) causes physical and cognitive-behavioral impairments that reduce participation in employment, leisure, and social relationships. Demographic and injury-related factors account for a small proportion of variance in participation post-injury. Personal factors such as resilience may also impact outcomes. This study aimed to examine the association of resilience alongside demographic, injury-related, cognitive, emotional, and family factors with participation following TBI. It was hypothesized that resilience would make an independent contribution to participation outcomes after TBI. Participants included 245 individuals with mild-severe TBI [Mage = 44.41, SDage = 16.09; post traumatic amnesia (PTA) duration M 24.95 days, SD 45.99] who completed the Participation Assessment with Recombined Tools-Objective (PART-O), TBI Quality of Life Resilience scale, Family Assessment Device General Functioning Scale, Rey Auditory Verbal Learning Test, National Adult Reading Test, and Hospital Anxiety and Depression Scale an average 4.63 years post-injury (SD3.02, R 0.5–13). Multiple regression analyses were used to examine predictors of PART-O scores as the participation measure. Variables in the model accounted for a significant 38% of the variability in participation outcomes, F(13, 211) = 9.93, p < 0.05, R2 = 0.38, adjusted R2 = 0.34. Resilience was a significant predictor of higher participation, along with shorter PTA duration, more years since injury, higher education and IQ, and younger age. Mediation analyses revealed depression mediated the relationship between resilience and participation. As greater resilience may protect against depression and enhance participation this may be a focus of intervention.


Following traumatic brain injury (TBI), participation in employment, education, leisure, and relationships is often significantly reduced, leaving individuals substantially less integrated in their communities (14). As a result, many individuals spend increased time at home, straining family and other relationships (5). Given that TBI occurs commonly during young adulthood (6), participation deficits coincide with a critical period of development in which individuals are completing education, establishing a vocation, leaving home, and forming important lifelong relationships. Failure to attain these goals may profoundly impact their sense of self, mental health and general well-being. Reduced participation often extends beyond the acute recovery period and continues to be associated with poorer quality of life up to two decades after injury (7). Arguably participation in these life roles, including employment, education, leisure and relationships, represents one of the most important and objective indicators of injury outcomes.

Numerous variables have been associated with participation outcomes post-TBI, including injury-related and demographic variables as well as post-injury environmental and personal factors. Injury severity, cognitive difficulties, and limb injuries with related pain and impact on mood, affect an individual’s ability to engage socially and often present significant barriers to education and employment (816). Injury severity is a particularly well-researched predictor of participation outcomes, with duration of post traumatic amnesia (PTA) having the most robust association (1721). With respect to demographic factors, younger age, higher premorbid education level, higher premorbid IQ, and being employed prior to injury have all been associated with better participation outcomes (102229). Notably, older age at injury has been found to predict both worse participation overall as well as progressively worsening participation over time (10). Although gender does not appear to be directly associated with participation (30), it may have an indirect association, for example through mood and pre-injury education (14). Post-injury psychological functioning, particularly depression and anxiety, are also important predictors of participation outcomes (10123133). The impact of family functioning on participation is thought to be both direct, and through association with emotional well-being (3435).

Due to this broad range of factors influencing outcome, research has moved toward a multivariate approach to prediction of participation outcomes following TBI (24363738). These models contribute to a more comprehensive understanding of participation outcomes; however, the average amount of variance accounted for by predictive models is around 30% (21). This suggests there are additional predictive factors yet to be identified. One such factor that has increasingly gained scholarly recognition, due its positive association with quality of life and well-being outcomes among different clinical populations, is resilience.

Resilience has been conceptualized as a process of adaptation to adversity or the ability to bounce back after trauma or adversity. Resilience arguably influences the extent to which a person is able to resume important life roles after an injury. Resilience may impact participation outcomes directly through facilitating or promoting return to normal life or the development and achievement of new life goals (39), and indirectly through its effects on improved well-being, quality of life and psychological adjustment. Participating in employment, education, leisure, and relationships represent fundamental areas of participation. Resilience has been positively associated with physical and emotional well-being in individuals with cancer (40), Parkinson’s disease (41), diabetes (42), chronic spinal cord injury (43), multiple sclerosis, spina bifida, stroke, and posttraumatic stress disorder (4445). There has been less resilience research in TBI, with only one study to date examining the association between resilience and participation. Notably, it has been suggested that the study of resilience after TBI poses a distinct challenge, in that the skills characteristically associated with resilience are typically impaired after TBI (4547). For example, resilience requires emotional stability, a positive outlook, good problem-solving skills and social perception (47); however, TBI is commonly associated with impaired executive functioning (4849), irritability and aggression (5051), depression (3345), and difficulties with social perception (52).

The little research that has focused on resilience after TBI has been largely limited to patients with mild TBI, in whom no studies have examined impact on participation. In this group, greater resilience has been associated with less reporting of post-concussional and post-traumatic stress symptoms (5355), reduced fatigue, insomnia, stress, and depressive symptoms, as well as better quality of life (56). One study found that greater pre-injury resilience was significantly associated with greater post-concussion symptom severity 1 month post-injury (57), perhaps reflecting insufficient time for participants to “bounce back” (44), or overrating of pre-injury resilience levels, a phenomenon known as the “Good Old Days”(58).

Only three studies have examined resilience in individuals with moderate to severe TBI, of which one examined an association with participation. Marwitz et al. (39), conducted a large (n = 195) longitudinal study and found that resilience was significantly associated with participation over the first 12 months post-injury (39). Other studies have associated higher resilience in individuals with moderate to severe TBI with fewer depressive and anxiety symptoms, better emotional adjustment, use of task oriented coping and greater social support (4445). However, one of these studies used a sample of individuals who were actively seeking help with adjusting to changes post-injury, possibly biasing the sample toward those experiencing greater adjustment problems (45).

The aim of the present study was to examine the relative association of resilience, as well as demographic, injury-related, cognitive, emotional, and family factors with participation (productivity, social relations and leisure) following mild to severe TBI. To the best of our knowledge, this is the first study to examine the association between resilience and participation outcomes more than 12 months after mild to severe TBI. This critically extends previous research by examining the impact of resilience across the spectrum of TBI severity, from mild to severe, and how this association influences outcomes beyond the acute post-injury period. It was hypothesized that resilience would make an independent contribution to participation after TBI, in a model that would include demographic variables (gender, age, pre-morbid IQ, education, pre-injury employment), injury variables (injury severity, cognitive functioning, limb injury, time since injury) and post-injury personal and environmental factors (depression, anxiety, family support).[…]


Continue —> Frontiers | Psychological Resilience Is Associated With Participation Outcomes Following Mild to Severe Traumatic Brain Injury | Neurology

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