TIRR Memorial Hermann Researchers Lead Study of Digital Problem-Solving Training for Traumatic Brain Injury

New research being conducted by the Brain Injury Research Center (BIRC) at TIRR Memorial Hermann is investigating the utility of electronic problem-solving training (PST) for improving mental health and well-being of individuals with traumatic brain injury (TBI).

Furthermore, the project, which received funding via a grant from the Department of Defense, will directly engage TBI survivors and care partners in the decision making and planning of the study.

“This builds on research I have been conducting over the past six years to study the effects of PST on outcomes among care partners, though the evidence for PST extends even further back,” says Shannon Juengst, PhD, a senior scientist and clinical investigator in the BIRC, and an associate professor of physical medicine and rehabilitation at The University of Texas Health Science Center at Houston and UT Southwestern Medical Center in Dallas. “My prior mentor at UT Southwestern, Dr. Kathy Bell, studied the effects of PST among service members with TBI.”

“Further, much of my research since 2015 has focused on how we can leverage mobile health to better reach people with TBI who are living in the community and managing the chronic effects of their injury,” she adds.

The current project, Development and Pilot Testing of eHealth Problem Solving Training for Adults with TBI, builds on the combined work of Drs. Juengst and Bell.

PST is an intervention technique that teaches a standard, step-by-step strategy that can be used to solve problems or achieve goals.¹ There are six steps:

1. A = Assess
2. B = Brainstorm
3. C = Consider and Choose
4. D = Develop and Do
5. E = Evaluate
6. F = Flex

“This strategy could be applied to whatever everyday problems and goals a person chooses, making it flexible and adaptable to every individual,” Dr. Juengst notes. “By supporting goal achievement and a person’s ability to solve daily problems, we could improve function, health and overall quality of life of veterans and/or service members and civilians with TBI.”

While PST is already delivered remotely, either over the phone or by video call, it still requires time from a trained therapist, as well as coordination of times for a therapist and the individual with TBI to meet. Making the process digital may ease access and allow for enhanced outcomes.

“With more people having access to and comfort using mobile devices, more people could benefit from PST if we could adapt it to an electronic format,” Dr. Juengst says. “This project will adapt the evidence-based PST intervention so that it can be delivered using web-based modules and a mobile health smartphone app. It seeks to address the critical need for more widely available, accessible and effective supports for persons living with the chronic psychological health consequences of TBI.”

The initial 18 months of the study will focus on adapting and developing the electronic PST (ePST).

Specifically, Dr. Juengst and her team will be partnering with collaborators who have expertise in experiential and learning design, behavioral health interventions and TBI as well as a commercial app developer.

And key to this project will be the establishment of a community advisory board (CAB) made up of a diverse group of people with lived TBI experience, such as survivors and care partners; community partners, including professional organizations serving people with TBI; people from the community with disabilities; and TBI researchers in both civilian and military settings.

“Our CAB will codesign and codevelop our ePST intervention, inform pilot testing and iterative adaptations and actively participate in disseminating and implementing ePST at the end of the project,” Dr. Juengst says.

“What’s especially unique about this is that the CAB are not just advisors, but active partners and collaborators with equal say in all decisions,” she adds. “We’ll work with CAB members to include them as co-authors, co-presenters and future co-investigators.”

During the second 18 months of the project, the team will test three versions of the intervention: The first will focus on six sessions of traditional one-on-one PST with a coach/therapist, conducted over the phone or via video conference. The second intervention will consist of a hybrid ePST approach, which includes completing online ePST modules, followed by three one-on-one sessions with a coach/therapist. The third approach will be fully digital, using the self-guided ePST and the app, which is being labeled STEPS.

During the second 18 months of the project, the team will test three versions of the intervention: The first will focus on six sessions of traditional one-on-one PST with a coach/therapist, conducted over the phone or via video conference. The second intervention will consist of a hybrid ePST approach, which includes completing online ePST modules, followed by three one-on-one sessions with a coach/therapist. The third approach will be fully digital, using the self-guided ePST and the app, which is being labeled STEPS.

To Dr. Juengst, the project offers an exciting opportunity to explore novel approaches for aiding those with TBI and the people who aid in their care and reflects the ongoing status of TIRR Memorial Hermann as a center for cutting-edge clinical research.

“The BIRC at TIRR Memorial Hermann has a decades-long program of research that has focused on community participation, mental health and health disparities, which this work extends,” she notes. “BIRC research has always prioritized the needs and viewpoints of persons with lived experience, but the community-based participatory research approach formalizes and extends that to a new level.

“This project incorporates the innovation of mobile health technology with the needs and preferences of persons with TBI to have simple, accessible and easy-to-use tools to help them live meaningful lives and engage in self-management of their health and well-being,” she adds.

Reference

1. Nezu AM, Nezu CM, D’Zurilla TJ. Solving Life's Problems: A 5-Step Guide to Enhanced Well-Being. Springer; 2007.
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