Emotional activation during therapeutic interaction in traumatic brain injury: effect of apathy, self-awareness and implications for rehabilitation

Apathy and reduced self-awareness are frequent occurring neurobehavioural s equelae following traumatic brain injury (TBI). Apathy, in terms of reduced goal directed activity and lowered motivation, and reduced self-awareness have a negative impact on the rehabilitation process. In this study, 30 pat ients suffering severe TBI were clinically rated for apathy and monitored f or cardiovascular and electrodermal reactivity during baseline, neutral spe ech and therapeutic interaction. Applying a cut-off score criterion, two th irds of the TBI sample were classified as apathetic. The apathetic patients showed less psychophysiological reactivity from neutral speech to therapeu tic interaction, compared to non-apathetic patients. They also reported les s perceived emotional discomfort in the therapeutic situation measured with a visual analogue scale. Moreover, reduced self-awareness was associated w ith low autonomic reactivity. The results suggest that the reduced psychoph ysiological reactivity in apathetic patients may be a correlate to the lack of emotional responsivity, disengagement, lack of insight and concern abou t their own situation. Clinically, these results may have implications for psychotherapeutic intervention aimed at improving self-awareness. Recording psychophysiological responses during therapeutic interaction may serve as a method for monitoring emotional involvement during psychotherapy with TBI patients.