Neuropsychological Rehabilitation

Cognitive Behaviour Therapy (CBT) is the NICE recommended, first line treatment for many common mental health problems like depression and anxiety, which occur disproportionately in people who have suffered an acquired brain injury. RCNS understands that depression and anxiety contribute to poorer outcomes in people with brain injury, and so good neuropsychological treatment needs to address these. CBT is a process by which clients are supported to understand the ways that their thoughts, emotions and behaviours are interlinked, and to develop new ways of thinking and responding which break the negative cycles that low mood and anxiety can trick us into. 

Trauma-Focused Cognitive Behaviour Therapy is a NICE recommended, first-line treatment for Post-traumatic Stress Disorder (PTSD). As of November 2021 its evidence base was stronger and more extensive than the evidence base for the more well-known Eye Movement Desensitisation and Reprocessing, which is another NICE recommended treatment for PTSD. 

People with traumatic brain injury are often at high risk of PTSD due to the frequently traumatic nature of the index injury. RCNS is able to provide trauma-focused CBT in accordance with NICE recommendations. The steps involved in this treatment include: stabilisation and engagement in treatment; psychoeducation; symptom management; exposure; and relapse prevention. 

Our clinicians are able to offer evidence based psychological interventions for health problems that commonly arise as a result of neurological injury, such as insomnia, tinnitus, chronic pain, neuro-fatigue, and vestibular (inner ear and balance) disorders. We can offer: 

• Cognitive Behavioural Therapy for Insomnia (CBTi)
• Cognitive Behavioural Therapy for Vestibular Disorder 
• Cognitive behavioural Therapy for Tinnitus 
• Graded Behavioural Approaches for Fatigue and Chronic Pain 

We often find that clients require us to undertake this work as a first priority, in order to develop a stable base for the client to work towards other neurorehabilitation goals. 

Brain injury does not only affect the individual who sustained it. Its impact ripples out to the wider system around that person - family, partners, children, work colleagues, and friends. Systemic work in clinical neuropsychology in the broadest sense often involves helping a brain injured person to redevelop their sense of identity and role following brain injury by working with more than just that individual, and helping the whole system adapt to the changes that have occurred. 

Positive Behaviour Support suggests that behaviour that challenges usually happens for a reason and that challenging behaviour, often due to brain injury, may be the person's only way of communicating an unmet need. PBS helps us understand the reason for the behaviour so we can better meet people's needs, enhance their quality of life and reduce the frequency and severity of challenging behaviour. 

People with a brain injury can sometimes find it really difficult to find the 'get-up-and-go' to engage in multidisciplinary rehabilitation packages that would improve their quality of life. This can be for all kinds of reasons, including depression, poor insight or difficulty with initiation and drive ('adynamia'). Motivational Interviewing is an evidence-based, NICE recommended technique that aims to help people who are struggling with behaviour change to make the adjustments to their life that they need to make in order to achieve their goals.  

ACT is an empirically based psychological intervention that uses acceptance and mindfulness strategies along with commitment and behavior-change strategies to increase psychological flexibility. It can be useful in helping individuals to adjust to changes that have occurred secondary to brain injury. 

The objective of ACT is not to eliminate difficult feelings. Instead, it is to be present with what life brings and to move toward valued behavior. ACT invites people to open up to unpleasant feelings, learn not to overreact to them, and not avoid situations where they are invoked.   

RCNS regularly supports clients from a neuropsychological perspective to overcome the challenges they face in returning to vocational activity. We collaborate with our multidisciplinary colleagues to support individuals to undertake return to work trials, retrain into different areas, or develop meaningful voluntary or recreational activities following traumatic brain injury, in accordance with their goals.