Adapting behavioral interventions for traumatic brain injury: strategies to improve treatment receipt and enactment.

Authors

Amanda R Rabinowitz, Tessa Hart, Angelle M Sander, Charles H Bombardier, Shannon B Juengst, Simon Driver

Published in

Translational behavioral medicine. Volume 16. Issue 1. Jan 07, 2026.

Abstract

Behavioral interventions are effective for improving mental and physical health, but individuals with traumatic brain injury (TBI) often experience cognitive and behavioral impairments that limit their ability to engage with and benefit from standard treatments.
To describe practical adaptations to evidence-based behavioral interventions that enhance treatment receipt (comprehension and engagement) and enactment (application in daily life) for individuals living with TBI.
We synthesized adaptation strategies derived from seven clinical trials targeting emotional functioning, problem-solving, and health behaviors in individuals with TBI. Adaptations were organized using a treatment fidelity framework distinguishing treatment receipt and enactment and informed by cognitive rehabilitation principles.
Adaptations to support treatment receipt included simplifying and contextualizing information, increasing repetition, using visual aids, and incorporating structured prompts to accommodate deficits in processing speed, attention, and memory. Process modifications included slower pacing, shorter or more frequent sessions, and integration of remote delivery with technology training and support. Adaptations targeting treatment enactment emphasized habit formation, repeated practice, external memory aids, and technology-based prompts to support prospective memory and initiation. Involvement of care partners and peers further enhanced engagement and generalization of skills.
Systematic adaptations addressing cognitive and behavioral challenges can improve the accessibility and effectiveness of behavioral interventions for individuals with TBI. Further research should systematically document and evaluate treatment adaptations to determine which modifications are most strongly associated with improved treatment receipt, treatment enactment, implementation outcomes, and clinical benefit across differing cognitive and behavioral profiles.

PMID:
43002159
Bibliographic data and abstract were imported from PubMed on 09 Nov 2026.

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