Self-Regulation and Relaxation-Based Interventions for Adults With Traumatic Brain Injury (2013–2020)

Full Systematic Review Question

This systematic review addressed the question “What is the evidence for effectiveness of interventions that address psychosocial, behavioral, and/or emotional skills to improve social participation and other everyday activities and occupations for persons with TBI?”

Current Theme Reported

The main theme of the studies included in this systematic review brief is self-regulation and relaxation-based interventions to improve psychosocial outcomes for adults with traumatic brain injury.

Clinical Scenario

Traumatic brain injury (TBI) is a leading cause of death and disability that affects about 2.5 million Americans each year. While the symptoms and severity of TBI vary among people, psychosocial, behavioral, emotional changes are common and significantly impact successful and satisfying community participation. The increased prevalence of psychological problems in people with TBI, including depression, anxiety, suicidal ideation, substance abuse, sleep disorders, and posttraumatic stress disorder, highlight the need for appropriate and empirically based interventions. Psychological issues are commonly cited among those unmet rehabilitation needs (Mahoney et al., 2021), and these directly fall within occupational therapy’s scope of practice. Occupational therapy practitioners have knowledge, skills, and training in assessing and treating psychological impairments to improve occupational performance following TBI, making their role in the rehabilitation process vital across the continuum of recovery.

The use of yoga, mindfulness, and other mind– body practices are among the complementary, self- regulation approaches that may be incorporated into an occupational therapy plan of care to support participation in meaningful occupations (American Occupational Therapy Association [AOTA], 2020). The use of music for emotional self-regulation during adulthood has also been established in the literature and hence is also included within this theme (Baltazar & Saarikallio, 2016). Among the commonly cited benefits of these approaches is improved physical and psychological well-being.

Summary of Key Findings

Five articles related to self-regulation and relaxation-based interventions to improve social participation and other everyday activities and occupations for persons with TBI are included in this review. These five articles were further divided into three categories, depending on the specific type of intervention (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009).

Bottom Line for Occupational Therapy Practice

Occupational therapy practitioners use interventions to support occupations, including self-regulation tasks which may be used as preparatory or in concurrently with occupations and activities (AOTA, 2020) to improve social participation and other everyday activities and occupations for persons with TBI. The findings of this review indicate low strength of evidence for the use of self-regulation interventions such as yoga and mindfulness to address several areas including psychological impairments, perceived self-efficacy, quality of life, and overall health. The benefits observed from these programs were derived over a duration of 8–10 wk and generally involve weekly sessions conducted in a group environment. The benefits of preferred music were established in a shorter duration in the study by Park and colleagues (2016), but the sustainability of the derived outcome, reduced agitation, was not established. Interventions to support occupations should be used by occupational therapy practitioners within the context of an overall plan of care. As with other aspects of practice, the choice of interventions should be based upon evaluation findings and reflect a client’s cultural practices, prioritized wants and needs, and used in a manner that positively impacts participation and quality of life (AOTA, 2017). When using evidence-based complementary approaches to support active engagement and participation in meaningful occupations, it is essential that practitioners establish and maintain clinical competency and/or certifications and practice in accordance with applicable laws, regulations, and payer policies (AOTA, 2022).