Continuity Therapy for couples living with acquired brain injury: a non-randomised uncontrolled feasibility study

Background: Brain injuries can have a significant negative impact on marriages/partnerships. Available interventions either require specialists trained in relationship therapy (which most rehabilitation services do not have access to) or offer more structured manualised approaches that are restricted in scope and have generally led to only small or no improvement. Continuity Therapy was developed to provide a manualised approach that can be delivered by brain injury clinicians without specialist training, and that addresses a broader range of relationship issues. The aims of the study were to complete a preliminary evaluation of the benefits of the therapy to determine whether progression to a randomised controlled trial is justified; to obtain feedback that will be used to refine the therapy; and to evaluate selection criteria and patient-reported outcome measures. Methods: Fifteen couples living with brain injury received the therapy. They completed questionnaires about their relationship and psychological wellbeing before and after the therapy, and at 3-month follow-up. They and the therapists were also interviewed (or provided written feedback) about their experience of the therapy.Results: Although not everyone benefitted, participants showed a mean large effect improvement on post-therapy questionnaires about their relationship, and this was sustained at 3 months. They showed a mean moderate effect improvement in their individual psychological wellbeing that was again sustained at 3 months. Feedback provided suggestions about improvements to the therapy; information about the circumstances of couples that impacted the effectiveness of the therapy (relevant to selection criteria); and information about outcome measures.Conclusions: The therapy showed sufficient promise to support progression to a randomised controlled trial. A range of outcome measures is required to capture the benefits of the therapy for the relationship. Some refinement of the selection criteria is also necessary.Trial registration: The study was registered with ISRCTN: The UK’s Clinical Study Registry (registration number – 93611293) on 6.6.2023.