Evaluating The Effectiveness of a Psychoeducational Intervention (Phase 2) For Military Personnel Who Report Persistent Symptoms Following a Mild Traumatic Brain Injury.

Background: Defence Medical Rehabilitation Centre (DMRC) Headley Court is the UK Defence Medical Services’ premier rehabilitation facility and since 2008 it has provided the DMS Centre of Excellence for mild traumatic brain injury (MTBI). In response to concern over the potential incidence and significance of MTBI in the UK armed forces, as well as much media and parliamentary interest in this so-termed ‘signature injury’, DMRC established a four phase treatment programme for UK service members with suspected MTBI. The focus of this thesis is Phase 2 of this treatment programme: a psychoeducational intervention for military personnel who report persistent symptoms following an MTBI event. Aims: This thesis aimed to provide empirical evidence regarding the effectiveness of the Phase 2 intervention, and to explore patients’ experiences of both MTBI and their treatment at DMRC Headley Court. Methods: The thesis consists of five studies using quantitative and qualitative methodologies. Results: First, a cohort study compared those who had completed the Phase 2 intervention (n =55) to a control group (n =73) and found that treatment was associated with a lower impact of symptoms relating to memory and emotions. However, it was also associated with a greater impact of executive functions symptoms. Further, the results also showed that a longer delay between MTBI events and clinical assessment was related to poorer outcomes following the intervention. Second, a qualitative study using semi-structured interviews (N=16) revealed that MTBI is experienced as a highly disruptive event, initially characterised by a sense of chaos and confusion. Third, a further qualitative analysis (N=16) indicated that the Phase 2 intervention is experienced as flexible and tailored, and that it helps to reestablish order and continuity. Fourth, an experimental design was used to explore the effect of the intervention on positive psychological change following MTBI using the emotional Stroop task (N= 22). The results showed no differences in attentional bias between Phase 2 patients and MTBI controls. However, all participants reported greater benefit finding over time. Finally, in a second experimental study, Phase 2 patients were compared to controls in terms of their ability to manage a stress inducing task (N= 23). No group differences in cardiovascular reactivity were observed, but the Phase 2 patients reported feeling more stressed generally.Conclusion: The results suggest that MTBI can generate a sense of chaos and confusion. The Phase 2 intervention at DMRC Headley Court helps to reduce symptoms relating to memory and emotions and is experienced by service members as bringing order and stability into their lives. To conclude, early intervention following MTBI shows promise for improving related symptom experience. Treatment may need to be longer than 12 weeks to bring about changes in benefit finding and stress management