Acceptance and Commitment Therapy for Improving Adaptive Functioning in Persons with a History of Pediatric Acquired Brain Injury

Abstract

Acquired brain injury (ABI) often results in lifelong disability without affecting longevity. While abilities may be affected by neuronal damage, psychological factors may compound disability by inhibiting participation in life activities. Experiential avoidance (EA) is a common coping strategy among persons with ABI and may result in decreased participation through task and situational avoidance. However, research on psychotherapies targeting participation and EA is scant. The present study employed a staggered waitlist yielding a natural multiple baseline design to assess the effectiveness of an 8-session Acceptance and Commitment Therapy (ACT) group treatment to improve adaptive and psychological functioning among persons with late effects of pediatric ABI (N=17). All measures were given at baseline, pre- and post-intervention, and 1-month follow-up. Process measures were also given mid-intervention. Daily behavior tracking assessed orientation toward productive activities and maladaptive and adaptive behaviors. Participants experienced increased participation and decreased psychological distress after the intervention and at follow-up, with no change in satisfaction with participation reported. Participants reported less EA and behavioral avoidance but did not report changes in threat cognitions, ABI-specific EA, or self-compassion. Consistent changes in daily behavior tracking were not seen. These results support the feasibility of applying an ACT group treatment with individuals with neurocognitive impairments that have traditionally excluded them from psychotherapy and provide initial support for the effectiveness of ACT in improving adaptive and psychological functioning among persons with ABI.