Access Type

Open Access Dissertation

Date of Award

January 2020

Degree Type


Degree Name




First Advisor

Lisa J. Rapport


Introduction: People with moderate-to-severe traumatic brain injury (TBI) often have problems with social communication, reduced contact with friends, and less satisfying social relationships than adults without history of TBI. Impaired abilities in perspective-taking may underlie problems in social integration and relationships following injury. This study sought to examine the perspective-taking ability of adults with moderate-to-severe TBI and support people, and examined the relationship between perspective-taking accuracy and relationship quality.

Methods: 48 dyads of adults with moderate-to-severe TBI and support people were included in the study. Both members of each dyad completed scales of distress, personality, and psychological flexibility. Measures were completed as traditional self-report, and in a perspective-taking imagine-other condition in which participants predicted the response of their study partner. Study partner self-report scores were subtracted from participant perspective-taking scores. Difference scores were used to examine perspective-taking accuracy for each scale. Self-report measures of empathy, caregiver burden, and functional ability were also included.

Results: TBI participants tended to overestimate distress in their support people. Additional analyses indicated that people with TBI experienced significantly more distress than their dyad partners, and the pattern of their responses to self- and imagine-other tasks suggests that they had difficulty separating their personal experience from their partner’s. In contrast, support people tended to have accurate perspective-taking accuracy of partner distress and personality. Further, accurate perspective-taking among support people was positively associated with their education and reading ability, inversely associated with their experience of caregiver burden, and positively associated with functional ability in the person with TBI. The ability to understand the experience of a relationship partner was related to relationship quality for both people with TBI and support people under certain conditions, although associations varied depending on whether participants overestimated or underestimated partner report. There was an especially strong correlation showing that when support people underestimate depression in people with TBI, those people with TBI tend to report poorer relationship quality. There were also varied correlations between perspective-taking accuracy and self-reported empathy depending on whether relationship partners tended to over- or under- estimate their partner’s responses. Alternatively, support person self-reported empathy had a correlation of medium effect size with both support person and TBI relationship quality.

Conclusions: This study demonstrated that impairments in cognitive empathy observed in people with TBI generalize to specific close relationships. Findings from the current study may be used to educate families after injury and to inform assessment and intervention to support improved relationship quality after brain injury.