Evaluation of a Skill-Building, Supportive, and Educational Intervention for Couples

Much of the research on acquired brain injury (ABI) has focused on survivors, especially
functional and neurobehavioral outcomes. In recent years, researchers have begun to develop
and evaluate interventions designed to improve whole family functioning. Studies have
demonstrated that intervention can increase survivors' and family members' problem solving
skills, met needs, emotional adjustment, and perceptions about the quality of rehabilitation
services.

Research suggests at least one of every three survivors is in a martial or coupled
relationship at the time of injury. The literature examining postinjury marital breakdown has
yielded widely varying results with estimates of breakdown rates ranging from 15%-78%.
Whereas early studies suggested a majority of marriages ended in divorce, more recent studies
have indicated that marital breakdown rates for people with brain injury are substantially
lower than the general population. At the same time, research has generated concern that
while many people remain together the quality of the relationship is sorely diminished.

There is little doubt that healthy marriages and intimate relationships are important
elements of our society. Further, research in other medical disciplines has proven the
positive impact marital quality has on marital stability, emotional well-being, caregiver
burden, and family needs. Existing study has similarly established the sustained benefits of
promoting marital quality through intervention. Given the documented adverse impacts of brain
injury, there is a clear need for effective interventions to improve and maintain the quality
of coupled relationships.

To improve couples' relationship quality after ABI, and to target emotional well-being and
caregiver burden, VCU researchers developed a curriculum-based program for couples
(Therapeutic Couples Intervention, TCI). The study addresses issues and challenges commonly
confronting couples after brain injury. Relationship quality is a primary focus of the study
with the perceptions of both partners analyzed, allowing an understanding of individual
viewpoints and those of the couple as a whole. Objectives include:

1. to evaluate the efficacy of a structured outpatient couples intervention program (TCI)
on couples' marital quality

2. to assess the impact of the TCI on the emotional well-being of persons with ABI and
their partners

3. to ascertain the impact of the TCI on caregiver burden and unmet needs as reported by
partners of persons with ABI

4. to examine the extent to which treatment benefits for survivors and their caregiving
partners are sustained in the longer-term

Inclusion Criteria:

- partners and persons with ABI who are at least three months post-injury or
post-diagnosis

- ABI is defined as damage to brain tissue caused by aneurysm, brain abscess, stroke,
anoxia, or non-progressive brain tumor, or an external mechanical force as evidenced
by: loss of consciousness due to brain trauma, post-traumatic amnesia (PTA), skull
fracture, or objective neurological findings that can be reasonably attributed to ABI
on physical examination or mental status examination.

- a "partner" is defined as a person described by the individual with the injury as a
spouse, partner, or significant other

- able to understand and provide consent

Exclusion Criteria:

- active substance abusers (e.g., intoxicated at arrival to intake)

- at imminent risk of psychiatric hospitalization

- in imminent danger of hurting themselves or others

- individuals without a partner