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The Prevalence and Impact of Adjustment Difficulties and Substance Use Subsequent to Spinal Cord Injury

The Prevalence and Impact of Adjustment Difficulties and Substance Use Subsequent to Spinal Cord Injury. Presenter: Dr. Cheryl Bradbury, C.Psych. OVERVIEW: The scale of the problem. Prevalence of Emotional Distress and Substance Abuse Impact Potential Treatment Avenues. OBJECTIVES:.

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The Prevalence and Impact of Adjustment Difficulties and Substance Use Subsequent to Spinal Cord Injury

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  1. The Prevalence and Impact of Adjustment Difficulties and Substance Use Subsequent to Spinal Cord Injury Presenter: Dr. Cheryl Bradbury, C.Psych

  2. OVERVIEW:The scale of the problem • Prevalence of Emotional Distress and Substance Abuse • Impact • Potential Treatment Avenues

  3. OBJECTIVES: For Clinicians • Information on signs and signals • Information on intervention techniques and resources For Patients and Families • Information and Education • Potential Treatment Avenues

  4. PREVALENCE The scale of the problem

  5. Prevalence of emotional distress in SCI: • Depression upwards of 40% (Bombardier et al. 2004; Migliorini et al. 2008) • Anxiety range from 10-25% (Kennedy, P & Rogers, 2000; North et al1999) • Adjustment Difficulties • Comorbidity is common (Scivoletto et al 1997; Migliorini et al. 2008) Methodological Limitations (Elliott & Frank, 1996)

  6. Prevalence of substance abuse in SCI: • Alcohol Use 14 to 50 % (Kolakowsky-Hayner et al 2002; Tate et al 2004) • Substance Abuse in upwards of 11 to 26 % (Tate et al 2004 ) • Prescription Drug Use (Heinemann et al 1992) • Comorbidity is common

  7. THE IMPACT Rehabilitation and Beyond, Quality of Life and Community Re-Integration

  8. Impact of Emotional Distress in SCI • Rehabilitation Outcomes (Elliott & Kennedy, 2004) • Community Integration (Kennedy & Rogers, 2000) • Family Discord (Fuhrer et al, 1993) • Suicidality (Devivo MJ, et. al, 1991)

  9. Impact of Substance Usein SCI • Rehabilitation Outcomes (Heinemann, et al 1990) • Increased Depression Rates (Heinemann, et al 1990) • Medical Complications (Findley et al, 2011; Tate, 1993)

  10. TREATMENT AVENUESWhat might work &Where to find help

  11. Substance Abuse: • Abstinence • Harm reduction • Emotional Adjustment

  12. Depression and Adjustment: • Psychological Treatments (Craig et al, 1997; 1998; 1999; Duchnick et al 2009; Kennedy et al 2003) • Pharmacological Treatments (Kemp et al 2004; Kahan et al 2006) • Exercise (Hicks et al 2003; 2005; Kennedy et al 2006)

  13. CBT:A Possible Treatment? Preliminary evidence is promising (Craig et al, 1997; 1998; 1999; Kennedy et al 2003) Yet to be evaluated extensively with spinal cord injury and neurological populations

  14. Barriers to Treatment in SCI • Mobility Restrictions • Economic Limitations • Geographical Location

  15. Improving Psychological Wellness After Spinal Cord InjuryStudy Investigators: Dr. Robin Green, Dr. Mark Lau, Dr. Anthony Burns, Dr. Jim Huth, Ms. Heather FlettCollaborators: Ms. Jasmin Corbie, Mr. David Gold

  16. Objectives To evaluate the efficacy of a brief, CBT intervention for the treatment of emotional distress in SCI Predictions: • Significant improvement in emotional distress pre to post CBT • Benefits maintained at 1 month and 3 months post-treatment • Secondary benefits in life satisfaction and community integration

  17. Methods:Participants Participants with SCI living in the community Inclusion Criteria: • Age 18-65 (up to 70) • Greater than 1 year post SCI • Clinically significant emotional distress (Symptom Checklist 90, revised) Exclusion Criteria: • Current suicidality or psychotic disorder • Acquired language disorder • Other Neurodegenerative Disorder

  18. Methods: Demographics

  19. Methods: Measures Primary Outcome Measures • Symptom Checklist 90, revised (SCL-90R) Global Severity Index (GSI) • Depression Anxiety Stress Scale(DASS-21) Secondary Outcome Measures • Community Integration Questionnaire (CIQ) • Satisfaction with Life Scale (SWLS)

  20. Methods: Procedures Treatment Group (N=21) Pre-treatment Post-treatment 1- Month Follow-up 3- Month Follow-up Waitlist Control (N=25) Waitlist Treatment Post-treatment 1- Month Follow-up 3- Month Follow-up

  21. Methods:Procedures Pre-Treatment questionnaires Treatment • 12 sessions of CBT Control • Wait list for approximately 4 months Post treatment questionnaires 1 and 3 month Follow-up Sessions

  22. Methods: CBT Overview • Thoughts • Feelings • Behaviours

  23. The Five Factor Model Environment/Situation Thoughts/Images Moods/ Feelings PhysicalReactions Behaviour

  24. The General Cognitive Model Situation Automatic Thoughts And Images Reaction (Emotional/ Behavioural/Physiological)

  25. Core Beliefs and Assumptions Automatic thoughts Assumptions Core Beliefs

  26. Thinking Mistakes/Cognitive Distortions • Identify thinking mistakes/cognitive distortions • Catastrophizing • All or nothing thinking • Emotional reasoning • Should thinking • Mind reading • Etc.

  27. Data Analysis • Repeated Measures ANOVA • Planned comparisons with Individual t-tests • Planned comparisons with Paired t-tests

  28. Results: Between Group Differences on SCL-90-R ** ** P<.05, ***P<.001

  29. Results: Between Group Differences on Total DASS-21 Total Score *** ** P<.05, ***P<.001

  30. Results: Between Group Differences on SWLS ** P<.05, ***P<.001

  31. Results: Between Group Differences on CIQ ** P<.05, ***P<.001

  32. Discussion Group CBT for the treatment of emotional distress in SCI is promising: • Group CBT was beneficial • Treatment effects were maintained over time • However a significant barrier was accessibility to services

  33. Summary and Future steps… • Substance Misuse & Emotional Distress in SCI are pertinent concerns • Can adversely impact upon health and quality of life • CBT improved emotional wellbeing with some lasting effects but further research is needed Further Research • Factors predicting outcomes • Investigate teletherapy options for services delivery

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