Brain Injury Coping Skills: A support and education program for adults with brain injury and their caregivers

Brain Injury Coping Skills: A support and education program for adults with brain injury and their caregivers

Samantha Backhaus, Ph.D. and Summer Ibarra, M.A.

Brain Injury Coping Skills was developed to advance evidence-based practice to help families and survivors cope with the effects of brain injury. This intervention includes supportive psychotherapy, psychoeducation, stress management and problem-solving skills through the use of cognitive behavioral therapy approaches. This unique approach to helping adults with brain injury and their caregivers in the community uses a 16 week cognitive behavioral treatment intervention. The manual documents content for 20 sessions with detailed instructions for facilitators, session activities, homework assignments, and a CD with handouts and worksheets. Winner of 2009 McDowell Award by American Society for Neurorehabilitation

Item: BICS
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Full Description

Brain Injury Coping Skills is based on the recognition that education and support are critical for helping families and survivors rebuild their lives and relationships after an acquired brain injury. Authors Backhaus and Ibarra have developed a comprehensive and unique program that is pragmatic and user friendly. The workbook provides detailed instructions and handouts covering modules on:

  • Healthy Brain
  • Effects of Brain Injury
  • Importance of Family
  • Expectations for Recovery
  • Challenges after Brain Injury
  • Stress Management Skills

Designed as a 16 week program with 20 sessions, research studies on the Brain Injury Coping Skills have demonstrated improvements in participants’ perceived self-efficacy, emotional status, anger control, and disinhibition. With an emphasis on stress management and neurobehavioral techniques, this program is ideal for out-patient rehabilitation programs, residential services, and community agencies.

ISBN# 978-1-931117-63-0
Pages 117 pages with CD for all worksheets
Year 2012


Samantha Backhaus, Ph.D

She is a Clinical Neuropsychologist at the Rehabilitation Hospital of Indiana’s comprehensive outpatient brain injury Neuro Rehab Center. Her primary focus is working with adults who have acquired brain injuries, both providing neuropsychological assessments and formulating appropriate interdisciplinary treatment plans to help individuals reintegrate back to the community.

Her passion is working with families with the overall goal of helping the survivor achieve a positive long-term outcome following brain injury. Dr. Backhaus developed a 16-week treatment intervention, the Brain Injury Coping Skills Group (BICS) that won the 2009 McDowell Award for Best Presentation presented by the American Society for Neurorehabilitation. She is asked to teach this intervention to clinicians throughout the rehabilitation field, both nationally and internationally.

She has won one of the Healthcare Heroes of the Year in her community in 2001 for her work in neurorehabilitation. She also developed a Peer Mentoring Program for brain injury survivors and family members, as well as chairs a support group called Bridging the Gap, specifically designed to meet the needs of families and caregivers in addition to survivors of brain injury.

Summer Ibarra, M.A.

As a Neuropsychology Technician at the Rehabilitation Hospital of Indiana, Ms Ibarra assisted in the development, data collection, and evaluation of the Brain Injury Coping Skills program. Working closely with Dr. Backhaus, she was instrumental in the design and implementation of the program.



The Dr. Lisa's Story

Rationale for BICS

References Components of the BICS Group

Module 1

Session 1: The Healthy Brain, Part 1

Worksheet 1: Inside View of the Brain

Worksheet 2: The Two Halves of the Brain

Worksheet 3: The Four Lobes

Session 2: The Healthy Brain, Part 2

Worksheet 4: The Four Lobes, continued

Worksheet 5: Another View of the Brain

Worksheet 6: Brainstem and Injuries Deep in the Brain

Worksheet 7: The Brain

Module 2

Session 3: Brain Injury and its Effects

Worksheet 1: Leading Causes of Brain Injury

Worksheet 2: Closed versus Open Head Injury

Worksheet 3: Diffuse Axonal Injury

Worksheet 4: Hypoxia

Worksheet 5: Stroke

Worksheet 6: Risk Factors for Stroke

Worksheet 7: Survivor Symptom Checklist

Module 3

Session 4: The Importance of Family and Caregivers

Worksheet 1: 10 Warning Signs of Caregiver Stress

Worksheet 2: Helping Caregivers Cope

Module 4

Session 5: Expectations for Your Recovery

Worksheet 1: Healing and Recovery

Worksheet 2: Factors that Strengthen Recovery

Worksheet 3: Returning to Driving

Worksheet 4: Returning to Work

Worksheet 5: Alcohol Use and Brain Injury .

Module 5

Session 6: Tips on Managing Challenging Situations, Part 1

Worksheet 1: Wise Mind

Worksheet 2: General Tips for Caregivers

Session 7: Tips on Managing Challenging Situations, Part 2

Worksheet 3: Managing Irritability

Worksheet 4: Managing Anger

Session 8: Tips on Managing Challenging Situations, Part 3

Worksheet 5: Managing Impulsivity

Worksheet 6: Managing Lack of Initiation

Worksheet 7: Changes in Sexual Behavior

Worksheet 8: Decreased Sexual Interest

Worksheet 9: Increased Sexual Interest

Session 9: Tips on Managing Challenging Situations, Part 4

Worksheet 10: Managing Fatigue

Worksheet 11: Managing Problems with Sleep

Session 10: Tips on Managing Challenging Situations, Part 5

Worksheet 12: Managing Problems with Memory

Module 6

Session 11: Learning About the Signs and Symptoms of Depression

Worksheet 1: Signs and Symptoms of Depression

Module 7

Session 12: The 5 R's of Stress Management

Worksheet 1: Fight or Flight Response

Worksheet 2: Monitoring your Responses to Stress

Session 13: Relaxation

Worksheet 3: Relaxation

Worksheet 4: Deep Breathing

Session 14: Practicing More Relaxation

Worksheet 5: Having a Mindful Moment

Worksheet 6: Up, Up, and Away

Session 15: Reassuring Thinking and Effective Problem-Solving, Part 1

Worksheet 7: Reassuring Thinking

Worksheet 8: Common Types of Alarming Thoughts

Session 16: Reassuring Thinking and Effective Problem-Solving, Part 2

Worksheet 9: Cognitive Distortions

Worksheet 10: FAST Friends

Worksheet 11: Realistic Self-Talk Activity

Session 17: Solving Everyday Problems

Worksheet 12: 5 Steps to Problem-Solving

Worksheet 13: Problem-Solving Worksheet

Session 18: Caregiver Connection and Survivor

Session 19: Relating Assertively

Worksheet 14: Relating Assertively

Worksheet 15: Relating Assertively Scenarios

Session 20: Recovery “Do's and Don'ts”

Worksheet 16: Recovery Do's and Don'ts

Worksheet 17: The Art of Stress Management


Rationale for Family Involvement

There have been numerous studies documenting the significant psychological and physical effects of traumatic brain injury in survivors and caregivers, as well as justifying the need to involve family in the rehabilitation process. Brain injury can be devastating to both survivors and family members, may be life-long, and can result in psychological distress at any time after the injury. The reactions of family members and their ability to cope can also directly affect the survivor’s recovery. Thus, treatment necessitates that family members be involved to improve the rehabilitation process for their loved ones with brain injury. Teaching survivors and family members about important issues related to having an injury is likely to improve patient and family emotional well-being, as well as reduce survivor and family psychological distress.

These issues typically include:

  • the brain injury and its multitude of effects;
  • expectations for when recovery may occur;
  • strategies for managing behavioral and emotional difficulties;
  • identification of reactions to stressful situations;
  • engaging in reassuring and realistic thinking;
  • learning problem solving skills training; and
  • identifying how to recognize signs of depression and getting help.

Families have reported that they lack knowledge of the aforementioned areas and seek to obtain more information. By teaching survivors and family members about these important issues, they are likely to develop appropriate coping strategies and feel better equipped psychologically and cognitively to manage the chronic deficits that can accompany brain injury.

BICS was developed to advance evidence-based practice in assisting families coping with brain injury. This intervention includes:

  • supportive psychotherapy
  • psychoeducation
  • stress management and
  • problem-solving skills via use of CBT approaches.

The components of the group were conceptually derived and developed in response to the most important needs indicated by families and survivor reports. Furthermore, the purpose of BICS is not solely to serve as an intervention program, but also to serve as a preventive approach to the development of psychological distress in the long-term. It not only provides information on relevant topics and teaches problem-solving and stress management techniques, but it also teaches individuals how to utilize and apply appropriate stress management and problem-solving skills to everyday situations.

Studies have demonstrated that individuals who participate in BICS when compared to standard outpatient brain injury rehabilitation actually show significantly better self-efficacy and were able to maintain their improvements in mood. It also showed that when comparing BICS to other support groups, while both groups were able to show some improvement in mood and self-efficacy, participants in BICS actually maintained these benefits over time. Also, those participants showed significantly better ability to manage problems with anger control, emotional disturbances, irritability, and impulsivity than those who attended standard support groups. This suggests that it is extremely important for survivors and caregivers to participate in this type of program to help adapt to daily challenges post injury.

Components of the BICS Group

Frequently asked questions about conducting a BICS group are...

How many people can participate?

We recommend a maximum of 4-5 pairs of an adult with a brain injury and a caregiver or significant other. Adults may be from ages 18 to 65. The brain injury may be traumatic or caused by non-traumatic events including encephalopathy, anoxia hypoxia, stroke, and other causes.

How many sessions are needed?

There are 20 sessions, each 2 hours long. Although it was originally developed to be a 20-week intervention, facilitators can choose which topics to cover, depending on the needs of the class.

How many modules are there?

There are 7 modules. Some modules require more than 1 session.

Is this an open or closed format?

The sessions are a closed format with a formal start and “graduation” date.

Who can be a leader or facilitator?

Facilitators should have experience working with individuals with brain injury at a clinical level. This can include a therapist, psychologist or neuropsychologist, nurse or nurse practitioner, or social worker. However, it is strongly recommended that since this is primarily a CBT-based intervention, at least one of the facilitators should have some experience using cognitive-behavioral therapy in their practice which primarily includes individuals in the mental health field.

What teaching style is used by session facilitators?

The group is a combination of psychoeducation, supportive therapy, and teaching of cognitive-behavioral strategies. It is not a lecture, but rather involves significant discussion and learning of content material that is applied to meet the individual needs of participants. Thus, while educational content is included in the manual, facilitators are advised to carefully ascertain the needs of the participants and address areas that are pertinent to their recovery. Content that is not applicable can be skipped.

Is there a workbook?

Each group member (survivor and caregiver) receives a BICS Workbook with psychoeducation and activity sheets. It is expected that workbooks will be brought to each session for members to easily follow along. Facilitators can arrange this workbook as they best see fit. This manual is accompanied by a CD with PDF files for facilitators to print activity sheets.

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