title: Cognitive and psychological flexibility after a traumatic brain injury and the implications for treatment in acceptance-based therapies: A conceptual review.
abstract: This paper provides a selective review of cognitive and psychological flexibility in the context of treatment for psychological distress after traumatic brain injury, with a focus on acceptance-based therapies. Cognitive flexibility is a component of executive function that is referred to mostly in the context of neuropsychological research and practice. Psychological flexibility, from a clinical psychology perspective, is linked to health and well-being and is an identified treatment outcome for therapies such as acceptance and commitment therapy (ACT). There are a number of overlaps between the constructs. They both manifest in the ability to change behaviour (either a thought or an action) in response to environmental change, with similarities in neural substrate and mental processes. Impairments in both show a strong association with psychopathology. People with a traumatic brain injury (TBI) often suffer impairments in their cognitive flexibility as a result of damage to areas controlling executive processes but have a positive response to therapies that promote psychological flexibility. Overall, psychological flexibility appears a more overarching construct and cognitive flexibility may be a subcomponent of it but not necessarily a pre-requisite. Further research into therapies which claim to improve psychological flexibility, such as ACT, needs to be undertaken in TBI populations in order to clarify its utility in this group.
authors.affiliation: a Liverpool Brain Injury Rehabilitation Unit , Liverpool Hospital , Liverpool , Australia.|b School of Psychology , University of Wollongong , Wollongong , Australia.|d Brain Injury Rehabilitation Research Group , Ingham Institute of Applied Medical Research , Liverpool , Australia.
authors.forename: Diane L
authors.initials: DL
authors.lastname: Whiting
authors.affiliation: b School of Psychology , University of Wollongong , Wollongong , Australia.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Deane
authors.affiliation: a Liverpool Brain Injury Rehabilitation Unit , Liverpool Hospital , Liverpool , Australia.|c John Walsh Centre for Rehabilitation Research , University of Sydney , Sydney , Australia.|d Brain Injury Rehabilitation Research Group , Ingham Institute of Applied Medical Research , Liverpool , Australia.
authors.forename: Grahame K
authors.initials: GK
authors.lastname: Simpson
authors.affiliation: e Institute of Health and Well-being , University of Glasgow , Glasgow , Scotland.
authors.forename: Hamish J
authors.initials: HJ
authors.lastname: McLeod
authors.affiliation: f Institute of Positive Psychology & Education , Australian Catholic University , Strathfield , Australia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ciarrochi
mesh_terms: D064869:Acceptance and Commitment Therapy; D000070642:Brain Injuries, Traumatic / Q000523:psychology* / Q000534:rehabilitation; D003071:Cognition; D006801:Humans; D013315:Stress, Psychological / Q000523:psychology* / Q000628:therapy
keywords: Acceptance and commitment therapy (ACT); Cognitive flexibility; Conceptual review; Psychological flexibility; Traumatic brain injury