Interventions
anger, anxiety, Cognitive symptoms, post-brain injury, depression, Stress reduction
SESSION, HEART, POST-CONCUSSION SYNDROME
Participants randomized to the psychoeducation group received a 60-min psychoeducation session both orally and on paper and were given a booklet to take home. The psychoeducation included standardized information about the causes, incidence, and possible consequences of mTBI, as well as advice on strategies for post-brain injury symptom reductions, memory and attention improvement, stress and emotional regulation, and sleep hygiene (Table The Psychoeducation Session ComponentSession 1- General exploration of mTBI: typical symptoms, deficits, and time course- Understanding post-concussion syndrome: (1) Physical symptoms (2) Cognitive symptoms (3) Emotional symptoms- Sleep hygiene- Stress reduction strategies: (1) Problem-solving orientation (2) Emotionally focused orientation- Strategies for coping with physical symptoms: (1) Adjusting workload and achieving pre-injury performance gradually (2) Rest adequately and avoid overloading- Strategies for coping with cognitive symptoms: (1) Concentration and memory: be inquisitive, reduce distractions, and use compensatory strategies- Strategies for coping with emotional symptoms (depression, anxiety, anger (1) Examine thoughts and check facts (2) Behavioral activation (3) Stress and anger management (4) Maintain friends and family support networksThe Heart Rate Variability Biofeedback Session ComponentSession 1- An introduction to the HRV-BF- Estimating the resonance frequency for the individual- Providing abdominal breathing training instructions that emphasize slow, stable, and smooth breathing- Homework: the participant was instructed to practice breathing comfortably at his/her resonance frequency by connecting the KYTO Bluetooth mobile heart rate monitor to the ear clip, as well as using the Elite HRV smartphone app as a tool for HRV-BF home exercise by exhaling more than inhaling for two 20-min periodsSession 2- Reviewing home practice records through the Elite HRV dashboard (HRV tracking, identifying trends and behavior patterns, and detailed reporting)Session 3- Reviewing home practice records through the Elite HRV dashboard (HRV tracking, identifying trends and behavior patterns, and detailed reporting)- A review of abdominal breathing with slow exhalations at the resonance frequency- A cardiotachometer display is used as biofeedback to instruct the participant to maximize RSA. Breathing in phase with HR changes and maximizing heart rate changes is instructed to the participant- Homework: the participant was instructed to practice breathing comfortably at his/her resonant frequency by connecting the KYTO Bluetooth mobile heart rate monitor to the ear clip, as well as using the Elite HRV smartphone app as a tool for HRV-BF home exercise by exhaling more than inhaling for two 20-min periodsSession 4–9- Reviewing home practice records through the Elite HRV dashboard (HRV tracking, identifying trends and behavior patterns, and detailed reporting)- A cardiotachometer display is used as biofeedback to instruct the participant to maximize RSA. Breathing in phase with HR changes and maximizing heart rate changes is instructed to the participant- Homework: the participant was instructed to practice breathing comfortably at his/her resonant frequency by connecting the KYTO Bluetooth mobile heart rate monitor to the ear clip, as well as using the Elite HRV smartphone app as a tool for HRV-BF home exercise by exhaling more than inhaling for two 20-min periodsSession 10- Reviewing home practice records through the Elite HRV dashboard (HRV tracking, identifying trends and behavior patterns, and detailed reporting)- A cardiotachometer display is used as biofeedback to instruct the participant to maximize RSA. Breathing in phase with HR changes and maximizing heart rate changes is instructed to the participant- Review the treatment effectiveness of HRV-BF