How flexible is coping after acquired brain injury? A 1-year prospective study investigating coping patterns and influence of self-efficacy, executive functioning and self-awareness

Brands, Ingrid; S Köhler; Stapert, Sven; Wade, Derick T; van Heugten, Caroline · 2014 · OpenAlex-citations

DOI: 10.2340/16501977-1849

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Summary

This prospective study investigated coping flexibility in patients with newly acquired brain injury (ABI), specifically examining how coping patterns evolve over one year and how they are influenced by self-efficacy, executive functioning, and self-awareness. While coping is a known determinant of psychosocial adaptation after ABI, prior research largely relied on cross-sectional designs that failed to capture intra-individual flexibility—the ability to adapt strategies to changing situational demands. This study aimed to fill that gap by analyzing whether patients adjust their coping responses based on problem type and time, and how clinical variables affect this flexibility. The researchers conducted a prospective clinical cohort study involving 136 patients assessed at baseline (mean 15 weeks post-injury) and one year later. Participants identified three stressful ABI-related situations, which were categorized into problem types (e.g., physical, cognitive, emotional). Coping strategies were measured using the Coping Inventory for Stressful Situations (CISS), assessing task-oriented, emotion-oriented, and avoidance coping. The study quantified coping variability (range of strategy use across situations) and consistency (strategies used in every situation). Additional measures included the TBI Self-efficacy Questionnaire, the Dysexecutive Questionnaire for self-reported executive function, and the Awareness Questionnaire. Random effects regression analyses were employed to account for repeated measures and correlations within individuals. The results indicated that coping variability was limited, with patients relying on a defined set of strategies across different situations and over time. Consistency was highest for task-oriented coping. Patients utilized more task-oriented coping for cognitive problems than for physical ones. Over the one-year period, reliance on emotion-oriented coping decreased significantly. Higher self-efficacy correlated with increased task-oriented and avoidance coping, but decreased emotion-oriented coping and lower variability in emotion-oriented strategies. Conversely, greater self-reported executive dysfunction was associated with higher consistency in both task-oriented and emotion-oriented strategies, suggesting rigid coping patterns. Higher educational attainment was linked to substantially lower use of avoidance and emotion-oriented coping. The study concludes that patients with ABI generally exhibit low coping flexibility, maintaining consistent strategies regardless of situational demands. High self-efficacy promotes active, problem-focused coping, whereas subjective executive dysfunction appears to hamper effective strategy selection, leading to rigid coping behaviors. These findings suggest that interventions aimed at improving psychosocial adaptation after ABI should focus on enhancing self-efficacy and addressing executive function deficits to foster more flexible and adaptive coping mechanisms.

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• cognitive impairment