Narrative Discourse Treatment Development

Discourse impairments are breakdowns in meaningful communication beyond the level of single sentences and have a functional impact on the lives of Veterans with traumatic brain injury (TBI), disrupting return to work, communication re integration, socialization, and quality of life. The few prior attempts to treat discourse impairments have been small case studies and resulted in no change or limited gains. The proposed study evaluates the feasibility of a novel narrative discourse treatment that builds upon these prior attempts by addressing breakdowns in both story content and story organization using a theoretically-driven approach. If feasible, as demonstrated by tolerability and acceptability to participants, and later shown to be effective, the proposed discourse treatment has the potential to improve daily communication, which provides a gateway for Veterans with TBI to increase meaningful participation and improve functioning in major life domains.

Inclusion Criteria: * Veteran with diagnosis of traumatic brain injury (TBI) with mild to moderate functional cognitive impairments * Self-report of communication difficulty following traumatic brain injury that interferes with activities * Can identify a significant other (e.g., spouse, family member, friend) who is able and willing to serve as an informant, who will verify discourse ability pre- and post-treatment * The informant must be an individual with whom the participant engages in weekly social communication * Adequate hearing and visual acuity to participate in study procedures * Those who are willing and able to participate in telehealth sessions must have appropriate equipment and access * e.g., smartphone, tablet, computer with camera, internet access * Stable housing * Participants must have a safe, private and quiet environment in their home to engage in telehealth sessions * English as a primary language Exclusion Criteria: * Penetrating head injury * History of or current developmental disability (e.g., dyslexia), psychotic disorder, neurological illness * e.g., stroke, dementia, Parkinson's disease), aphasia or auditory processing disorder (APD) * Current (past 30 days) diagnosis of alcohol or substance abuse * An exception will be made for marijuana as a number of Veterans use marijuana occasionally to manage ailments, such as pain and post-traumatic stress disorder (PTSD) * Marijuana use must not occur regularly or interfere with daily functioning * Inclusion of Veterans using marijuana aligns with the VA's position that Veterans will not be denied VA benefits because of marijuana use