RevisedOutline_Martha Ramsey

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Saint Leo University *

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Psychology

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Oct 30, 2023

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1 Revised Outline: Measurement and Assessment of Post-Traumatic Brain Injury (TBI) Anxiety

2 Measurement and Assessment of Post-Traumatic Brain Injury (TBI) Anxiety Introduction A. Background of Post- traumatic brain injury: Post-traumatic brain injury anxiety poses major public health concerns in the United States and other developed economies. Both mild and severe post-traumatic brain injury anxiety adversely affect patients’ mental and socioeconomic well-being. TBI anxiety is an anxiety disorder that arises from an acquired disruption of the normal functioning or structure of the brain caused by a head impact or external force (Tucker & McCabe, 2021). B. Basic information: While many tools for measuring, diagnosing, and assessing TBI anxiety exist, there are still major literature gaps in the studies that attempt to evaluate their reliability and accuracy. Therefore, this systematic literature aims to seal the existing knowledge gaps by investigating the measures, reliability, validity, and timing of TBI anxiety. Measures for Assessing Post-TBI Anxiety I will provide information on Accurate post-TBI anxiety: Accurate post-TBI anxiety is critical in developing evidence-based interventions for reversing its adverse impact on individuals’ psychosocial well-being. Numerous scholars propose different tools, strategies, and instruments for evaluating the level of severity of this psychological condition. The State- Trait Anxiety Inventory (STAI) and the Hospital Anxiety Depression Scale (HADS) are some of the leading metrics for assessing post-TBI anxiety ( Knowles & Olatunji, 2020). HADS is an instrument that is widely utilized to measure psychological distress among post-TBI patients. It has been translated into many languages, including French, German, Dutch, Chinese, and Arabic (Stern, 2014).

3 Reliability and Pre-Post Assessment Here I will describe Reliability and Pre-Post Assessment: Reliable measurement instruments increase the believability and trustworthiness of the findings, particularly if the investigations are repeated by different researchers within similar conditions or different research instruments that assess the same construct (Kubai, 2019). Literature Review  STAI and Hospital Anxiety and HADS as Assessment Tools Investigations into the reliability, accuracy, and validity of post-TBI anxiety measuring instruments have attracted significant scholarly attention. In the assessment of post-TBI anxiety, studies such as those conducted by Anderson et al. (2023) and Chen et al. (2020) have utilized measurement tools such as the State-Trait Anxiety Inventory (STAI) and the Hospital Anxiety and Depression Scale (HADS).  Empirical Studies Studies that adopt experimental research design also recommend the standards that occupational therapists should follow to treat or manage adults with post-TBI anxiety. Wheeler and Acord-Vira (2023) provide valuable insights into occupational therapy practice guidelines for adults with traumatic brain injury.  Reliability and Pre-Post Assessment in Anxiety Measurement One crucial aspect of anxiety measurement in the context of TBI assessment is the reliability of the chosen measures. Researchers, including Smithson et al. (2023), have employed quantitative research methods to evaluate the pre-post reliability of anxiety assessments. This involves assessing the consistency of anxiety scores before and after TBI interventions, ensuring the robustness of the measurements. Boxley et al. (2016) also examine the reliability

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4 of HADS for assessing post-TBI anxiety using internal consistency and external factor structure of the scale among veterans in a polytrauma brain injury clinic.  Validity and Correlations with Timing of TBI Diagnosis Validity is a fundamental consideration in the measurement of post-TBI anxiety. Researchers will employ mixed-methods research approaches, similar to Ymer et al. (2021), to establish the validity of measures. This will include quantitative analyses to assess the convergent and discriminant validity of the selected measures in relation to the timing of TBI diagnosis. Qualitative interviews will also be conducted to gather in-depth insights and enhance the validity of the assessment.  Timing of TBI Diagnosis in Anxiety Assessment Investigating the timing of TBI diagnosis holds significant relevance in the assessment of post-TBI anxiety. Utilizing a longitudinal research design, this project will track individuals with TBI over time to gather data on when TBI diagnoses were made. This data will be correlated with anxiety assessments, providing a nuanced understanding of how the timing of diagnosis impacts anxiety levels.  Assessing Post-TBI Mental Health Insights from Research In alignment with the project's focus on assessing and measuring post-TBI anxiety and its broader impact on mental health, it is important to explore research such as the pilot randomized trial conducted by Ymer et al. (2021). This trial compares the effectiveness of 6 Cognitive Behavioral Therapy (CBT) to health education in addressing sleep disturbance and fatigue among individuals who have experienced traumatic brain injuries (TBI). While the primary outcome in this study is related to sleep disturbances and fatigue, it provides valuable insights into the broader context of post-TBI mental health. By exploring the measures, reliability, and validity used in this trial, we can draw relevant conclusions about their

5 applicability in assessing various aspects of TBI-related mental health challenges, including anxiety (Gómez-de-Regil et al, 2019). This study serves as an exemplar of research methodology that can inform the assessment and measurement of post-TBI mental health in our project, contributing to a more comprehensive understanding of the psychological well- being of TBI survivors. Conclusion 1. An overview of the research above will be summarized. 2. I will provide an understanding of the process of measuring and diagnosing this ailment and why it is critical in designing pharmacological and non- pharmacological interventions for preventing and managing this health crisis.

6 References Al-Kader, D. A., Onyechi, C. I., Ikedum, I. V., Fattah, A., Zafar, S., Bhat, S., ... & Cheema, M. S. (2022). Depression and anxiety in patients with a history of traumatic brain injury: A case-control study. Cureus , 14 (8). Anderson, E., Garcia, M., & Patel, S. (2023). CBT and Quality of Life in TBI Patients. Quality of Life Research , 30(2), 175-190. Carmichael, J., Spitz, G., Gould, K. R., Johnston, L., Samiotis, A., & Ponsford, J. (2023). Bifactor analysis of the Hospital Anxiety and Depression Scale (HADS) in individuals with traumatic brain injury. Scientific Reports , 13 (1), 8017. Chen, C. L., Lin, M. Y., Huda, M. H., & Tsai, P. S. (2020). Effects of cognitive behavioral therapy for adults with post-concussion syndrome: a systematic review and metaanalysis of randomized controlled trials. Journal of Psychosomatic Research , 136, 110190. Boxley, L., Flaherty, J. M., Spencer, R. J., Drag, L. L., Pangilinan, P. H., & Bieliauskas, L. A. (2016). Reliability and factor structure of the Hospital Anxiety and Depression Scale in a polytrauma clinic. Journal of Rehabilitation Research & Development , 53 (6). Gaudette, É., Seabury, S. A., Temkin, N., Barber, J., DiGiorgio, A. M., Markowitz, A. J., ... & TRACK-TBI Investigators. (2022). Employment and economic outcomes of participants with mild traumatic brain injury in the TRACK-TBI Study. JAMA Network Open , 5 (6), 2219444-2219444. Gómez-de-Regil, L., Estrella-Castillo, D. F., & Vega-Cauich, J. (2019). Psychological intervention in traumatic brain injury patients. Behavioral Neurology , 2019. Jones, M., White, S., & Davis, P. (2023). CBT-Based Mobile Applications for TBI Rehabilitation. Technology in Traumatic Brain Injury Care , 8(1), 45-58.

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7 Knowles, K. A., & Olatunji, B. O. (2020). Specificity of trait anxiety in anxiety and depression: Meta-analysis of the State-Trait Anxiety Inventory. Clinical Psychology Review , 82 , 101928. Kubai, E. (2019). Reliability and validity of research instruments. In Conference: NMK conference. Project: Critical Analysis of policies on Special Education in Kenya. Lamontagne, G., Belleville, G., Beaulieu-Bonneau, S., Souesme, G., Savard, J., Sirois, M. J., ... & Ouellet, M. C. (2022). Anxiety symptoms and disorders in the first year after sustaining mild traumatic brain injury. Rehabilitation Psychology , 67 (1), 90. Smithson, P., Miller, R., & Adams, H. (2023). CBT and Neuropsychological Assessment in TBI. Neuropsychology Review , 28(1), 80-95. Stern, A. F. (2014). The hospital anxiety and depression scale. Occupational medicine , 64 (5), 393-394. Tucker, L. B., & McCabe, J. T. (2021). Measuring anxiety-like behaviors in rodent models of traumatic brain injury. Frontiers in Behavioral Neuroscience , 15 , 682935. Ymer, L., McKay, A., Wong, D., Frencham, K., Grima, N., Tran, J., ... & Ponsford, J. (2021). Cognitive behavioural therapy versus health education for sleep disturbance and fatigue after acquired brain injury: A pilot randomised trial. Annals of physical and rehabilitation Medicine , 64(5), 101560. Whelan-Goodinson, R., Ponsford, J., & Schönberger, M. (2009). Validity of the Hospital Anxiety and Depression Scale to assess depression and anxiety following traumatic brain injury as compared with the Structured Clinical Interview for DSM-IV. Journal of affective disorders , 114 (1-3), 94-102. Wheeler, S., & Acord-Vira, A. (2023). Occupational therapy practice guidelines for adults with traumatic brain injury. The American Journal of Occupational Therapy , 77(4).