title: Coping and adaptive strategies of traumatic brain injury survivors and primary caregivers.
abstract: BACKGROUND
  Qualitative research methods allowed the investigator to contribute to the development of new theories and to examine change in processes over time, which added rich detail to existing knowledge of the use of coping and adaptive strategies by traumatic brain injury survivors and their primary caregivers (Ponsford, Sloan, & Snow, 2013). The advantages of phenomenological study were that it allows flexibility to explore and understand meanings attached by people to well-studied concepts such as coping, resiliency, and adaptation or compensation. Phenomenological study was sensitive to contextual factors. It also permitted the study of in-depth dynamics of coping and adaptive strategies of TBI survivors and primary caregivers, while understanding the social and psychological implications of the phenomenon.
  
  
  OBJECTIVE
  To explore the needs and deficits of adult traumatic brain injury (TBI) survivors and primary caregivers; and to identify their self-initiated coping and adaptive strategies. Significant to this study was the development of coping and adaptive strategies by the participants after their discharge from inpatient and rehabilitation treatment. The compensatory skills taught in treatment settings did not transfer to the home environment. Therefore, these strategies developed independently from previous treatment recommendations contributed to the development of theory related to rehabilitation and counseling. Distinctive to this study was the similarity of coping and adaptive strategies developed from both mild and severe traumatic brain injury survivors.
  
  
  METHODS
  This study consisted of eleven with TBI and six primary caregivers (N = 17), who participated in a series of semi-structured interviews aimed at discovering the coping and adaptive strategies utilized in dealing with the effects of brain injury. A Qualitative Phenomenological design was employed.
  
  
  RESULTS
  Patience and understanding, support, and professional help were identified by TBI survivors and caregivers as being their most relevant needs. Self-reported deficits included short-term memory loss (STM), fatigue, anger, and personality changes, and the strategies that TBI survivors and caregivers identified tended to address their problems with these specific day-to-day deficits. Problem focused, emotion focused, and avoidant coping were utilized to some degree in their adjustment to home life and activities of daily living. Participants offered suggestions for mental health professionals addressing how to more effectively work with brain injury survivors and their primary caregivers.
  
  
  CONCLUSIONS
  TBI survivors and caregivers had multiple self-reported unaddressed needs following their discharge from facility-based treatment. They reported spontaneously engaging in various coping and adaptive strategies to address their needs and deficits. However, further education regarding potential post-TBI challenges and strategies for addressing them are needed, including a need for community and mental health resources.
authors.affiliation: Hope After Brain Injury, Fort Worth, TX, USA.|Center for Counseling & Enrichment, Arlington, TX, USA.
authors.forename: Deana
authors.initials: D
authors.lastname: Adams
authors.affiliation: Baylor Institute for Rehabilitation, Dallas, TX, USA.|Baylor Regional Medical Center of Plano, Plano, TX, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Dahdah
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000223:Adaptation, Psychological / Q000502:physiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000070642:Brain Injuries, Traumatic / Q000523:psychology* / Q000534:rehabilitation; D017028:Caregivers / Q000523:psychology*; D003376:Counseling; D004644:Emotions / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology; D008875:Middle Aged; D010551:Personality / Q000502:physiology; D017741:Survivors / Q000523:psychology*
keywords: Coping skills; anger; brain injuries; caregivers; mental health; social support