The influence of cognitive complaints, cognitive performance and emotional
distress on self-efficacy in patients with acquired brain injury
I. Verlinden1, I. Brands1
1
Department of Neurorehabilitation, Libra Rehabilitation Medicine & Audiology, Eindhoven,
The Netherlands
Objective
Self-efficacy refers to the belief in one’s capabilities in achieving goals. High self-efficacy
implies a high sense of control and mastery. In acquired brain injury (ABI) higher levels of
both general self-efficacy and self-efficacy for managing brain injury-specific symptoms have
been associated with better quality of life (QoL) and social participation. In patients with
cancer and rheumatoid arthritis the stress-buffering effect of high self-efficacy is well
documented. Highly self-efficacious patients reported lower levels of distress, anxiety and
depression. Cognitive deficits are frequently present in patients with ABI and often interfere
with many aspects of daily life and psychosocial functioning. In stroke patients, subjective
memory complaints showed to be associated with lower memory self-efficacy, but not with
objective memory performance. In MS, better cognitive performance was associated with
higher levels of self-efficacy. The aim of this study was to examine the influence of cognitive
performance, cognitive complaints and emotional distress on self-efficacy for managing brain
injury-specific symptoms in patients with ABI.
Methods
Data were collected from a prospective clinical cohort study of 61 patients with acquired
brain injury assessed after discharge home (mean time since injury = 14.8 weeks). Selfefficacy was measured using the TBI Self-Efficacy Questionnaire (SEsx), emotional distress
with the Hospital Anxiety and Depression Scale (HADS), cognitive complaints with the
Dysexecutive Questionnaire of the Behavioral Assessment of the Dysexecutive syndrome
(DEX). Information processing speed was measured using the Symbol Digit Modalities Test
(SDMT), cognitive flexibility with a compound score of condition 4 of the D-KEFS trail making
test (number-letter sequencing) and subtask III of the Stroop Color Word Test, memory with
a compound score of the total correct and delayed recall score on the 15 words learning
task. Multiple hierarchical regression analyses were used to analyse data.
Results
Higher levels of emotional distress and higher levels of subjective cognitive complaints were
significantly associated with lower self-efficacy for managing brain injury-specific symptoms
(β = −.37; p = 0.008 and β = −.45; p = .002 respectively). DEX scores accounted for 42% and
HADS scores for 5% of the total 65% variance explained. Objective cognitive performance
was not significantly associated with self-efficacy.
Conclusion
Control over interfering emotions and developing a sense of control and mastery over brain
injury-associated symptoms seem to be of importance in the development of self-efficacy for
managing brain injury-specific symptoms. Treatment programmes should focus explicitly on
reinterpretation of interfering thoughts and symptoms and the reinforcement of self-beliefs.