Access Type

Open Access Dissertation

Date of Award

January 2012

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Psychology

First Advisor

Lisa J. Rapport

Abstract

Many survivors of traumatic brain injury (TBI) and their significant others face the chronic stress of living with cognitive and physical impairments associated with TBI; this stress takes a toll on well-being. Unfortunately, research on the mechanisms of coping after TBI has been sparse. Thus, the present study examined the influence of acquired cognitive impairment on the pattern of relationships between emotional expression, coping styles and health outcomes. Sixty individuals with moderate to severe TBI as well as 63 significant others of individuals with TBI participated. Coping style was assessed via the Coping Inventory for Stressful Situations. Emotional expression was assessed via linguistic analysis (Linguistic Inquiry and Word Count Program) as well as observation ratings made during a speech task in which participants described stressful aspects of recovery from TBI. Main outcomes were subjective well-being, including psychological distress (depression, anxiety, and somatization), life satisfaction, and for TBI participants, objective functional independence assessed via ratings from their significant others. Results indicate that individuals with TBI and their significant others show different patterns of coping style, and that these patterns are differentially related to subjective well-being and functional outcome: Consistent with prior research, task-oriented coping was associated with good outcomes whereas emotion-oriented coping was associated with poor outcomes. Moreover, significant others were more likely to adopt a task-oriented coping style than were adults with TBI, whereas adults with TBI used relatively more emotion-oriented coping; consistent with this finding, the TBI group fared substantially worse in well-being than did the significant other group. When describing stressful aspects of recovery, both verbal emotional expressions and observations of expressed emotions predicted well-being outcomes; however, the pattern differed between adults with TBI and their significant others. Among TBI participants, expressing awareness about the stressful aspects of recovery was associated with distress and low satisfaction with life, whereas avoiding problems or demonstrating acceptance predicted low distress and high satisfaction with life. Ongoing expression of anger long after the survivor's injury was a dysfunctional marker for distress in significant others. Interventions aimed at facilitating healthy coping styles may be helpful for individuals with TBI and their families.

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