Resilience following spinal cord injury: A prospective controlled study investigating the influence of the provision of group cognitive behavior therapy during inpatient rehabilitation.
OBJECTIVE
To examine change in resilience in people with spinal cord injury (SCI) when group cognitive behavior therapy (GCBT) was added to routine psychosocial rehabilitation (RPR).


METHODS
A prospective repeated-measures cohort design was used to determine the efficacy of the addition of GCBT (n = 50). The control group consisted of individuals receiving RPR, which included access to individual CBT (ICBT) when required (n = 38). Groups were assessed on 3 occasions: soon after admission, within 2 weeks of discharge, and 6-months postdischarge. Measures included sociodemographic, injury, and psychosocial factors. The outcome variable was resilience, considered an important outcome measure for recovery. To adjust for baseline differences in self-efficacy, depressive mood and anxiety between the 2 groups, these factors were entered into a repeated measures multivariate analysis of covariance (MANCOVA) as covariates. Latent class analysis was used to determine the best-fitting model of resilience trajectories for both groups.


RESULTS
The MANCOVA indicated that the addition of GCBT to psychosocial rehabilitation did not result in improved resilience compared with the ICBT group. Trajectory data indicated over 60% were demonstrating acceptable resilience irrespective of group.


CONCLUSIONS
Changes in resilience mean scores suggest the addition of GCBT adds little to resilience outcomes. Latent class modeling indicated both groups experienced similar trajectories of improvement and deterioration. Results highlight the importance of conducting multivariate modeling analysis that isolates subgroups of related cases over time to understand complex trajectories. Further research is needed to clarify individual differences in CBT intervention preference as well as other factors which impact on resilience.
John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, University of Sydney.
Rebecca
R
Guest
John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, University of Sydney.
Ashley
A
Craig
Australian College of Applied Psychology.
Kathryn
K
Nicholson Perry
John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, University of Sydney.
Yvonne
Y
Tran
Spinal Cord Injury Unit, Royal Rehabilitation Centre.
Catherine
C
Ephraums
Spinal Cord Injury Unit, Royal Rehabilitation Centre.
Alison
A
Hales
Spinal Cord Injury Unit, Prince of Wales Hospital.
Annalisa
A
Dezarnaulds
School of Psychology, Charles Sturt University.
Rocco
R
Crino
John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, University of Sydney.
James
J
Middleton
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001008:Anxiety Disorders / Q000523:psychology / Q000534:rehabilitation; D015928:Cognitive Behavioral Therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000523:psychology / Q000534:rehabilitation; D010343:Patient Admission; D011615:Psychotherapy, Group; D055500:Resilience, Psychological; D020377:Self Efficacy; D013119:Spinal Cord Injuries / Q000523:psychology* / Q000534:rehabilitation*; D055815:Young Adult