Appraisals of Symptom Control in Acquired Brain Injury (ABI) Outcomes
Research type
Research Study
Full title
The Importance of Appraisals of Symptom Controllability for Psychosocial Outcomes Following Acquired Brain Injury
IRAS ID
338237
Contact name
Martha Wallace
Contact email
Sponsor organisation
University of Oxford, Research Governance, Ethics and Assurance
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Many people experience low mood and anxiety following an acquired brain injury (ABI). This can limit their physical recovery as well as their long-term quality of life and wellbeing. Research suggests that the way people think about the brain injury, and how they choose to cope with symptoms, are important in why some people experience these negative outcomes in the long term, when others do not. In particular, it seems that believing you or the treatment you undertake have some control over the symptoms of ABI can influence your mood, wellbeing and quality of life more than beliefs about other aspects of injury. However, there is currently not enough research to fully understand this relationship. This study therefore aims to examine whether people with different beliefs in their ability to influence symptoms of ABI also have different levels of mood and life satisfaction, and whether this seems to be because they use more helpful coping strategies or think more positively about their injury. This will help us to give better support to people struggling after an ABI. The study will involve asking people with an ABI to complete questionnaires on their beliefs about their injury and symptoms, their mood, and their general wellbeing. Participants will be recruited from a community head injury service, provided by the NHS. The study is funded by the University of Oxford and is being completed as part of the primary researcher’s doctorate course.
Lay summary of study results: Many people experience low mood and anxiety following an acquired brain injury (ABI). This can limit their physical recovery as well as their long-term quality of life and wellbeing. However, it has been found that not everyone experiences these negative outcomes, and there is significant variation in long-term adjustment to injury.
Current research suggests that the way people think about the brain injury, and how they choose to cope with symptoms, are important factors in this variation in people’s outcomes following ABI. However, it is currently unclear whether specific beliefs are especially important. It is possible that believing you or the treatment you undertake have some control over the symptoms of ABI can influence your mood and quality of life more than beliefs about other aspects of injury. In particular, strong belief in your ability to impact symptoms may lead to greater engagement in positive activity, positive coping strategies, and positive ways of thinking about life after ABI, which may all positively impact mood and life satisfaction. However, it has not yet been studied whether these beliefs about controllability are more significant than other beliefs.
This study therefore aimed to examine whether people with different beliefs in their ability to influence symptoms of ABI also have different levels of mood and life satisfaction. The study also explored whether this seems to be because they use more helpful coping strategies. It is hoped that understanding this better will help us to give better support to people struggling after an ABI. Forty-four adults with an ABI severe enough for referral to a specialist rehabilitation team, and who had lived with their ABI for at least twelve months, were recruited from the Buckinghamshire Community Head Injury Service (CHIS). All types of ABI were considered eligible for the study, including traumatic brain injury, stroke, brain haemorrhage, aneurysm or tumour, hypoxic brain injury, hydrocephalus, meningitis, or encephalitis. Participants completed questionnaires on their beliefs about their head injury, their coping strategies, their current mood and current quality of life.
At the stage of scoring questionnaire results, participants were grouped into ‘high’, ‘low’ and ‘average’ controllability beliefs. These groups were then compared to see if mood and quality of life differed depending on controllability beliefs. Further analyses then considered whether participants’ beliefs about control were significantly associated with mood and quality of life scores, above and beyond other beliefs about injury and factors such as age, time since injury, length of and time since rehabilitation, and degree of disability following ABI. Finally, ‘high’, ‘low’ and ‘average’ controllability groups were compared to see if use of different coping strategies differed depending on controllability beliefs.
As expected, belief in the ability to control or influence ABI symptoms was significantly associated with mood and quality of life, and those with higher beliefs in their ability to control or influence their ABI symptoms had greater mood and quality of life than those with limited beliefs in their ability to control symptoms. This difference between groups was particularly great when considering quality of life related to physical health and participants’ environment. It is notable that this difference existed irrespective of other potentially important factors, such as participants’ level of disability following ABI. Beliefs about controllability were also found to account for a statistically significant amount of variation in mood and some quality of life scores, above and beyond other beliefs about injury and participant or injury factors; this suggests that controllability beliefs are an important and defining factor in how people feel after ABI.
However, it was notable that other beliefs about ABI, particularly how much people feel their injury makes sense and how much ABI defines their life, were also important factors in predicting mood and quality of life. As such, although controllability beliefs are important, so too are these other beliefs. Additionally, it was found that whilst people with the greatest belief in their ability to control their injury and symptoms used more positive coping strategies and fewer negative coping strategies, this difference was not as great as expected. Moreover, use of more positive coping strategies was not related to mood or quality of life, and therefore did not explain why people who believe their symptoms can be controlled appear to feel happier and more satisfied with life.
This study was only conducted with people who had undergone rehabilitation and were living in the community; we do not therefore know whether the results can be extended to people who have not undergone this treatment, or who are still receiving inpatient care. The number of participants was also relatively small, which may limit how far the findings can represent the ABI population as a whole. It would therefore be helpful for future research to replicate the present study with extended samples, particularly recruiting from inpatient settings or from those who have not undergone rehabilitation. The findings that coping strategies were not as important as expected also means that further research into why control beliefs affect mood and life satisfaction is needed.
However, these findings suggest to us that rehabilitation programmes should support people to have a good understanding of their injury and how ABI fits with their wider sense of themself, and positive expectations of change over time, which they believe they can influence. This may be more significant for individuals than merely focusing on physical recovery, as the current study demonstrates that beliefs have more impact on wellbeing than physical ability, or positive coping strategies.
This study was conducted as part of a Doctorate in Clinical Psychology at the University of Oxford, and was conducted jointly by the University of Oxford and Buckinghamshire NHS Foundation Trust.REC name
North West - Liverpool Central Research Ethics Committee
REC reference
24/NW/0295
Date of REC Opinion
29 Oct 2024
REC opinion
Further Information Favourable Opinion