Selecting the appropriate psychotherapies for individuals with traumatic brain injury: what works and what does not?

BACKGROUND: When traditional psychotherapy is provided to patients with traumatic brain injuries (TBIs), the primary focus is on treating mood changes such as depression, anxiety or anger. However, traditional psychotherapeutic methods developed specifically for mood changes fall short when treating most TBI patients. In large part, this is because the psychological adjustment difficulties that most TBI patients face are linked to life-altering changes that are interwoven with permanent physical, cognitive, and social sequelae. In addition, mood changes in TBI patients are also caused by vocational and financial losses. OBJECTIVE: The sudden onset of these unfamiliar and interdependent problems necessitates a psychotherapeutic approach that acknowledges the inherent challenges of coping with multiple life-altering changes. For patients who experience a shattered sense of self, interventions need to be explored to make life meaningful following a TBI. METHODS: Anexistentially-oriented approach is introduced in the following steps: (1) identifying pre-injury future expectations, (2) examining how the TBI has altered these expectations, (3) grieving the loss of the expected future, and (4) developing a realistic future that is existentially meaningful. RESULTS: Pivotal gains are achieved when patients rebuild their lives according to their own core values. CONCLUSION: TBI patients can benefit from existential psychotherapy.