Nico Conrad

Looking beyond the importance of life goals. The personal goal model of subjective well-being in neuropsychological rehabilitation

Objective: To identify subjective importance, attainability and success of life goals and their predictive value for subjective well-being in patients with acquired brain injury. Design: Cross-sectional, descriptive. Setting: Two inpatient neurological rehabilitation centres. Participants: Patients with non-progressive neurological disorders. Interventions: Survey using questionnaires. Measures: Life goal characteristics were assessed using a life goal questionnaire (GOALS). Subjective well-being (composite score) was measured using the Center of the Epidemic Studies Depression Scale (CES-D), the Positive and Negative Affect Schedule (PANAS) and the Satisfaction With Life Scale (SWLS). Results: Fifty-nine patients participated in the study. The most important life goals are intimacy (4.59/5), achievement (3.96/5) and altruism (3.89/5). The intimacy goals are considered most attainable (4.19/5) and patients feel most successful in this domain (3.98/5). Two important predictions of the personal goal model of subjective well-being could be confirmed. First, goal attainability moderates the relation between goal importance and goal success. Second, the influence of goal importance on subjective well-being is mediated by experienced success. The most powerful predictors for subjective well-being are success in the achievement domain (β = 0.404) and discrepancy between importance and success in the intimacy domain (β = —0.276). Conclusions: The subjective well-being of neurological patients depends not only on the appraised importance of life goals but also on their attainability and success.

Decline in attainability of communion and agency life goals over 2 years following acquired brain injury and the impact on subjective well-being.

Acquired brain injury (ABI) confronts patients with sudden and possibly permanent functional impairments which disrupt or block the attainment of important life goals and reduce subjective well-being (SWB). This longitudinal study aimed at investigating changes in the importance and the attainability of communion and agency life goals and their impact on SWB. Self-report measures of life goals, functional status and SWB were assessed in 42 patients during acute rehabilitation two months following ABI (baseline) and reassessed 19 months following discharge (follow up). Results indicate a significant longitudinal decrease of the general attainability of life goals and of the present success in achieving communal and agentic life goals. Life goal importance remained stable. After controlling for baseline SWB and follow up functional status the attainability of communal life goals significantly predicted SWB at follow up whereas agentic life goals failed to predict SWB. The present findings show long-term deterioration of life goal attainability. They highlight that more emphasis should be given to realistic attainability attributions during rehabilitation processes. Moreover, the results stress the need for outpatient treatment to promote disengagement from unobtainable life goals and to offer means for the engagement in alternative life goals in order to maintain or regain SWB.

Integration von Verhaltenstherapie und Neuropsychologie

Nach einer HirnschÄdigung leiden viele Patienten unter anhaltenden kognitiven und emotional-motivationalen StÖrungen. Etwa die HÄlfte aller hirnverletzten Personen entwickelt nach der SchÄdigung, hÄufig im 1. Jahr danach, eine psychische StÖrung, von der eine erhebliche GefÄhrdung des psychosozialen Funktionsniveaus und des weiteren Rehabilitationserfolges ausgeht. Die Behandlung dieser komplexen Problemlagen erfordert die Integration neuropsychologischer und psychotherapeutischer Interventionen. Methoden der kognitiven Verhaltenstherapie (KVT) kÖnnen hirngeschÄdigten Patienten helfen, Kompensationstechniken zu erwerben und kognitiv-affektive Einstellungen zu finden, um mit anhaltenden oder chronischen Folgen einer HirnschÄdigung im Alltag zurechtzukommen und trotz vielleicht bleibender FunktionseinschrÄnkungen subjektives Wohlbefinden zu erleben. Die vorliegende Arbeit stellt ein integratives Modellprogramm fÜr die postakute ambulante Behandlung neuropsychologischer StÖrungen vor. Vorteile des neuen Behandlungsprogramms liegen in der Kombination von psychotherapeutischen und neuropsychologischen Methoden innerhalb eines individuellen ProblemlÖseansatzes. Das Programm fokussiert auf die Kompensation kognitiver Defizite im Alltag, den Umgang mit negativen Emotionen und eine Neuorientierung des Selbstkonzeptes und der Lebensziele. Erste Erfahrungen mit diesem kombinierten Vorgehen im Rahmen einer klinischen Studie werden berichtet.