Caring for someone with acquired brain injury: the role of psychological flexibility and a systematic review of remotely delivered interventions

To care for someone with an Acquired Brain Injury (ABI) can be a valued role in one’s life, and caregivers play a key role in the rehabilitation process. Unfortunately, caregivers of people with ABI have also been found to report greater levels of psychological distress and worse wellbeing compared to the general population. The first chapter of this thesis reports findings from a cross-sectional study exploring the role of psychological flexibility in depression, anxiety and satisfaction with life amongst ABI carers. The aim of the study was to investigate the relative strength of psychological flexibility in explaining caregiver outcomes compared to established constructs, namely cognitive appraisals, coping, social support and the perceived functional disability of the care-recipient. Psychological flexibility was found to predict most of the variance in depression and anxiety, whilst cognitive appraisal was the strongest predictor of satisfaction of life. Cognitive appraisal mediated the influence of functional disability on all outcomes, and this mediating effect was moderated by psychological flexibility on depression. Chapter one concluded that psychological flexibility appears to have a central role in psychological distress amongst ABI carers, which is adding to our understanding of how to support this population. Chapter two presents a systematic review of the evidence for remotely delivered interventions to improve the wellbeing of ABI carers. Twelve studies were identified from systematic searches. These studies evaluated a wide range of interventions that were being offered to caregivers remotely using various modes of delivery. Promising results were found on primary and secondary wellbeing outcomes. However, due to a limited number of studies it was concluded that it is currently not feasible to make any general conclusions on the efficacy of specific interventions being delivered remotely for this population. Besides, in many studies low-intensity support was potentially as effective as a structured programme. Methodological issues were discussed, and specific recommendations for future research and developments in the field were provided. Combined, the two chapters of this thesis have identified that psychological flexibility appears to play a central role for outcomes amongst ABI carers, and that remote delivery is a promising field with the potential to improve wellbeing for this population.