Continuity Therapy for couples living with brain injury: A tier 3 study focused on development of an intervention

Research question This is a Tier 3 study focused on the development and preliminary evaluation of a psychological therapy for couples living with brain injury, in preparation for a subsequent controlled trial.

Background The study tackles two problems commonly associated with brain injury: deterioration in the marriage/partnership, and loss of self-identity and self-esteem experienced by the person with the injury. Research suggests that one factor contributing to these problems is a sense of discontinuity .

This refers to the couple feeling that the person with the injury is now very different compared to before (“I ve lost the old-me”) and that their relationship is also radically changed (“I feel like his carer, not his husband”). We have been developing a therapy focused on increasing the sense of continuity between past and present.

In a recent paper, we described using this therapy with a couple who showed improvements in their relationship and wellbeing following therapy.

Aims to expand and refine the therapy to give people living with ABI the opportunity to contribute to its development to collect information on contextual factors that might impact on effectiveness to develop detailed guidelines for delivering the therapy that can be used in a subsequent controlled evaluation to collect information to enable a decision about whether a subsequent controlled evaluation is merited Method Ten couples will receive the therapy.

Initial guidelines for delivering the therapy will be produced, incorporating some new components.

These will be used to deliver the therapy to the first three couples that take part, each couple receiving 10 one-hour sessions. Therapists and participants will give feedback about the therapy through interviews and report forms. Based on this feedback, the therapy and guidelines will continue to be refined as more couples take part.

The interviews and report forms will also be used to gather information on contextual factors that might impact on effectiveness.

Participants will complete questionnaires before and after the therapy evaluating their perceptions of continuity, their wellbeing and their relationship. These scores, along with feedback from participants, will be used to decide whether a controlled evaluation is merited.

Timeline, impact and dissemination This is a two-year Tier 3 study focused on intervention development and it would not lead to immediate benefit.

If the data indicate that subsequent evaluation is merited, the plan would be for this to begin within 18 months of the end of this study. The impact of brain injury on wellbeing and relationships is substantial. Services already try to address these issues, but there is a lack of proven interventions.

Development of a new therapy would be a major advance.

Because existing services already address the issues, this therapy, if and when effectiveness is demonstrated, could be implemented relatively quickly and without the need for extensive additional infrastructure or finances.

We will share the findings with researchers and clinicians working in brain injury, brain injury charities, and couples living with brain injury. Dissemination will be through a local West Midlands event, online platforms, and an academic conference and journal.