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IU researchers develop new therapy to help brain injury patients with emotion processing

IU School of Medicine • 1/19/17

INDIANAPOLIS — Researchers at Indiana University School of Medicine  are developing a potential treatment for people who have problems processing their emotions after a traumatic brain injury. This promising treatment incorporates a short series of lessons and exercises.

The researchers said their newly developed intervention is the first, to their knowledge, to show benefits for people with such traumatic brain injury-induced problems. Currently there are no standard treatments for such emotion processing problems.

The results of the small phase 1 trial merit additional larger studies, they said. The research was a collaboration of the school and EmotEd LLC, a startup company developing emotional rehabilitation products.

The phase I trial, led by Dawn Neumann, PhD, assistant professor of physical medicine and rehabilitation and founder of EmotEd, was published online, ahead of print in the Journal of Head Trauma Rehabilitation. This article will be appearing in a special topic issue on treatments for emotional deficits after traumatic brain injuries that is scheduled to be published in the summer of 2017.

Emotional self-awareness is critical for emotional regulation and successful interpersonal interactions. Poor emotional self-awareness – called alexithymia – is seen in 30 to 60 percent of people with a traumatic brain injury. This emotional disconnect can make it difficult for people to recognize, label, and differentiate their own emotional responses, which can be damaging to relationships.

A few earlier studies targeting alexithymia have drawn subjects from the general population, whereas Dr. Neumann developed the treatment to address people with traumatic brain injuries, who are several times more likely to develop alexithymia.

The intervention included eight lessons with interactive discussion. The first four taught the participants how to identify and label emotions.

The last four lessons were scenario based, allowing participants to process an emotional response to certain events simulated through first person perspective videos, such as being yelled at by their boss in front of their colleagues. Throughout the intervention, participants learned how to recognize, label, and differentiate how they felt in response to emotional events.

“This trial’s primary focus was more on establishing emotional awareness and an emotional vocabulary rather than emotional control, and past studies have shown that emotional responses are better regulated when one is able to label emotions using specific words,” said Dr. Neumann.

Initially, study participants underwent testing to measure alexithymia, emotional awareness, anger, anxiety, depression, affect and overall emotion regulation. Participants were tested again after the eight-session intervention.

After the intervention, 62 percent of participants were classified in a less severe category of alexithymia. Six participants were reclassified to normal, and five of those six remained in that category at the two-month follow-up. Forty-six percent of participants showed a clinical change in emotional awareness immediately after the treatment, and 62 percent of participants exhibited a clinical change at the two-month follow-up. Anxiety, anger, positive affect, and overall emotion dysregulation assessments also showed improvements, however the improvements in anger did not appear in the follow up. Researchers found that the intervention had no significant impact on depression.

Dr. Neumann and her team expect to proceed to a phase II trial, based on the positive results of the phase I trial. The phase II trial would include more participants and a control group.

Support for the research was provided by a National Institutes of Health Small Business Technology Transfer Phase I grant, 1R41HD077967-01A1, to EmotEd, and by the Indiana University Funding Opportunities for Research Commercialization and Economic Success program.

Dr. Neumann, founder of EmotEd, was financially compensated for efforts pertaining to this research and has a commercial interest in the training program described in the research. Co-authors James Malec, PhD, research director of physical medicine and rehabilitation, and Flora Hammond, MD, chair of the Department of Physical Medicine and Rehabilitation, received funds through Indiana University’s subcontract with the business for their work on this project.