Traumatic brain injury refers to a brain lesion caused by an external mechanical force, leading not only to physical impairments and cognitive deficits, but also to changes in behavior and personality.1,2 Especially after damage to orbitofrontal and ventromedial prefrontal brain areas, deficits in social cognition can occur.3,4
According to Adolphs,5 social cognition consists of three stages: (1) the ability to perceive social information (i.e. emotional facial expressions, bodily language), (2) the capacity to process and interpret social information (i.e. theory of mind, perspective taking), and (3) the ability to adapt behavior in accordance with the situation. Babbage et al.6 estimated that 13%–39% of individuals with moderate to severe traumatic brain injury experienced emotion perception deficits and up to 70% reported low empathy.7–9
Deficits in social cognition often appear in the shape of socially inadequate behavior, such as disinhibited or indifferent emotional behavior.10–12 Such behaviors have detrimental consequences for the ability of patients to establish and maintain social relationships, to hold jobs, and to participate in society.1,13,14 It has been found that poor theory of mind and behavioral problems significantly predict poor participation and community integration.15,16For all these reasons, it is important to provide a tailored rehabilitation treatment, in order to prevent an unfavorable outcome.
In their review of cognitive rehabilitation, Cicerone et al.17 stressed the need to provide detailed information about the theoretical base, the protocol design, and the ingredients of a treatment, as a prerequisite to analyze its effectiveness. In the current paper, we give a comprehensive description of the treatment of social cognition and emotion regulation protocol (T-ScEmo). The effectiveness of T-ScEmo was evaluated in 59 patients with traumatic brain injury. It was compared with a computerized control treatment in a randomized controlled trial.18 Compared to the control treatment, T-ScEmo resulted in significant improvements in emotion recognition, theory of mind, emphatic behavior, quality of life partner relationship, quality of life and societal participation, up to five months posttreatment. Patients with traumatic brain injury as well as their life partners were satisfied with the treatment.18 A detailed description of the T-ScEmo protocol is relevant for researchers and clinical therapists; they can use, replicate, or expand this newly developed treatment.[…]