Emotional experience of acquired brain injury patients after learning emotional regulation: a qualitative study.
DOI:
https://doi.org/10.61989/b153ar62Keywords:
acquired brain injury, emotions, dysregulation, dialectical behavior, interpretative phenomenological analysis, speech therapyAbstract
Context: Acquired Brain Injury (ABI) is responsible for multiple deficits affecting motor skills, language, cognition, behavior and also emotional regulation, which impair the quality of life of patients and their families.
Purpose: The aim of this study is to explore the emotional experience of this population after learning to regulate emotions using a dialectical behavior therapy (DBT) approach called GREMO (Groupe de Régulation ÉMOtionnelle).
Method: Semi-structured interviews were conducted with 17 patients (mean age: 38.9 years) with ABI (traumatic brain injury, stroke, encephalitis, cerebral anoxia) sustained on average of 10.5 years before the interview. Data was analyzed using Interpretative Phenomenological Analysis (IPA). From 20 hours 26 minutes of interviews, transcripts totaling 185,471 words were analyzed using double coding.
Results: Four superordinate themes were identified: (1) identification and regulation of emotions facilitated by DBT; (2) pervasive emotions: a constant challenge for emotional regulation even after DBT; (3) emotions and relationship with others; (4) meaning, rereading one's life and desire for the future; in the light of emotional regulation.
During the interviews, participants were able to identify a range of emotions such as anger, fear, sadness, shame, as well as pleasant ones. They noted an increased awareness of their emotions since their participation in DBT, enabling them to better understand, know and recognize their emotional states. In addition, they noted an improvement in the control of their emotions and found that learning DBT skills facilitated their ability to regulate them. Despite this, they stressed that emotional management remains a daily challenge, and some expressed persistent difficulties in their interpersonal relationships, including feelings of misunderstanding and social isolation. The interviews also offered participants the opportunity to reflect on their emotional functioning and future aspirations.
Conclusion: It is therefore essential to integrate the participants' emotional experiences and goals into a perspective of post-traumatic growth and identity reconstruction, paying particular attention to this dimension in speech and language therapy.
References
Al-Kader, D. A., Onyechi, C. I., Ikedum, I. V., Fattah, A., Zafar, S., Bhat, S., Malik, M. A., Bheesham, N., Qadar, L. T., & Sajjad Cheema, M. (2022). Depression and anxiety in patients with a history of traumatic brain injury: A case-control study. Cureus, 14(8), e27971. https://doi.org/10.7759/cureus.27971
Ashworth, F., Evans, J. J., & Mcleod, H. (2017). Third wave cognitive and behavioural therapies: Compassion focused therapy, acceptance and commitment therapy and positive psychotherapy. Dans B. A. Wilson, J. Winegardner, C. M. van Heugten et T. Ownsworth (dir.), Neuropsychological Rehabilitation: The International Handbook (p. 327-339). Taylor and Francis Group. https://doi.org/10.4324/9781315629537
Bradbury, C. L., Christensen, B. K., Lau, M. A., Ruttan, L. A., Arundine, A. L., & Green, R. E. (2008). The efficacy of cognitive behavior therapy in the treatment of emotional distress after acquired brain injury. Archives of Physical Medicine and Rehabilitation, 89(12S), S61-S68. https://doi.org/10.1016/j.apmr.2008.08.210
Breheret, C. (2019). Effets d’une intervention orthophonique axée sur l’identification et la compréhension des émotions auprès d’enfants atteints de troubles du spectre de l’autisme. [Mémoire de master pour l’obtention du certificat de capacité en orthophonie, Université de Rouen Normandie]. HAL. https://dumas.ccsd.cnrs.fr/dumas-02171127v1
Chen, F., Chi, J., Niu, F., Gao, Q., Mei, F., Zhao, L., Hu, K., Zhao, B., & Ma, B. (2022). Prevalence of suicidal ideation and suicide attempt among patients with traumatic brain injury: A meta-analysis. Journal of Affective Disorders, 300, 349-357. https://doi.org/10.1016/j.jad.2022.01.024
Clark, A., Stedmon, J., & Margison, S. (2008). An exploration of the experience of mothers whose children sustain traumatic brain injury (TBI) and their families. Clinical Child Psychology and Psychiatry, 13(4), 565-583. https://doi.org/10.1177/1359104508090607
Clore, G. (1994). Why emotions require cognition. Dans P. Ekman et R. J. Davidson (dir.), The nature of emotion: Fundamental questions (p.181-191). Oxford University Press.
Cohen, S., Kuppelin, M., Wagnon, M., Ifitissen-Husser, C., Krasny-Pacini, A., & Speranza, M. (2023). Connexions Familiales®, un programme de psychoéducation à destination des proches de personnes souffrant de dysrégulation émotionnelle. Dans M. Kuppelin, I. Tavares, C. Jourda et A. Krasny-Pacini (dir .), Gérer les émotions en rééducation. (p.79-92). Sauramps médical.
Cohen, S. & Speranza, M. (2023). Pratiquer la validation pour diminuer la détresse familiale. Dans M. Kuppelin, I. Tavares, C. Jourda et A. Krasny-Pacini (dir .), Gérer les émotions en rééducation. (p.139-145) Sauramps médical.
Côté, G., Gosselin, P., & Dagenais, I. (2013). Évaluation multidimensionnelle de la régulation des émotions : propriétés psychométriques d’une version francophone du Difficulties in Emotion Regulation Scale. Journal de Thérapie Comportementale et Cognitive, 23(2), 63-72. https://doi.org/10.1016/j.jtcc.2013.01.005
Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135-168. https://doi.org/10.1146/annurev-psych-113011-143750
Dimeff, L. A., & Koerner, K. (dir.). (2007). Dialectical behavior therapy in clinical practice: Applications across disorders and settings. Guilford Press.
Dunkley, C. (2019). Conceptual and practical issues in the application of emotion regulation in DBT. Dans M. A. Swales (dir.), The Oxford handbook of dialectical behaviour therapy (p. 283–306). Oxford University Press.
Fischer, A. H., Manstead, A. S. R., (2016). Social functions of emotion and emotion regulation. Dans L. Feldman Barrett, M. Lewis et J. M. Haviland-Jones (dir.), Handbook of emotions (4e éd., p. 424-439). The Guilford Press.
Fleminger, S., & Ponsford, J. (2005). Long term outcome after traumatic brain injury. The BMJ, 331, 14-19. https://doi.org/10.1136/bmj.331.7530.1419
Grace, J. J., Kinsella, E. L., Muldoon, O. T., & Fortune, D. G. (2015). Post-traumatic growth following acquired brain injury: A systematic review and meta-analysis. Frontiers in Psychology, 6, 1162. https://doi.org/10.3389/fpsyg.2015.01162
Gross, J. J. (1998). The emerging field of emotion regulation : An integrative review. Review of General Psychology, 2(3), 271-299. https://doi.org/10.1037/1089-2680.2.3.271
Haslam, C., Holme, A., Haslam, S. A., Iyer, A., Jetten, J., & Williams, W. H. (2008). Maintaining group memberships: Social identity continuity predicts well-being after stroke. Neuropsychological Rehabilitation, 18(5 6), 671-691. https://doi.org/10.1080/09602010701643449
Holloway, M. (2014). How is ABI assessed and responded to in non-specialist settings? Is specialist education required for all social care professionals? Social Care and Neurodisability, 5(4), 201-213. https://doi.org/10.1108/SCN-12-2013-0043
Howes, H., Benton, D., & Edwards, S. (2005). Women’s experience of brain injury: An interpretative phenomenological analysis. Psychology & Health, 20(1), 129-142. https://doi.org/10.1080/0887044042000272903
Koponen, S., Taiminen, T., Portin, R., Himanen, L., Isoniemi, H., Heinonen, H., Hinkka, S., & Tenovuo, O. (2002). Axis I and II psychiatric disorders after traumatic brain injury: A 30-year follow-up study. American Journal of Psychiatry, 159(8), 1315-1321. https://doi.org/10.1176/appi.ajp.159.8.1315
Krasny-Pacini, A, & Kuppelin, M. (2023). Fonctions exécutives, résolution de problème et émotions : à propos d’un cas. Dans M. Kuppelin, I. Tavares, C. Jourdan et A. Krasny-Pacini (dir.), Gérer les émotions en rééducation (p.153-175). Sauramps médical.
Kuppelin, M., Goetsch, A., Choisel, R., Isner-Horobeti, M.-E., Goetsch, T., & Krasny-Pacini, A. (2024). An exploratory study of dialectical behavior therapy for emotional dysregulation and challenging behaviors after acquired brain injury. NeuroRehabilitation, 55(1), 77-94. https://doi.org/10.3233/NRE-230383
Kuppelin, M., & Krasny-Pacini, A. (2023). La thérapie comportementale dialectique et la régulation émotionnelle. Dans M. Kuppelin, I. Tavares, C. Jourdan et A. Krasny-Pacini
(dir.), Gérer les émotions en rééducation (p.49-60). Sauramps médical.
Kuppelin, M., Tavares, I., Jourdan, C., & Krasny-Pacini, A. (dir.) (2023). Gérer les émotions en rééducation. Sauramps médical.
Levack, W. M. M., Boland, P., Taylor, W. J., Siegert, R. J., Kayes, N. M., Fadyl, J. K., & McPherson, K. M. (2014). Establishing a person-centred framework of self-identity after traumatic brain injury: A grounded theory study to inform measure development. BMJ Open, 4, e004630. https://doi.org/10.1136/bmjopen-2013-004630
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
Linehan, M. M. (2015). DBT skills training manual (2e éd.). Guilford Press.
Menzies, R. G., O’Brian, S., Onslow, M., Packman, A., St Clare, T., & Block, S. (2008). An experimental clinical trial of a cognitive-behavior therapy package for chronic stuttering. Journal of Speech, Language, and Hearing Research, 51(6), 1451-1464. https://doi.org/10.1044/1092-4388(2008/07-0070)
Murray, C. D., & Harrison, B. (2004). The meaning and experience of being a stroke survivor: An interpretative phenomenological analysis. Disability and Rehabilitation, 26(13), 808-816. https://doi.org/10.1080/09638280410001696746
Norman, A., Holloway, M., Odumuyiwa, T., Kennedy, M., Forrest, H., Suffield, F., & Dicks, H. (2020). Accepting what we do not know: A need to improve professional understanding of brain Injury in the UK. Health & Social Care in the Community, 28(6), 2037-2049. https://doi.org/10.1111/hsc.13015
O’Keeffe, F., Dunne, J., Nolan, M., Cogley, C., & Davenport, J. (2020). « The things that people can’t see » The impact of TBI on relationships: An interpretative phenomenological analysis. Brain Injury, 34(4), 496-507. https://doi.org/10.1080/02699052.2020.1725641
Ownsworth, T., & Gracey, F. (2017). Cognitive behavioural therapy for people with brain injury. Dans B. A. Wilson, J. Winegardner, C. M. van Heugten et T. Ownsworth (dir.), Neuropsychological rehabilitation: The international handbook (p. 313-326). Routledge/Taylor & Francis Group.
Ponsford, J., Velikonja, D., Janzen, S., Harnett, A., McIntyre, A., Wiseman-Hakes, C., Togher, L., Teasell, R., Kua, A., Patsakos, E., Welch-West, P., & Bayley, M. T. (2023). INCOG 2.0 Guidelines for cognitive rehabilitation following traumatic brain injury, part II: Attention and information processing speed. Journal of Head Trauma Rehabilitation, 38(1), 38 51. https://doi.org/10.1097/HTR.0000000000000839
Poynter, B., Shuman Hon, M., Diaz-Granados, N., Kapral, M., Grace, S. L., & Stewart, D. E. (2009). Sex differences in the prevalence of post-stroke depression: A systematic review. Psychosomatics, 50(6), 563-569. https://doi.org/10.1016/S0033-3182(09)70857-6
Rath, J. F., Hradil, A. L., Litke, D. R., & Diller, L. (2011). Clinical applications of problem-solving research in neuropsychological rehabilitation: Addressing the subjective experience of cognitive deficits in outpatients with acquired brain injury. Rehabilitation Psychology, 56(4), 320-328. https://doi.org/10.1037/a0025817
Robinson, R. G., & Jorge, R. E. (2016). Post-stroke depression: A review. The American Journal of Psychiatry, 173(3), 221-231. https://doi.org/10.1176/appi.ajp.2015.15030363
Roy, C., Leclerc, A., Isner-Horobeti, M. E., Kuppelin, M., & Krasny-Pacini, A. (soumis). Emotional experience of persons living with the consequences of an acquired brain injury: A qualitative study.
Smith, J. A. (dir.) (2015). Qualitative psychology: A practical guide to research methods (3e éd.). Sage Publications.
Spikman, J. M., Boelen, D. H. E., Pijnenborg, G. H. M., Timmerman, M. E., van der Naalt, J., & Fasotti, L. (2013). Who benefits from treatment for executive dysfunction after brain injury? Negative effects of emotion recognition deficits. Neuropsychological Rehabilitation, 23(6), 824-845. https://doi.org/10.1080/09602011.2013.826138
Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1 18. https://doi.org/10.1207/s15327965pli1501_01
Tison, E. (2022). Influence d’une prise en soins orthophonique du bégaiement développemental persistant sur l’estime de soi et l’anxiété sociale. [Mémoire de master pour l’obtention du certificat de capacité en orthophonie, Université de Bordeaux]. HAL. https://dumas.ccsd.cnrs.fr/dumas-03967350v1
Togher, L., Douglas, J., Turkstra, L. S., Welch-West, P., Janzen, S., Harnett, A., Kennedy, M., Kua, A., Patsakos, E., Ponsford, J., Teasell, R., Bayley, M. T., & Wiseman-Hakes, C. (2023). INCOG 2.0 Guidelines for cognitive rehabilitation following traumatic brain injury, part IV: Cognitive-communication and social cognition disorders. The Journal of Head Trauma Rehabilitation, 38(1), 65-82. https://doi.org/10.1097/HTR.0000000000000835
Watkins, E. (2004). Adaptive and maladaptive ruminative self-focus during emotional processing. Behaviour Research and Therapy, 42(9), 1037-1052. https://doi.org/10.1016/j.brat.2004.01.009
Watkins, E. R., & Roberts, H. (2020). Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behaviour Research and Therapy, 127, 103573. https://doi.org/10.1016/j.brat.2020.103573
Wiles, M. D. (2022). Management of traumatic brain injury: A narrative review of current evidence. Anaesthesia, 77(S1), 102-112. https://doi.org/10.1111/anae.15608
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Copyright (c) 2025 Perrine Roulin, Lola Marmisse, Marie Kuppelin, Charone Attias, Salomé Klein, Marie-Eve Isner-Horobeti, Hélène D'Apote Vassiliadou, Agata Krasny-Pacini

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