Studies of traumatic brain injury

Today, we’re looking at studies of traumatic brain injury. First, Whiting, Faulkner, Gates, Metcalf & Simpson (2025) published “Inhibitory Control Underpins the Relationship between Cognitive and Psychological Inflexibility after a Moderate to Severe Traumatic Brain Injury” in Neuropsychology. Here are the edited abstract and impact statement:

Cognitive flexibility is proposed as being one “building block” of psychological inflexibility/flexibility, yet empirical studies examining these associations are scarce. This study aims to examine the relationship between these constructs in those with a moderate to severe traumatic brain injury who demonstrate impairments in cognitive flexibility. A total of 66 individuals with a traumatic brain injury were administered a battery of cognitive flexibility measures in conjunction with their standard neuropsychological assessment, general (Acceptance and Action Questionnaire–II [AAQ-II]) and context-specific (Acceptance and Action Questionnaire–Acquired Brain Injury [AAQ-ABI]) measures of psychological inflexibility and psychological distress (Depression Anxiety Stress Scale–21). Linear regression modeling found the Stroop color–word interference score was the only measure of cognitive flexibility that was significantly associated with AAQ-ABI (β = −.14, p < .001), a finding that remained when controlling for Full-Scale Intelligence Quotient and education. Similarly, the Stroop color–word interference score significantly predicted the AAQ-II (β = −0.13, p = .024). Simple mediation analysis found the AAQ-ABI and AAQ-II fully mediated the relationship between the Stroop color–word interference score and psychological distress. This research provides support for the theory of cognitive flexibility being an essential component of psychological inflexibility. Inhibitory control may be an important process within cognitive flexibility that contributes to psychological inflexibility. 

What is the relationship between cognitive flexibility and psychological inflexibility in individuals with a moderate to severe traumatic brain injury? Cognitive flexibility, or specifically inhibitory control, is associated with both general and context-specific measures of psychological inflexibility. Psychological inflexibility mediated the relationship between inhibitory control and psychological distress. This is the first study to demonstrate a component of cognitive flexibility is associated with self-report measures of psychological inflexibility. Further research exploring the associations between “hot” measures of cognitive flexibility and multifaceted measures of psychological inflexibility will provide a more comprehensive understanding of the relationship. 

Note that here the sample had moderate to severe TBI. I thought it was helpful to learn that inhibitory control is the major predictor of cognitive inflexibility. The next study looks at mild TBI in service members and vets.  Brickell et al. (2025) published “Intimate Partner Distress is Strongly Associated with Worse Warfighter Brain Health Following Mild Traumatic Brain Injury” in Psychological Trauma: Theory, Research, Practice, and Policy. Here again the edited abstract and impact statement:

Purpose: To examine (a) change in chronic neurobehavioral symptoms in service members/veterans (SMVs) with an uncomplicated mild traumatic brain injury (MTBI) at two time points over 3 years and (b) the influence of intimate partner (IP) health-related quality of life (HRQOL) risk factors for chronic neurobehavioral symptoms. IPs (N = 175) completed measures of SMV neurobehavioral adjustment symptoms and 13 IP HRQOL risk factors at Time 1 (T1) ≥ 12 months post-TBI and Time 2 (T2) 3 years later. Scores on the risk factor measures were classified into four IP HRQOL symptom trajectory categories based on clinically elevated (≥ 60 T) symptoms: (a) persistent (T1 + T2 ≥ 60T), (b) developed (T1 < 60T + T2 ≥ 60T), (c) improved (T1 ≥ 60T + T2 < 60T), and (4) asymptomatic (T1 + T2 < 60T). There was little change in mean SMV adjustment scores or the percentage of clinically elevated scores from T1 to T2. The percentage of clinically elevated adjustment scores was 30% at T1 and T2; 14.3% at T1 only; and 5.7% at T2 only. The IP HRQOL symptom trajectories had a stronger effect on mean SMV adjustment than within-group change in adjustment, which was largely driven by the persistent and asymptomatic IP HRQOL categories. The strongest effects were found for caregiving and social HRQOL risk factors, followed by psychological, and then physical HRQOL risk factors. A range of clinically elevated IP HRQOL constructs emerged as long-term risk factors for chronic neurobehavioral symptoms in SMVs post-MTBI. More attention to the role that family distress has on poor warfighter recovery and return to duty following an MTBI is required. 

An important and unique addition to the literature was the finding that a range of clinically elevated intimate partner physical, psychological, social, and caregiving health-related quality of life outcomes emerged as long-term risk factors for chronic neurobehavioral symptoms in service members and veterans following a remote uncomplicated mild traumatic brain injury. The findings may have important implications for military traumatic brain injury treatment programs. If a warfighter is discharged from treatment to a home environment with high levels of distress and dysfunction, improvement in symptoms and return to duty outcomes may diminish over time. More attention to the role that family distress has in poor warfighter recovery and return to duty following a mild traumatic brain injury is required. 

Health-related quality of life in an intimate partner predicted the service member or vet’s chronic neurobehavioral symptoms. I thought this was important to anyone working with this population. Finally, Stevens, Marquardt, Tong, Davenport & Sponheim (2025) published “Posttraumatic Stress Symptomatology Rather than Mild Traumatic Brain Injury is Related to Atypical Early Neural Processing during Cognitive Control” in Neuropsychology. The edited abstract and impact statement follow:

Many veterans with posttraumatic stress disorder (PTSD) or a history of mild traumatic brain injury (mTBI) report disruptions in cognition; however, the neurophysiological underpinnings of these cognitive difficulties are not well understood. It is also unknown whether PTSD symptomatology or past mTBIs uniquely impact functions important to adaptation such as cognitive control. We examined event-related potentials elicited by a flanker task to evaluate brain responses during conflict monitoring in a sample of 192 U.S. military veterans with combat-zone experience and exposure to explosive blasts. Clinical assessments characterized diagnoses as well as the severity of PTSD symptoms and mTBI so that we could parse overlapping syndromes and directly contrast effects of the two conditions. Across groups, participants performed worse on conflict trials (Incongruent distractors), particularly when preceded by a no-conflict (Congruent distractors) trial. We found that greater dysphoric PTSD symptomatology was related to a reduced early perceptual response (P1), while greater avoidance PTSD symptomatology predicted a larger early visual attention response (N1). Although late cognitive processes (N2, P3) were sensitive to cognitive control demands of the flanker task, posttraumatic symptomatology and mTBI severity were unrelated to them. Results provide evidence that the Avoidance and Dysphoria domains of PTSD symptomatology may differentially relate to early neural functions of perception and visual attention rather than later cognitive responses. Rehabilitation and treatment of individuals with PTSD and mTBI may be most productive when focused on perceptual and attentional processing, which could improve cognitive control.

We examined cognitive control among veterans with posttraumatic stress disorder (PTSD) and mild traumatic brain injury and assessed the effects on neural markers related to early perceptual processing or later conflict monitoring. Avoidance and Dysphoria PTSD symptom domains were associated with early perceptual and attentional evoked brain responses, while mild traumatic brain injury severity failed to be related to neural responses during cognitive control. The study highlights the importance of psychological consequences of trauma for basic brain processes, even in the presence of mild brain injury, and can serve to shape effective clinical interventions. Future research may benefit from targeting brain processes related to early perception and attention to improve cognition among veterans with PTSD, including veterans with a history of mild brain injury. 

This time, we again look at vets with mild TBI. I found it intriguing that that severity of the TBI mattered less than avoidance and dysphoria PTSD symptoms. Finally, we’re looking at memory for emotions. Sanders et al. (2025) published “Assessing Memory for Emotions Separately from Emotion Recognition after Traumatic Brain Injury” in Neuropsychology. The edited abstract and impact statement follow:

Adults with traumatic brain injury (TBI) often show deficits in recognition of facial emotion, but their ability to remember emotions is poorly understood. Furthermore, there are no practicable tasks that measure this ability. This study examined the construct of memory for emotions using a novel Facial Recognition and Memory for Emotion (FRAME) test. Participants were 53 adults with complicated mild-to-severe TBI and a comparison group of 64 neurologically healthy adults. The FRAME and a neuropsychological battery were administered to participants. Analyses included zero-order and partial correlations, as well as group comparisons. A series of hierarchical logistic regressions evaluated the incremental utility of the FRAME in distinguishing adults with and without TBI. Adults with TBI performed worse than healthy participants across FRAME indices. Processing speed was the strongest correlate of both emotion recognition and memory for emotion. The FRAME demonstrated a pattern of correlations with cognitive tests supporting convergent and discriminant validity of the concept that memory for emotion is distinct from the simple perception of it. Hierarchical logistic regression models showed that memory for emotion accounted for unique variance in group membership beyond emotion recognition accuracy, memory for nonemotional faces, and verbal delayed recall. Support was found for the construct validity of a novel performance-based assessment measure of recognition and memory for facial displays of emotion. We conclude that memory for facial emotions represents a unique aspect of social cognition, distinct from accurate recognition of facial emotions.

Is memory for emotion different from the recognition of emotion? Memory for facial emotions appears to represent a unique aspect of social cognition that is related to, but distinct from, accurate recognition of facial emotions. Impairment in memory for emotions was uniquely related to TBI status even after accounting for component abilities in emotion perception accuracy and face memory. This study lends support to the hypothesis that memory for emotion is a distinct cognitive ability, separate from emotion recognition, and that this ability can be objectively measured. Future research should evaluate the association of memory for emotions with psychosocial characteristics important to rehabilitation outcomes, such as the quality of interpersonal relationships and community integration. 

Here the sample included people with mild to severe TBI. I thought it was important to know that impaired memory for emotions uniquely relates to TBI status. This may be very helpful to therapists as well as assessment specialists.