Promoting Resilience Following Traumatic Brain Injury: Application of an Interdisciplinary, Evidence‐Based Model for Intervention

Traumatic brain injury (TBI) has been identified by the Centers for Disease Control as having reached epidemic proportions, with more than 1.7 million TBIs now diagnosed annually in the United States (Faul, Xu, Wald, & Coronado, 2010). Worldwide, estimates are that 1 in 50 people will acquire a brain injury in their lifetime (Brain Injury Association of Queensland, 2010). Furthermore, TBI has been identified as the "signature injury" of the Operation Iraqi Freedom/Operation Enduring Freedom conflicts (Silver, MacAllister, & Yudofsky, 2011). The multinational military engagement in these conflicts has resulted in vast numbers of soldiers returning to their home countries after having incurred a brain injury. TBI is associated with long-term, frequently debilitating symptoms that extend well beyond common physical complications such as headache, tinnitus, vertigo, and disturbed coordination, among others. In fact, symptoms in emotional, behavioral, and social domains are often cited as the TBI complications that create the greatest long-term hurdles to successful survivorship (Zasler et al., 2012). At present, both military and civilian populations worldwide are profoundly impacted by this epidemic.In addition to the chronic, whole-life implications for many individuals currently diagnosed with brain injury, clinicians in the field of rehabilitation have long identified TBI as a "family injury" (Lezak, 1988). As such, the emotional and psychological toll of injury on a TBI survivor can be secondary in impact to the deleterious effects on family members and family relationships (Lezak, 1986). Spouses in particular are often negatively impacted. Spousal rates of depression in the years following TBI diagnosis have long been shown to outpace rates of TBI survivor depression (Mauss-Clum & Ryan, 1981). TBI survivors in a committed relationship will rely on their partner to be their caregiver (Brooks, 1991), resulting in substantial caregiver burden (Carnevale, Anselmi, Busichio, & Mills, 2002), relationship role confusion (Anderson, Parmenter, & Mok, 2002), an unbalancing of responsibilities (Gill, Sander, Robins, Mazzei, & Struchen, 2011), and isolation from sources of social support (Nabors, Seacat, & Rosenthal, 2002).Long-term outcomes are heavily tied to family well-being after TBI. For example, family functioning is less associated with the degree of injury severity than with the whole-family psychological factors associated with TBI, such as burden, stress, and neurobehavioral functioning (Kreutzer, Gervasio, & Camplair, 1994). In addition, family member functioning is positively correlated with long-term survivor outcomes. Yet neither families nor spouses routinely receive services during acute rehabilitation or as part of long-term postacute care. Spouses and family members, who become acculturated into the individually focused medical paradigm, learn to focus all their attention and energy on the medical, physical, emotional, and social care of the TBI survivor. As a result, spouses often struggle to prioritize self-care as well as the care of noninjured family members. Without intervention, the family's pull toward maintaining stability can result in these intensely unbalanced relationships persisting indefinitely.The systemically pervasive impacts of TBI are long term. TBI is classified as a chronic condition (Masel & DeWitt, 2010), rather than an acute injury, because of the enduring nature of physical, emotional, behavioral, and social survivor symptoms and the long-term exacerbated stress levels, social isolation, and sustained emotionality often experienced by the whole family. A decade after injury, family members and survivors alike continue to report difficulty with emotional and psychological functioning (Seel, Macciocchi, & Kreutzer, 2010), family and marital stability (Arango-Lasprilla et al., 2008; Kreutzer, Marwitz, Hsu, Williams, & Riddick, 2007), financial security (Carnes & Quinn, 2005), and life satisfaction (Kolakowsky-Hayner, Miner, & Kreutzer, 2001). …