Abstract
BackgroundAcquired brain injury (ABI) affects approximately 79.3 million individuals annually and is linked with elevated rates of depression and low mood. Existing methods for treating depression in ABI have shown mixed efficacy. Behavioural activation (BA) is a potentially promising intervention. Its premise is that individuals with low mood avoid planning and engaging in activities due to low expectations of a positive outcome. Consequently, their exposure to positive reinforcement is reduced, exacerbating low mood. BA aims to break this cycle by encouraging activity planning and engagement. It is unknown whether cognitive demands of traditional BA may undermine efficacy in ABI. Here, we assess the feasibility and acceptability of two groups designed to increase activity engagement. In the activity planning group (traditional BA), the importance of meaningful and positive activity will be discussed and participants encouraged to plan/engage in activities in everyday life. The activity engagement group (experiential BA) instead focuses on engagement in positive experiences (crafts, games, discussion) within the group. The primary aims are to evaluate the feasibility and acceptability of the two groups in ABI. A secondary aim is to explore relative efficacy of the groups compared to an equivalent period of waitlist controls.MethodThis study outlines a parallel-arm pilot feasibility trial for individuals with low mood and ABI that compares a traditional vs experiential BA group vs waitlist controls. Adults (≥ 18 years) will be recruited from local ABI services and randomised to condition. Feasibility and acceptability will be assessed via recruitment, retention, attendance and participant feedback. Groups will be compared (pre- and post-intervention and 1 month follow-up) by assessing self-reported activity engagement. Secondary outcomes include self-report measures of depression, anxiety, post-traumatic distress related to the ABI, motivation, participation and sense of control over one’s life.Ethics and disseminationThe trial has been approved by the Health Research Authority of the NHS in the UK (East of England—Cambridge Central, REF 18/EE/0305). Results will inform future research on interventions for mood in ABI and be disseminated broadly via peer-reviewed journals, conference presentations and social media.Trial registrationClinicalTrials.gov, NCT03874650 pre-results. Protocol version 2.1, March 5, 2019
Highlights
Acquired brain injury (ABI) affects approximately 79.3 million individuals annually and is linked with elevated rates of depression and low mood
One of the major barriers to successfully treating depression and other mental health disorders in ABI is the need for an intervention that addresses the complex needs of the population [20]
Various studies have documented the link between lowered activity level and depression in ABI [28, 35, 83,84,85]; investigating whether Behavioural activation (BA) is a feasible, acceptable and potentially efficacious treatment is warranted— with group delivery, as is done here
Summary
Acquired brain injury (ABI) affects approximately 79.3 million individuals annually and is linked with elevated rates of depression and low mood. Its premise is that individuals with low mood avoid planning and engaging in activities due to low expectations of a positive outcome. Their exposure to positive reinforcement is reduced, exacerbating low mood. BA aims to break this cycle by encouraging activity planning and engagement It is unknown whether cognitive demands of traditional BA may undermine efficacy in ABI. Individuals with an ABI and depression are more likely to experience greater difficulties in many aspects of day-to-day function [8, 9], including poorer quality of life, impaired overall cognitive function, reduced physical activity and engagement in activities of daily living and a higher mortality rate [15,16,17,18]. Individuals with an ABI are at least 3 times as likely to die by suicide relative to the general population [19]
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