Carrie Gibbons

Mindfulness-based cognitive therapy reduces symptoms of depression in people with a traumatic brain injury: results from a randomized controlled trial.

Objective:We sought to determine if we could reduce symptoms of depression in individuals with a traumatic brain injury using mindfulness-based cognitive therapy. Setting:The study was conducted in a community setting. Participants:We enrolled adults with symptoms of depression after a traumatic brain injury. Design:We conducted a randomized controlled trial; participants were randomized to the 10-week mindfulness-based cognitive therapy intervention arm or to the wait-list control arm. Main Measures:The primary outcome measure was symptoms of depression using the Beck Depression Inventory-II. Results:The parallel group analysis revealed a greater reduction in Beck Depression Inventory-II scores for the intervention group (6.63, n = 38,) than the control group (2.13, n = 38, P = .029). A medium effect size was observed (Cohen d = 0.56). The improvement in Beck Depression Inventory-II scores was maintained at the 3-month follow-up. Conclusion:These results are consistent with those of other researchers that use mindfulness-based cognitive therapy to reduce symptoms of depression and suggest that further work to replicate these findings and improve upon the efficacy of the intervention is warranted.

The Psychological and Health Consequences of Caring for a Spouse With Dementia: A Critical Comparison of Husbands and Wives

Caring for someone with dementia can be demanding, particularly for spouses living with the care recipient. The main goal of this study was to clarify differences in the experience of caregivers who were husbands and wives with respect to burden, health, healthy behaviors, presence of difficult care recipient behaviors, social supports, and the quality of the premorbid relationship. The results of this study support research demonstrating a difference between the caregiving experiences of women and men. It is becoming increasingly apparent that female gender is a marker that places them at increased risk of high burden and less support.

Using the Resident Assessment Instrument-Mental Health (RAI-MH) to Determine Levels of Care for Individuals with Serious Mental Illness

This paper outlines the development of an algorithm to determine appropriate levels of care (LOC) for individuals with a serious mental illness (SMI). The algorithm, drew on several domains of the Resident Assessment Instrument-Mental Health (RAI-MH) to support a statistical model that would explain a maximum of variance with the gold standard, a consensus-based global rating of required LOC. The RAI-MH model explained 67.5% of the variance. The validity of the model was further examined by determining how the discrepancy between the current and predicted levels of care related to psychiatric outcomes. The results demonstrated that undersupported clients experienced significant negative psychiatric outcomes compared to clients receiving adequate care. Although the model based on the RAI-MH is not perfect, the results warrant further research to determine its usefulness in predicting required LOC.

One- and Three-Screen Driving Simulator Approaches to Evaluate Driving Capacity: Evidence of Congruence and Participants’ Endorsement

OBJECTIVE We examined the validity of one-screen versus three-screen driving simulators and their acceptability to middle-aged and older drivers. METHOD Participants aged 40-55 or 65 and older (N = 32) completed simulated drives first with a single monitor and then with a three-monitor setup, followed by pen-and-paper measures and an interview. RESULTS Mean differences between one- and three-screen drives were not statistically significant for Starting/Stopping and Passing/Speed. Correlations between the two drives indicated moderate positive linear relationships with moderate agreement. More errors occurred on the one-screen simulator for Signal Violation/Right of Way/Inattention, Moving in a Roadway, Turning, and Total Scores. However, for Moving in a Roadway, Turning, and Total Scores, correlations between drives indicated strong positive linear relationships. We found no meaningful correlation between workload, computer comfort, simulator discomfort, and performance on either drive. Participants found driving simulators acceptable. CONCLUSION Findings support the use of one-screen simulators. Participants were favorable regarding driving simulators for assessment.

Using Serial Trichotomization With Common Cognitive Tests to Screen for Fitness to Drive

OBJECTIVE. The aim of this study was to illustrate the use of serial trichotomization with five common tests of cognition to achieve greater precision in screening for fitness to drive. METHOD. We collected data (using the Montreal Cognitive Assessment, Motor-Free Visual Perception Test, Clock-Drawing Test, Trail Making Test Part A and B [Trails B], and an on-road driving test) from 83 people referred for a driving evaluation. We identified cutpoints for 100% sensitivity and specificity for each test; the driving test was the gold standard. Using serial trichotomization, we classified drivers as either “Pass,” “Fail,” or “Indeterminate.” RESULTS. Trails B had the best sensitivity and specificity (66.3% of participants correctly classified). After applying serial trichotomization, we correctly identified the driving test outcome for 78.3% of participants. CONCLUSION. A screening strategy using serial trichotomization of multiple test results may reduce uncertainty about fitness to drive.

1494 – Mindfulness-based cognitive therapy reduces depression symptoms in people who have a traumatic brain injury: results from a randomized controlled trial

Introduction Traumatic brain injuries (TBI) may lead to persistent depression symptoms. We conducted several pilot studies to examine the efficacy of mindfulness-based interventions to deal with this issue; all showed strong effect sizes. The logical next step was to conduct a randomized controlled trial (RCT). Objective We sought to determine the efficacy of mindfulness-based cognitive therapy for people with depression symptoms post-TBI (MBCT-TBI). Methods Using a multi-site RCT design, participants (mean age = 47) were randomized to intervention or control arms. Treatment participants received a group-based, 10-week intervention; control participants waited. Outcome measures, administered pre- and post-intervention, and after three months, included: Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire-9 (PHQ-9), and Symptom Checklist-90-Revised (SCL-90-R). The Philadelphia Mindfulness Scale (PHLMS) captured present moment awareness and acceptance. Results BDI-II scores decreased from 25.47 to 18.84 in treatment groups while they stayed relatively stable in control groups (respectively 27.13 to 25.00; p = .029). We did not find statistically significant differences on the PHQ-9 and SCL-90R post- treatment. However, after three months, all scores were statistically significantly lower than at baseline (ps Conclusions MBCT-TBI may alleviate depression symptoms up to three months post-intervention. Greater mindfulness may have contributed to the reduction in depression symptoms although the association does not confirm causality. More work is required to replicate these findings, identify subgroups that may better respond to the intervention, and refine the intervention to maximize its effectiveness.

The Ability to Drive in Mild Cognitive Impairment

Driving is a complex activity that, for many older adults, is a primary means of mobility. Driving draws upon multiple cognitive, sensory, and physical systems to operate the vehicle and navigate the roadway environment safely. It follows that when one of these systems is impaired, driving safety may be hindered. Individuals with mild cognitive impairment (MCI) are impaired in at least one cognitive domain, which may, depending on the nature of their deficit, make them at increased risk for collision. Research indicates that memory, executive functions, and attention are all associated with driving performance. While a number of assessment instruments are available to aid professionals’ decisions related to fitness to drive, health professionals must strike a balance between safety and mobility when making this determination. This chapter discusses the components of the driving task, the impact of an MCI diagnosis on driving fitness, methods to assess drivers with MCI, and strategies to promote continued mobility among adults who have ceased driving.

Mindfulness-Based Cognitive Therapy Improves Depression Symptoms After Traumatic Brain Injury

Traumatic brain injury (TBI) presents a significant public health concern with considerable impact on rates of disability and traumatic death. Residual symptoms comprise a host of cognitive, physical and/or psychological problems that may continue over an extended period. People with TBI are also at an increased risk for developing long-term psychiatric disorders, including depression, generalized anxiety disorder and posttraumatic stress disorder. Mindfulness meditation training has resulted in positive physical and psychological outcomes in other clinical populations. With the strong evidence of Mindfulness-Based Cognitive Therapy (MBCT) for recurrent depression and Mindfulness-Based Stress Reduction for anxiety and depression symptoms in various populations, we sought to adapt MBCT for TBI. In three separate studies, we found that MBCT adapted for individuals with TBI resulted in significant improvements in depression symptoms to an extent that was clinically meaningful for half of those who took the interventions. Future research could benefit from exploring individual characteristics in people with TBI to help determine factors related to treatment response. Improving depression symptoms through MBCT may be the first step at targeting the complex emotional sequela after TBI.