What we study
We do traditional neuropsychological research that examines psychological (cognitive, behavioural, and emotional) consequences of brain injury or illness. However, we are especially interested in how people think about and cope with neurological symptoms such as memory problems and sensory sensitivity, how coping behaviours influence the experience and expression of symptoms, and how we can reduce symptoms and disability with rehabilitation interventions that facilitate adaptive coping. In other words, we study the psychological determinants of health in neurological disorders. Concussion (mild traumatic brain injury) is a major focus of our research, as it is a useful clinical model for understanding how people cope with neurological symptoms. We also study the implementation of evidence into clinical care for patients with concussion.
Examples of active research projects
GET FAB (Graded Exposure Therapy for Fear Avoidance Behaviour after Concussion)
Status: Data collection completed, analyses and secondary studies underway.
How people cope with their symptoms following concussion powerfully influences their recovery. Our early research indicated that fear avoidance behaviour is a particularly unhelpful approach to coping, in which people perceive their pre-injury activities as unnecessarily dangerous and take great care to avoid overexertion and overstimulation. We developed and pilot tested a psychological therapy, called graded exposure therapy, to reduce fear avoidance behaviour. Our preliminary work suggested that graded exposure therapy was acceptable to patients with concussion and beneficial for their recovery. In this definitive randomized controlled trial, patients were recruited from a network of concussion clinics across Canada. Patients were assigned at random to a treatment-as-usual control group, graded exposure therapy group, or a group receiving another kind of therapy that might have similar benefits (prescribed aerobic exercise). We expected that patients who participated in graded exposure therapy would have reduced fear avoidance behaviour and post-concussion symptom severity compared to other treatment conditions and this difference would be greatest for patients who entered the study with high fear avoidance behaviour.
See the Clinicaltrials.gov registration and protocol paper for details.
Co-investigators: Mark Bayley, Matthew Burke, Molly Cairncross, Chantel Debert, Will Panenka, Debbie Snell, Carmela Tartaglia, Ana-Maria Vranceanu, Keith Yeates.
REMEMBR (REhabilitation of MEMory symptoms after BRain concussion)
Status: Ongoing
People often experience memory and other cognitive problems that are not fully explained by brain injury or disease. It is not well understood how “functional” cognitive symptoms develop and persist. Persistent memory symptoms after concussion are common, and likely perpetuated by unhelpful illness beliefs and coping behaviors. We created and piloted a novel cognitive behavioural therapy (CBT) protocol to target these perpetuating factors. We are now comparing this CBT intervention to traditional cognitive rehabilitation in a larger, multisite randomized controlled trial for adults with persistent memory symptoms after concussion.
See Clinicaltrials.gov for details.
Co-investigators: Mark Bayley, Matthew Burke, Miles Byworth, Chantel Debert, Michael Rathbone, Carmela Tartaglia, Roger Zemek.
MAPS (Mobile assessment for post-concussion symptom mapping)
Status: Ongoing
Up to 30% of Canadians who sustain a concussion will endure persistent disabling symptoms (i.e., headaches, fatigue, dizziness, and difficulty concentrating) for more than 3-6 months. Clinical practice guidelines recommend symptom-based treatment; however, most clinic patients present with multiple symptoms, in varying constellations and there is currently no evidence-based method for prioritizing or sequencing symptom-based treatments. Person-specific network mapping is a new method for identifying the most central symptoms (i.e., if treated, will have the largest effect on the entire network of symptoms) at the individual patient level. The present study aims to evaluate the feasibility of person-specific network modeling after mTBI. We will confirm that ecological momentary assessment (EMA) is acceptable and feasible in adults with concussion, determine what resources are needed to achieve high compliance in this population, and assess the feasibility of deriving informative person-specific networks from EMA data. In a substudy exploring wearable sensors, participants will wear smart watches and rings during the EMA period to track physiological indicators of stress.
Co-Investigators: Aaron Fisher, Jiaer (Cecilia) Guo, Amanda Rabinowitz, Shuyuan Shi.
Framing (nocebo) effects of head injury infographics
Status: Ongoing
A current standard of care for concussion patients is to provide early education about head injury symptoms and expectations for recovery. Written concussion education materials vary widely in how they emphasize, present, and frame the information provided (e.g., focusing on reassurance vs. vigilance; gain vs. loss, risk vs. reward; including icons or images). Despite this variation in presentation, the potential for educational materials to negatively influence recovery has not been investigated. This study aims to assess whether commonly found differences in framing between educational materials have the potential to affect illness perceptions in patients and to assess whether the negative framing of concussion educational information has the potential to influence concussion-related illness perceptions in a clinical population of people who have recently sustained a concussion.
Co-Investigators: Baljeet Brar, Jeff Brubacher, Matthew Burke, Joseph Ip, Brendan Kelliher, Edwina Picon, Frank Scheuermeyer, Nancy Sin.