Training to Reconnect With Emotional Awareness Therapy: A Randomized Controlled Trial in Participants With Traumatic Brain Injury.

Objective: To examine the efficacy of an intervention, Training to Reconnect with Emotional Awareness Therapy (TREAT) at improving alexithymia, emotion dysregulation, anxiety, depression, anger, and global positive and negative affect in participants with traumatic brain injury (TBI).

Design: Randomized, waitlist control (WLC) trial with 3-month follow-up.

Setting: Outpatient brain injury rehabilitation center.

Participants: Adult participants, who were on average 11.37 years postcomplicated mild-to-severe TBI and also had elevated alexithymia (n=44), who were randomized to immediate treatment (TREAT; n=20) or WLC (WLC=24).

Interventions: Eight sessions, structured training program that teaches emotional awareness and discrete labeling of emotions.

Main Outcome Measures: Toronto Alexithymia Scale-20, Levels of Emotional Awareness Scale, Difficulty with Emotion Regulation Scale, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9; State-Trait Anger Expression Inventory (STAXI), Positive and Negative Affect Schedule (PANAS); and Patient Global Impression of Change.

Results: Thirty-four participants completed the study per protocol. Compared with WLC participants (n=16) who had not yet received the intervention, TREAT participants (n=18) had significantly less alexithymia, emotion dysregulation, anxiety, and depression (all P's<.05) within approximately 1 week of completing the intervention. Before/after results from the pooled sample (n=34) showed significant improvements, immediately and 3 months after the intervention, on all outcomes except the STAXI and the Positive Affect subscale of the PANAS. On the Patient Global Impression of Change, a noticeable change in global emotional function and quality of life was reported by 80%. Intent-to-treat analyses (n=38) revealed similar results to the per protocol sample.

Conclusions: Findings support the efficacy of TREAT for reducing alexithymia and emotion dysregulation in individuals with chronic TBI. Although outcomes were also promising for anxiety and depression, more research using attention-control designs are warranted to control for the attention received during treatment.