Positive PsychoTherapy in ABI Rehab (PoPsTAR): A pilot randomised controlled trial

ABSTRACT

Psychological distress is common following acquired brain injury (ABI), but the evidence base for psychotherapeutic interventions is small and equivocal. Positive psychotherapy aims to foster well-being by increasing experiences of pleasure, engagement and meaning. In this pilot trial, we investigated the feasibility and acceptability of brief positive psychotherapy in adults with ABI and emotional distress. Participants were randomised to brief positive psychotherapy plus usual treatment, or usual treatment only. Brief positive psychotherapy was delivered over eight individual out-patient sessions, by one research psychologist. A blinded assessor administered the Depression Anxiety Stress Scales (DASS-21) and the Authentic Happiness Inventory (AHI) at 5, 9 and 20 weeks post-baseline. Of 27 participants randomised (median age 57; 63% male; 82% ischaemic stroke survivors; median 5.7 months post-injury), 14 were assigned to positive psychotherapy, of whom 8 completed treatment. The intervention was feasible to deliver with excellent fidelity, and was acceptable to participants. Retention at 20 weeks was 63% overall. A full-scale trial would need to retain n = 39 per group to end-point, to detect a significant difference in change scores on the DASS-21 Depression scale of 7 points (two-tailed alpha = .05, power = .80). Trials including an active control arm would require larger sample sizes. We conclude that a full-scale trial to investigate efficacy is warranted.

KEYWORDS:

• Brain injury
• stroke
• positive psychology
• psychotherapy
• randomised controlled trial

Acknowledgements

We are grateful to Dr Tayyab Rashid, University of Toronto, for providing original treatment materials from which the present intervention programme was adapted. We thank Dr Tessa Hart, Moss Rehabilitation Research Institute, for providing an unblinding prevention script example. We are grateful to the clinicians who facilitated recruitment, and to all the participants who gave considerable time and effort to be part of the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the Scottish Executive Health Department, Chief Scientist Office [ref. CZH/4/778]. Support with sample recruitment was received through the Scottish Stroke Research Network.