Post traumatic growth and rehabilitation outcomes in traumatic brain injury

Traumatic brain injury (TBI) can result in significant distress (Collicutt McGrath, 2008). Post traumatic growth (PTG) is defined as "substantial positive psychological change resulting from the struggle to overcome highly challenging life circumstances" (Tedeschi & Calhoun, 2004). An association between PTG and well-being (e.g., emotional health) has been demonstrated with several populations (Helgeson, Reynolds, & Tomich, 2006). The generalizability of previous findings to patients with TBI who are currently participating in brain injury rehabilitation programs is limited by several factors. Informed by Tedeschi and Calhoun's PTG model (1996), and the Y-Shaped Model of change in rehabilitation (Gracey, Evans, & Malley, 2009), the current study was designed to address the limitations and extend the findings of previous studies. Primary aims of the current study included: 1) Examine the relationship between perceived PTG and rehabilitation outcomes; 2) Investigate cognitive coping, self-awareness, and mindfulness as possible predictors of PTG; and 3) Assess the role of time since injury as a potential moderator of the relationship between cognitive coping variables and PTG. Adults with TBI who were receiving services from Bancroft Brain Injury Services (BIS), a community-based post-acute rehabilitation provider; oriented to time, place and year; and had at least two Mayo Portland Adaptability Inventory (MPAI-4; Malec, 2005) ratings assessed by BIS, were included. Persons who were currently, actively psychotic (as diagnosed by a mental health provider) were excluded. PTGI Total score was found to be significantly associated with the MPAI Adjustment Index. CPOTS Positive Cognitive Restructuring was significantly related to PTGI Total. Impaired self-awareness was significantly associated with PTGI Total. In addition, both PHMLS variables (Awareness and Acceptance) were significantly related to PTGI Total. The variables investigated in this study (e.g., PTG, self-awareness, cognitive coping, rehabilitation outcomes) are valuable as both assessment and treatment targets in TBI rehabilitation settings. Furthermore, findings may contribute to the literature base that informs rehabilitation-specific theoretical models of PTG. Finally, the general concept of PTG in rehabilitation settings explored in this study may apply to other populations (e.g., spinal cord injury, amputation), because the processes explored in this study are believed to parallel the process of positive rehabilitation.