Building Emotional Self-awareness Teletherapy in Civilians and Service Members With Mild Traumatic Brain Injury

OBJECTIVES: To explore the early efficacy of building emotional self-awareness teletherapy (BEST) at reducing alexithymia and improving emotional functioning in civilians and military service members and veterans with mild traumatic brain injury (TBI). DESIGN: Nonrandomized, pretest-posttest design and a 3-month follow-up. SETTING: Community. PARTICIPANTS: Forty participants with mild TBI (20 civilians and 20 service members and veterans) and elevated alexithymia and emotion dysregulation. On average, participants were 40 years old and 13 years post-TBI. INTERVENTION: BEST is an 8-session, remotely delivered intervention that trains emotional insight. MAIN OUTCOME MEASURES: Toronto Alexithymia Scale-20, Levels of Emotional Awareness Scale, Difficulty with Emotion Regulation Scale, Brief Resilience Scale, Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety and Anger, Patient Health Questionnaire-9 (depression), Posttraumatic stress disorder Checklist for DSM-5 (PCL-5), Positive and Negative Affect Schedule, and Patient Global Impression of Change. RESULTS: Thirty-six participants completed the study (90% retention). Compared with baseline, participants had significant improvements immediately and 3 months after treatment on the Toronto Alexithymia Scale-20, Levels of Emotional Awareness Scale, Difficulty with Emotion Regulation Scale, Brief Resilience Scale, Positive and Negative Affect Schedule negative affect scale, PROMIS Anxiety and Anger, Patient Health Questionnaire-9, and PCL-5. All P values were <.001, except Positive and Negative Affect Schedule negative affect at immediate posttest (P=.001), PROMIS Anxiety at both posttreatment time points (P=.009 and P=.006, respectively), and PROMIS anger at 3-month follow-up (P=.001). At posttest, 75%, 70%, and 60% of participants improved by ≥½ SD on the Toronto Alexithymia Scale-20, Levels of Emotional Awareness Scale, and Difficulty with Emotion Regulation Scale, respectively. On the Patient Global Impression of Change, 83% of participants reported noticeable positive changes in their emotional functioning. CONCLUSIONS: Findings support the preliminary efficacy of BEST at improving psychological health in civilian and military participants with mild TBI who have elevated alexithymia and emotion dysregulation. However, larger trials with more rigorous designs are necessary to determine the true impact of BEST.