Restructuring Blank Spaces: The Role of Cognitive-Behavioral Interventions for Two Patients With Post-traumatic Amnesia After Severe Traumatic Brain Injury

Abstract

Differentiation of symptoms associated with post-traumatic amnesia (PTA) versus post-traumatic stress symptoms (PTSS) following trauma presents many treatment challenges among veterans and active duty service members receiving rehabilitation after traumatic brain injury (TBI). The acute phase of rehabilitation poses difficulties for amnestic individuals that may elicit classic PTA symptoms as well as premorbid PTSS, thereby activating maladaptive cognitions and an increase in agitation and arousal. Historically, explicit learning and memory strategies were considered non-efficacious with amnestic individuals until PTA resolves; therefore, rehabilitation therapies have utilized implicit learning in the initial phases of recovery. However, cognitive-behavioral therapy (CBT), which uses explicit learning and memory strategies based on cognitive, trauma, and neuropsychology lowers agitation and confusion for amnestic individuals with PTSS. In this paper, two case studies present preliminary evidence for effective implicit learning following a CBT intervention for individuals in PTA after a severe TBI receiving care. Notably, following a CBT intervention, agitation, confusion, and arousal were diminished despite having no recollection of the intervention. Thus, these cases suggest amnestic individuals in the acute recovery stage after severe TBI benefit from CBT to replace maladaptive attributions minimizing PTA and PTSS (e.g., confusion, arousal, and agitation) and improving motivation, participation, and recovery.