Discussion
fits, Anxiety, ’, depressive symptoms, brain injury, cognitive deficits, aphasia
Anxiety or depressive symptoms following acquired brain injury are common and there is a need for effective evidence-based treatment options. The potential usefulness of acceptance and commitment therapy for this patient group has been mentioned beforeStrong points of the BrainACT treatment are (i) its adaption to the possible cognitive deficits of patients with acquired brain injury based on previous recommendations,General alterations are the use of visual materials, summaries and repetition. Acceptance and commitment therapy specific adaptions include the Bus of Life metaphor as a recurrent exercise, shorter mindfulness exercises, and simplified explanations. Furthermore, the protocol places a strong emphasis on values and monitoring of committed actions as value-driven behaviour has already been found beneficial for people with acquired brain injury.The BrainACT treatment is an acceptance and commitment therapy covering all the processes included in the psychological flexibility model. The BrainACT treatment is in its essence acceptance and commitment therapy, no other theories or approaches, such as psycho-educations on the consequences of acquired brain injury, were integrated into the protocol; the goal was to examine whether acceptance and commitment therapy can contribute to well-being following acquired brain injury. When this approach is found beneficial it could be integrated into a holistic neurorehabilitation context and/or combined with psycho-education.Theoretically, the six core components of acceptance and commitment therapy can contribute to the adaptation process following acquired brain injury.Some cautionary remarks should be made. First, while adjustments were made for possible deficits following acquired brain injury, it is still possible that the intervention is too demanding for some patients, for instance, patients with aphasia.Next, as is common in acceptance and commitment therapy, metaphors were utilised to illustrate its different core components. Metaphors have been proven useful in other therapies for people with acquired brain injury, such as metaphoric identity mapping.Furthermore, we did not define nor explore the optimal timing for the BrainACT intervention following the acquired brain injury. The psychological adaptation process following acquired brain injury can be a long road, encompassing several years. It is not clear when the BrainACT intervention would be most helpful in this process.Lastly, as with most interventions, this is not a ‘one size fits all’ approach. For some patients, different psychotherapies might be more appropriate.The next step will be to examine the feasibility, clinical effectiveness, and cost-effectiveness of this intervention. This is currently being investigated in a multicentre randomised controlled trial with a one-year follow-up period