17 - Judith: learning to do things ‘at the drop of a hat’: behavioural experiments to explore and change the ‘meaning’ in meaningful functional activity

Summary

Introduction

The emotional sequelae of acquired brain injury (ABI) are now well documented and increased attention in the literature is being paid to intervention. In addition to this, research has identified the profound impact of ABI on sense of identity (Tyerman and Humphrey, 1984; Nochi, 1998; Cantor et al., 2005; Dewar and Gracey, 2007). Ylvisaker and Feeney (2000) present a rehabilitative approach that explicitly involves developing ‘identity maps’ with their clients, and McGrath and King (2004) describe how behavioural experiments in cognitive behaviour therapy (CBT) can address beliefs and assumptions about self and abilities following ABI. As we described in earlier chapters (e.g. Chapter 4), such work is a key feature of the Oliver Zangwill Centre (OZC) for Neuropsychological Rehabilitation.

At the OZC we have been developing the application of CBT beyond treatment of Axis 1 emotional disorders following ABI (see Williams and Evans, 2003) to explore applications for facilitating acceptance and adjustment across the holistic rehabilitation process. This case illustrates two important aspects of this innovative modification of CBT: the use of behavioural experiments in rehabilitation (McGrath and King, 2004), and the constructive development of what we call a ‘positive formulation’ to support identity change and adjustment (Mooney and Padesky, 2000; Ylvisaker and Feeney, 2000). The chapter shows how these methods enabled Judith to change the meanings associated with attempts to engage in meaningful activities through the programme, with some enduring behaviour change maintained for a year post-programme.