Experience of adapted cognitive behaviour therapy to address sexuality problems after traumatic brain injury: A qualitative study

Figures & data

Table 1. Participant demographic characteristics.

Variables		Participant
		1	2	3	4	5	6	7	8
Demographic data
	Age (years)	49	31	64	63	56	33	33	41
	Sex	Male	Female	Male	Male	Female	Female	Male	Female
	Education (years)	12	18	14	12	15	16	14	18
	Preinjury relationship	Single	De-facto relationship	Married	Married	De-facto relationship	De-facto relationship	De-facto relationship	Married
	Baseline relationship	Single	Single	Married	Married	Single	Single	De-facto relationship	Married
Injury characteristics
	Cause of TBI	Bicycle Accident	MVA	Work-related injury	MVA	MVA	MVA	Fall	Pedestrian stuck by car
	PTA duration (days)	70	16	21	0.5	20	8	68	23
	Worst GCS score	3	15	8	15	14	3	3	13
	Time since injury (years)	33	6	6	2	3	1	1	0.90
	CT brain imaging	Petecchial haemorrhages in frontal and paraventricular regions	Frontal contusion, subarachnoid haemorrhage, contrecoup injury with contusion in the orbitofrontal region	NAD	Interhemispheric subarachnoid hemorrhage	NAD	Fractured parietal and temporal bones, contusion and intracerebral haemorrhage in temporal region, extra-axial haemorrhage	Fractured occipital lobe, subfalcine herniation, inferior frontal contusion, grey and white matter loss, haemorrhage	Left subdural hematoma, contusions in right frontal and temporal regions, fractured left temporal bone

Note: TBI: Traumatic Brain Injury; MVA: Motor Vehicle Accident; PTA: Post Traumatic Amnesia; GCS: Glasgow Coma Scale; CT: Computed Tomography; NAD: No Abnormality Detected.

Table 2. Treatment structure and modules.

Module		Title	Objective
Session 1–2
	1	Assessment and formulation	Work closely with the individual/couple to develop a shared understanding of the problem and collaboratively set treatment goals.
	2	Psychoeducation and goals	Explore the individual's/couple's understanding of sexuality and provide psychoeducation surrounding sexuality, TBI, and overall health and wellbeing.
Session 3–7
	3	Self-esteem and body image	Explore self-esteem or body image and identify and adjust biased expectations, negative self-evaluations, and rules and assumptions.
	4	Understanding arousal	Define desire and arousal, explore dimensions of touch, identify brakes and accelerators.
	5	Reframing thoughts	Explore links between thoughts, emotions, and behaviours. Employ cognitive restructuring techniques that allow the individual/couple to feel in control of their sexuality.
	6	Communication	Understand expressive and receptive listening skills using modelling and in-session coaching.
	7	Relaxation	Teach mindfulness, breathing, and progressive muscle relaxation techniques to enhance sexual experiences.
	8	Psychosexual skill exercises	Practise exercises targeted to the individual's/couple's sexual problem.
	9	Social skills	Establish relevant techniques to increase positive and rewarding social behaviours and decrease negative social behaviour.
	10	Sleep and fatigue management	Identify practical strategies to improve sleep and manage physical and mental fatigue.
	11	Medical review	Assess neurological/medical basis to sexuality problem.
Session 8
	12	Relapse prevention	Summarize skills and content learned throughout treatment and generate plan for managing setbacks.

Note: TBI, Traumatic Brain Injury.

Figure 1. Thematic map displaying participants’ experiences of the intervention.

Four distinct squares representing each qualitative theme displayed horizontally. There are three to four circles included within each square which represent the subthemes. Underneath the squares is an arrow representing the treatment journey across time.

Table 1. Semi-structured interview schedule.

Sexuality after TBI		Tell me about your sexuality after your injury?
		What changes did you experience?
		How was it managed or addressed by healthcare professionals at the time?
		Why do you think your sexuality changed/did not change?
Treatment Experience		What did you think the treatment would be like before you started?
		Was it different from what you expected? Why or why not?
		What do you remember about the treatment?
		What were some of the changes you noticed in yourself and/or your relationship from participating? What things helped you achieve these changes?
		Tell me about what, if any, strategies, information, or material you liked/are likely to use in your everyday life?
		Tell me about what, if any, strategies, information, or material you did not like/are not likely to use in your everyday life?
		Did you experience any challenges engaging with the sessions or the content of the sessions?
Treatment Structure		Tell me about the experience of doing the treatment sessions online/in person (choose whichever is applicable)?
		Do you have a preference between in-person or online? Why or why not?
		How did you find the number and the length of the sessions?
Treatment Feedback		Overall, what did you find most helpful?
		Overall, what do you think could be improved?
		Would you recommend this treatment to others? Why or why not?
		Is there anything else you would like to share?