Date of Award

7-25-2014

Degree Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Committee Chair

BJ Scott, Psy.D

Second Advisor

Jennifer Antick, Ph.D.

Third Advisor

Paul Michael, Ph.D.

Abstract

[Introduction]

Approximately 1,400,000 people sustain traumatic brain injury (TBI) in the United States each year (Langlois, Rutland-Brown, & Wald, 2006). Of these, 1.1 million will be treated for their injuries and released, 50,000 will die, and 235,000 will require hospitalization. Additionally, the rise of war veterans who sustain brain injuries is increasing (Defense and Veterans Brain Injury Center, 2005). According to recent TBI screenings, the number of active military personnel who have sustained a brain injury has risen far beyond the usual 14-20%. Other populations at high risk for TBI include children from infancy to four years old and adults 75 years of age and older (Langlois et al., 2006). Falls are the leading cause of brain injury across all age groups and levels of injury severity, accounting for 28% of the annual number of TBIs in the United States, with motor vehicle collisions accounting for an additional 20%. The annual cost of direct medical care and loss of productivity as a result of TBI in the United States is estimated at 60 billion dollars per year (Finkelstein, Corso, Miller, & Associates, 2006).

Severe to moderate TBI frequently leads to long-term deficits, involving changes in the physical, emotional, behavioral, cognitive, occupational, social, and familial functioning of survivors (Draper, Ponsford, & Schonberger, 2007; Roebuck-Spencer & Sherer, 2008). Physical effects of TBI may include weakness or spacticity in one or more parts of the body, difficulties with balance, breathing, swallowing, damage to parts of vision, fatigue, sleep disturbance, incontinence, and difficulty controlling body movements (Murphy & Carmine, 2012; World Health Organization [WHO], 2004). Emotional and behavioral effects often include irritability, lability, difficulty controlling one’s anger, depression, anxiety, agitation or belligerence, and destructive behavior (Babin, 2003; Draper et al., 2007; Thurman, Alverson, Dunn, Guerrero, & Sniezek, 1999; WHO, 2004). Additionally, persons with a history of moderate to severe TBI
often experience significant impairment in their cognitive abilities, which frequently interferes with work performance and may lead to job loss (Ylvisaker, Todis, & Glang, 2001). Additionally, persons with TBI may experience difficulty in making or understanding speech, (WHO, 2004). Due to deficits in planning and organization as well as motor impairments, many TBI survivors also experience difficulties with basic decision making, driving, maintaining financial independence, and living independently (Mateer & Sira, 2006; Mazaux & Richer, 1998). As a result of these changes and the impact across multiple domains of functioning, TBI survivors frequently experience problems in coping, lowered quality of life, and difficulty maintaining strong social connections and employment.

Rehabilitative interventions to address the functional, cognitive, and emotional sequelae of brain injury are provided by professionals in occupational therapy, rehabilitation nursing, physical therapy, speech therapy, psychology, and therapeutic recreation (Defense and Veterans Brain Injury Center, 2005; Draper et al., 2007; Mateer, & Sira, 2006; Pickelsimer, Selassie, Gu, & Langlois, 2006; Tomberg, Toomela, Ennok, & Tikk, 2006). However, even after rehabilitation treatments, many survivors continue to experience debilitating symptoms (Draper et al., 2007; Lee, LoGalbo, Banos & Novack, 2004; Mazaux & Richer, 1998).

Many studies have examined the long term effects of TBI and have concluded that advances in rehabilitation are needed to improve the lives of persons living with disabling effects of TBI (Ciceroni, 2004; Dickmen, Machamer, Powell, & Temkin, 2003; Dickmen, Machamen, Temkin, & Mclean, 1990; Draper, et al., 2007; Mazaux & Richer, 1998). These studies measured lasting effects of brain injury and emphasized a need to develop and improve treatments to improve the quality of life for survivors of brain injury and help alleviate residual impairments. Additionally, there is support for the idea that patients with acquired brain injuries are capable of setting self-identified goals, and this should be used to direct client-centered treatment practices (Turner, Ownsworth, Turpin, Fleming, & Griffin, 2008). Further, there is some evidence that persons with acquired injuries who are able to maintain high levels of goal-stability and motivation show significantly lower levels of depression and greater well-being than those who do not (Elliott, Uswatte, Lewis, & Palmatier, 2000; Elliott, Witty, Herrick, & Hoffman, 1991; Jackson, Taylor, Palmatier, Elliott, & Elliott, 1998). An initial review of the literature did not provide any manualized treatments to address lowered quality of life in persons with TBI, which include but are not limited to community integration, occupational performance, and subjective well-being (Cicerone, 2004; Cicerone & Azulay, 2007; Londos et al., 2008). However, there is support that a goal-oriented manualized treatment could improve quality of life for persons with TBI and others with mild cognitive impairments (Londos, et al., 2008). Hope, as operationally defined by C.R. Snyder (Snyder, 2000), is a goal-oriented cognitive process that may be used in problem solving to improve daily functioning. Five studies provide preliminary evidence suggesting that higher levels of hope and goal-oriented thinking result in significantly improved outcomes in populations with acquired injuries including brain injuries, spinal cord injuries, stroke, and visual impairments (Elliott, et al., 2000; Elliott, et al., 1991; Gum, Snyder & Duncan, 2006; Jackson, et al., 1998; Webb & Glueckauf, 1994). Additionally, there is some evidence to suggest that hope as a goal-oriented treatment may significantly improve treatment outcomes by reducing depression, maximizing cognitive and physical abilities, increasing treatment participation, and increasing personal goal attainment in brain injured patients (Gum, et al., 2006; Webb & Glueckauf, 1994, Wilbur & Parenté, 2008). The purpose of this study was to test a new manualized hope-based treatment for persons with TBI to determine if hope treatment significantly improves daily functioning over wait-list controls.

First, a general overview of the constructs and structure involved in hope and other goal-related theories will be provided in order to compare Snyder’s hope theory (Snyder, 2000) to other goal-oriented theories. Secondly, a general overview of the constructs in Snyder’s hope theory will be provided. Finally, a critical analysis of previous studies using hope and goals as a treatment modality for TBI will be reviewed.

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