A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
Brain injuries can occur as a result of external trauma, such as a fall or accident, or internal trauma, such as a stroke or aneurysm. These injuries can cause lasting brain damage leading to a variety of long-term disabilities. Changes in how people think, feel, or communicate after a brain injury can make it challenging to maintain close relationships, such as a marriage or romantic partnership. Furthermore, after someone experiences a brain injury, their spouse or partner may serve as their caregiver, supporting the person with activities of daily living as well as coordinating their medical care and therapies. This need for caregiving within a relationship can lead to changes in roles and expectations for both partners, which can be stressful. A recently developed short-term couples therapy program, called the Therapeutic Couples Intervention (TCI), was found to improve relationship quality for couples in which one partner has a brain injury. In a recent NIDILRR-funded study, researchers looked specifically at the effects of the TCI for the uninjured partners of persons with brain injuries. The researchers wanted to find out whether the TCI decreased unmet needs for these partners. They also wanted to find out whether the partners felt less burdened by their caregiving duties after the TCI than before.
Researchers at the Virginia Commonwealth University Traumatic Brain Injury Model System Center enrolled 75 couples in the study. Most of the couples were married or living together and had been in a relationship for an average of 11.4 years. One partner in each couple had experienced a brain injury, such as a traumatic brain injury, a stroke or aneurysm, or other nonprogressive neurologic condition. For most of the participants, the injury occurred after they had begun their relationship. Most of the uninjured partners reported providing one or more hours of care to their partner with brain injury each day.
The researchers randomly divided the couples into two groups: an experimental group who received the TCI program, and a comparison group who received no services. At the end of the study, the couples in the comparison group were invited to receive the TCI if they wished.
The couples in the TCI group met with a therapist once a week for 5 weeks, with an optional sixth meeting. During each weekly session, the couple and therapist discussed specific topics related to brain injury and relationship building. Topics included the effects of brain injuries on relationships, effective communication, problem-solving, and building intimacy. A sixth optional session was available that focused on parenting, for couples who were raising children.
Before their first session in the TCI group, and within the first week after enrollment in the study for the comparison group, the uninjured partners of persons with brain injuries completed two questionnaires. The first questionnaire asked about the following: needs related to caregiving, and whether they felt these needs were not met, partially met, or met; needs for different types of support such as emotional support, support from the community, and physical or tangible support such as help with household management; and need for health information. On the second questionnaire, the partners were asked how much their caregiving responsibilities affected their health, social life, and finances, with higher scores reflecting a higher level of caregiver burden. The partners in the TCI group then completed the same questionnaires at the end of their fifth session, while the partners in the comparison group returned five weeks after they completed those questionnaires the first time to complete them a second time.
Finally, 3 months after the end of the study, the partners in the TCI group completed both questionnaires a third time to find out whether the TCI had a lasting benefit. There was no third session for the comparison group.
The researchers looked at the percentage of needs that the partners rated as being completely met. They found that the partners in the TCI group reported an average of 22% increase in met needs overall after the TCI. This increase was maintained at the 3-month follow-up. In contrast, the partners in the comparison group reported no change in met needs.
When they looked at caregiver burden scores, the researchers found that the partners in the TCI group reported an average of 15% decrease in caregiver burden after the TCI program. At the 3-month follow-up, their caregiver burden scores dropped by another 13%. In contrast, the caregiver burden scores reported by the partners in the comparison group dropped by only 4% over the course of the study.
The authors noted that for couples affected by brain injuries, a brief couples therapy program may not only improve relationship quality, but may also increase needed supports and reduce burden for the uninjured partner in the relationship. Interestingly, the partners continued to experience lower levels of burden after the program was over. According to the authors, the TCI program may have effectively taught problem-solving, stress management, and communication skills that both partners could continue to apply in their daily interactions, helping to reduce conflict and stress that could create a feeling of burden for the uninjured partner. Future research may be useful to identify the long-term benefits of couples’ therapy programs for both individuals with brain injuries and their partners.
To Learn More
The Model Systems Knowledge Translation Center offered a suite of resources for Relationships After TBI, including video interviews with couples living with TBI and factsheets on how TBI can impact intimate relationships.
Brainline.org, a service of WETA, offers extensive resources for TBI, including a section on Family Relationships. Co-author Jeffrey Kreutzer, PhD, discussed the topic of couples therapy after TBI in a video interview with Brainline.
For health professionals interested in the Therapeutic Couples’ Intervention, visit http://www.tbifamilyresearch.com/tci.
To Learn More About this Study
Graham, K. M., Kreutzer, J. S., Marwitz, J. H., Sima, A. P., & Hsu, N. H. (2019, December 19). Can Couples’ Intervention Reduce Unmet Needs and Caregiver Burden After Brain Injury? Rehabilitation Psychology, 2019. This article is available from the NARIC collection under Accession Number J82660.