Gerard A. Riley

Stress and depression in family carers following traumatic brain injury: the influence of beliefs about difficult behaviours

Objective: Difficult behaviours are significant contributors to the distress experienced by carers of people with a traumatic brain injury. This study investigated whether the beliefs carers hold about such behaviours also contribute to the distress. Design: Questionnaire survey. Participants: Forty family carers recruited from Headway, a traumatic brain injury support organization. Main measures: Zungs Self-Rating Depression Scale, Perceived Stress Scale, Social Support Questionnaire, a measure of the severity of difficult behaviours shown by the person cared for and two measures of carer beliefs about the behaviour (including the Controlling Beliefs Scale). Results: Higher depression and stress scores were associated with more severe behaviours and less social support. Carer belief in their own ability to control the behaviours was associated with less stress. Belief that the behaviour was under the control of the person with traumatic brain injury and/or was motivated by hostile intentions was associated with more depression but less stress. Taken together, severity of behaviour and social support accounted for about 19% of the variance in both depression and stress scores. Carer beliefs accounted for another 5% of the depression scores, and another 11% of the stress scores. Conclusions: The results were consistent with the idea that carer beliefs about difficult behaviour contribute to carer distress, but longitudinal and treatment studies are needed to establish causality.

Threat appraisal and avoidance after traumatic brain injury: why and how often are activities avoided?

Objective: Goldstein emphasized the anxiety-related avoidance of activities after brain injury, but such avoidance has rarely been systematically investigated. This study aimed to compile a list of specific threat appraisals that may lead to avoidance and to obtain data on the frequency with which these appraisals and consequent avoidance occur. Design: Survey. Method: Qualitative methodology was used to obtain an account of threat appraisals. These data were then used to compile two questionnaires that asked about the experience of these appraisals and consequent avoidance. Fifty individuals with a TBI completed the questionnaires. Results: A varied list of threat appraisals was obtained. Appraisals and consequent avoidance were frequent in the sample. Males and those whose TBI resulted from an assault reported more avoidance. Conclusions: A core aim of rehabilitation is to facilitate participation in valued roles and activities. Threat appraisals and avoidance deserve more attention in research and practice because they may constitute a significant obstacle to achieving this.

Guidelines for the Selection of a Method of Fading Cues

There are various ways in which cues can be faded. The method of vanishing cues is just one option. It is argued that, when selecting a method, we should choose one that will encourage effortful recall on the training trials, but at the same time avoid too many errors and omissions. To achieve this end, we must take into account the circumstances of application, including the difficulty of the item to be learnt and the memory abilities of the learner. More difficult items and poorer memories may require more gradual fading to avoid an excess of errors and omissions; easier items and better memories may require more rapid fading to encourage effortful recall. To test this prediction, two methods of fading were compared in teaching general knowledge items to 12 individuals with a history of head injury. Consistent with the prediction, Increasing Assistance (that permits more rapid fading) was more effective for those with better memories and for easier items, and Decreasing Assistance (in which fading is more gradual) was more effective for those with poorer memories and more difficult items.

The dynamics of continuity and discontinuity for women caring for a spouse with dementia

This qualitative study explores spouse caregivers’ understanding of and responses to partners with dementia. Six wives who had been providing care to their husbands in the community for at least two years were interviewed. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA) and four interconnected themes were proposed: same person or different; relational change; emotional responses to behaviours; and impact on day-to-day life. Participants’ sense of continuity with the past was suggested to influence each theme. The construct of continuity was proposed to be elastic, with both intra-psychic and inter-psychic factors impacting upon its elasticity. Broadly, a sense of continuity seemed to be associated with better adjustment to caregiving.

Do stigma, blame and stereotyping contribute to unsafe sexual behaviour? A test of claims about the spread of HIV/AIDS arising from social representation theory and the AIDS risk reduction model

In the context of social representation theory and the AIDS risk reduction model, it has been claimed that stigmatizing, blaming and stereotyping attitudes make people feel less at risk of contracting HIV/AIDS, and that this, in turn, results in them taking fewer precautions in their sexual behaviour. Previous research has failed to provide convincing evidence to support these claims. The present study provided a test of the claims that addressed some of the methodological issues identified in the earlier research. A sample of 460 young people from Ghana, ranging in age from 15 to 28 years (mean=18), completed a questionnaire that measured the relevant constructs. The results supported the claims in relation to stigmatizing and intended sexual risk behaviour, but not stigmatizing and actual sexual risk behaviour. Although the latter two were correlated, this was not mediated by reduced perceptions of vulnerability. Claims in relation to blaming and stereotyping were not supported. Contrary to expectation, specific blaming and stereotyping attitudes that constructed HIV/AIDS as a sexual disease were associated with safer intended sexual behaviour, and this relationship was mediated by feeling at greater risk.

Which is more effective in promoting implicit and explicit memory: The method of vanishing cues or errorless learning without fading?

Errorless learning without fading (ELWF) and the method of vanishing cues (MVC) have been widely researched in rehabilitation contexts, but little is known about their effectiveness relative to each other. With respect to explicit memory, it was hypothesised that the MVC can lead to better performance than ELWF for those with less severe memory difficulties, provided that it elicits effortful but successful study‐trial recall. This hypothesis was supported in two studies involving participants with less severe memory difficulties following acquired brain injuries, using free recall as the measure of explicit memory. With respect to implicit memory, it was suggested, on the basis of the transfer appropriate processing approach, that the relative effectiveness of the two methods will depend on the way in which memory is tested. Specifically, it was hypothesised that the MVC would be more effective than ELWF on a stem completion task, equally effective on a free association task, and less effective on a perceptual identification task. These hypotheses were supported in the two studies involving participants with brain injuries, and in two larger studies involving university students. The implications of these findings for the use of these methods in rehabilitation are discussed. It is argued that the MVC may be more effective when the task can be learnt explicitly, the learner retains significant explicit memory ability and the study‐trial recall is effortful but successful. With respect to implicit memory, one interpretation of the findings is that, in most practical contexts, neither method will have any intrinsic advantage, although ELWF may be preferable because it is more effective in eliminating errors. However, this suggestion is very tentative because of issues concerning the generalisability of the present findings, and further research is recommended.

Evaluation of coping resources and self-esteem as moderators of the relationship between threat appraisals and avoidance of activities after traumatic brain injury.

It is not uncommon for people after a traumatic brain injury (TBI) to develop anxieties about possible negative outcomes (i.e., threat appraisals) in relation to participating in valued activities. Some respond to this anxiety by avoiding the activities, but others maintain their participation. The present study investigated two factors that may help explain this variation across individuals in their response to threat appraisals – self-esteem and the evaluation of coping resources. Forty-one individuals with a TBI completed the Avoidance and Threat Appraisals Questionnaire, the Rosenberg Self-Esteem Scale and the Coping Resources Questionnaire. The studys hypotheses were supported: Those low in self-esteem, and those with a negative evaluation of their ability to cope with the TBI, were significantly more likely to respond to threat appraisals with avoidance. Those whose injury was more recent and those whose injury was the result of an assault were also more likely to respond with avoidance. The theoretical and therapeutic implications of these results are discussed.

How robust is performance on the National Adult Reading Test following traumatic brain injury

OBJECTIVE To investigate whether National Adult Reading Test (NART) performance may be impaired by severe traumatic brain injury (TBI). METHOD A sample of 26 people who had been given a NART within 12 months of a severe TBI was given a second NART at least 12 months after the first NART. RESULTS Mean performance on the second NART was significantly better than performance on the first NART. Of the participants, 11 (42%) showed an improvement of more than 5 IQ points in respect of the verbal IQ estimates based on their NART scores, with three participants showing an improvement of 20 points. In applying the NART to determine the presence of an acquired intellectual impairment, use of the first NART scores alone would have resulted in such impairments being missed in at least 25% of a subsample of 16 participants for whom an actual verbal IQ had been obtained at the time of the first NART. CONCLUSION An NART given within 12 months of a severe TBI runs the risk of significantly underestimating pre-morbid IQ. If applied in this context, it is recommended that the NART score is used in conjunction with other methods of estimation, such as those based on demographic data.

Errorless learning of novel routes through a virtual town in people with acquired brain injury

Impaired route learning is a common consequence of acquired brain injury (ABI) but has received little attention in the research literature. Errorless learning may be a method of facilitating the learning of routes but this is unclear as previous studies of errorless learning have focused mainly on verbal skills and the only previous study involving route learning was based upon a pencil and paper task. In the present study we therefore use virtual reality to explore the benefits of errorless learning for routes in an ecologically valid task. Twenty people with acquired brain injury learned two routes, of equivalent difficulty, around a virtual town based upon the city of Nice. For one route, full guidance was provided throughout the learning trials in an errorless learning paradigm; the other route was learned using a procedure that allowed for trial and error. Route recall following the errorless learning condition was significantly more accurate than recall after errorful learning. This suggests that the benefits of errorless over errorful learning in acquired brain injury rehabilitation extend beyond verbal learning tasks to the practical task of route memorisation.

The impact on parents of developments in the care of children with bleeding disorders

Summary.  This research considered the impact on parents of children with bleeding disorders of the increased use of home‐based treatment and greater parental responsibility for management of the condition. Although they have undoubted advantages, these changes also present parents with new challenges. Some found administration of the treatment difficult, and decisions about treatment and the everyday management of the condition can also prove problematic. Services should be aware of these issues and help parents access appropriate support.