TBI CBT DBT What to do Psychological and
TBI, CBT, DBT? What to do? Psychological and neuropsychiatric care of the patient with TBI. Margo Lauterbach, MD Sarah Loeffler, LCSW-C Andrea Gottlieb, Ph. D Sheppard Pratt Health System Concussion Clinic at the Neuropsychiatry Program at Sheppard Pratt
Disclosures • Dr. Gottlieb and Sarah Loeffler have no financial disclosures • Dr. Lauterbach is 1/3 owner of Brain Educators, LLC, publishers of The Brain Card®, a neuropsychiatry pocket reference 2
Objectives: (1) To understand neuropsychiatric and psychological symptoms that can accompany TBI (2) To understand the psychotherapy approaches to illness (3) Have an understanding of the adaptation of traditional modalities of psychological treatment for use with patients with TBI 3
What are neuropsychiatric vs psychosocial symptoms? 4
Common Symptoms Disorders of… – Mood – Cognition – Behavior – Other – Physical 5
Disorders of Mood Depression Dysphoria Elation Hostility Agitation/Irritability "Mania" "Bipolar" Lability Apathy 6
Disorders of Cognition Motivation Impulsivity * Attention Memory Language Processing Speed Cognitive Flexibility Abstract Thinking Planning Organization 7
Disorders of Behavior Personality Changes Impulsivity * Interpersonal Skills Substance Use Changes in Sexuality * Aggression Disinhibition Impaired Judgement 8
Other Disorders Anxiety PTSD Generalized Worry (GAD) Panic Disorder Psychosis Hallucinations Delusions Sleep Disorders * Safety Concerns * 9 Suicidal Violent
Physical Disorders Seizure Disorders Sleep Disorders * Movement Disorders Vestibular Disorders Headaches Chronic Pain Visual Changes Energy/Fatigue 10
The Importance of “Individual Brains” • Psychotherapy + psychopharmacology • Adapting modalities of treatment 11
Relevant Information for Consideration Litigation Third Parties Workers Compensation Insurance Companies Presence/Absence of Supports Multidisciplinary Providers – Pros and Cons Work/School Potential Finances Spiritual/Religious/Cultural 12
Examples of Therapies Supportive Counseling Cogntive Behavioral Therapy (CBT) Cognitive Rehabilitation Therapy (CRT) Self-Awareness Training Dialectical Behavioral Therapy (DBT) 13
DBT Disclaimer 14
DBT Acceptance and change model 15
DBT What are "dialectics"? 16
DBT Acceptance and change skills: • Mindfulness • Distress tolerance 17
DBT Acceptance and change skills: • Emotion regulation • Interpersonal effectiveness 18
DBT Why DBT for TBI? • DBT is designed for those with symptoms that sometimes overlap with post-TBI emotional symptoms and social impairments • • 19 Mood: irritability, lability, emotional dysregulation Social judgment/interpersonal relatedness and skills Tolerance of distress/frustration Safety concerns
DBT Adapting DBT 20
DBT Acceptance skills: • Mindfulness ("wise mind") • Emotion regulation (skill: observe and describe emotions) 21
DBT Change skills: • Distress tolerance (ex: "distracting skills") • Interpersonal effectiveness ("GIVE" skills) 22
DBT Why DBT and SP Concussion Clinic: • Matches the emotional needs we see for many of our patients. • Creates a language and a new frame for treatment. • It is adapted, hence flexible • It is working for many… 23
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