Building emotional self-awareness teletherapy in civilians and service members with mild traumatic brain injury

Abstract: OBJECTIVES: To explore the early efficacy of Building Emotional Self-awareness Teletherapy (BEST) at reducing alexithymia and improving emotional functioning in Civilians and military Service Members and Veterans (SM/V) with mild traumatic brain injury (mTBI). DESIGN: Non-randomized, pretest-posttest design and a 3-month follow-up. SETTING: Community. PARTICIPANTS: Forty participants with mTBI (20 civilians and 20 SM/V) and elevated alexithymia and emotion dysregulation. On average, participants were 40 years-old and 13 years post-TBI. INTERVENTION: BEST is an 8-session, remotely delivered intervention that trains emotional insight. MAIN OUTCOME MEASURES: Toronto Alexithymia Scale-20 (TAS-20); Levels of Emotional Awareness Scale (LEAS); Difficulty with Emotion Regulation (DERS); Brief Resilience Scale (BRS); PROMIS Anxiety and Anger; PHQ-9 (depression); Post-traumatic Stress Checklist-5 (PCL-5); Positive and Negative Affect Schedule (PANAS); and Patient Global Impression of Change (PGIC). RESULTS: Thirty-six participants completed the study (90% retention). Compared to baseline, participants had significant improvements immediately and 3-months after treatment on the TAS-20, LEAS, DERS, BRS, PANAS negative affect scale, PROMIS Anxiety and Anger, PHQ-9, and PCL-5. All p-values were <.001, except PANAS negative affect at immediate post-test (p=.001), PROMIS Anxiety at both post-timepoints (p=.009 and p=.006, respectively), and PROMIS anger at 3-month follow-up (p=.001). At post-test, 75%, 70%, and 60% of participants improved by ≥ ½ standard deviation (SD) on the TAS-20, LEAS, and DERS, respectively. On the PGIC, 83% of participants reported noticeable positive changes in their emotional functioning. CONCLUSIONS: Findings support the preliminary efficacy of BEST at improving psychological health in civilian and military participants with mild TBI who have elevated alexithymia and emotion dysregulation. However, larger trials with more rigorous designs are necessary to determine the true impact of BEST.