Communication patterns in a psychotherapy following traumatic brain injury: A quantitative case study based on symbolic dynamics

BMC Psychiatry

Kathryn E Korslund²  Miguel A Jiménez-Montaño¹  Adele MK Gilpin⁴  Christopher J Cellucci³  Paul E Rapp⁵ 

[1]Facultad de Física e Inteligencia Artificial, Universidad Veracruzana, Sebastián Camacho #5, Col Centro, Xalapa, Ver. 91000, Mexico

[2]Department of Psychology, University of Washington, Box 355915, Seattle, WA, 98195, USA

[3]Aquinas, LLC, 2014 St. Andrews Drive, Berwyn, PA 19312, USA

[4]Department of Epidemiology and Public Health, University of Maryland School of Medicine, Howard Hall, Suite 200, 660 W. Redwood Street, Baltimore, MD 20201 USA

[5]Department of Military and Emergency Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA

关键词: symbolic dynamics;    information theory;    entropy;    mutual information;    complexity;    psychoanalysis;    psychotherapy;    traumatic brain injury;   

Others  :  1124517
DOI  :  10.1186/1471-244X-11-119

 received in 2010-07-27, accepted in 2011-07-27,  发布年份 2011

【 摘 要 】

Background

The role of psychotherapy in the treatment of traumatic brain injury is receiving increased attention. The evaluation of psychotherapy with these patients has been conducted largely in the absence of quantitative data concerning the therapy itself. Quantitative methods for characterizing the sequence-sensitive structure of patient-therapist communication are now being developed with the objective of improving the effectiveness of psychotherapy following traumatic brain injury.

Methods

The content of three therapy session transcripts (sessions were separated by four months) obtained from a patient with a history of several motor vehicle accidents who was receiving dialectical behavior therapy was scored and analyzed using methods derived from the mathematical theory of symbolic dynamics.

Results

The analysis of symbol frequencies was largely uninformative. When repeated triples were examined a marked pattern of change in content was observed over the three sessions. The context free grammar complexity and the Lempel-Ziv complexity were calculated for each therapy session. For both measures, the rate of complexity generation, expressed as bits per minute, increased longitudinally during the course of therapy. The between-session increases in complexity generation rates are consistent with calculations of mutual information. Taken together these results indicate that there was a quantifiable increase in the variability of patient-therapist verbal behavior during the course of therapy. Comparison of complexity values against values obtained from equiprobable random surrogates established the presence of a nonrandom structure in patient-therapist dialog (P = .002).

Conclusions

While recognizing that only limited conclusions can be based on a case history, it can be noted that these quantitative observations are consistent with qualitative clinical observations of increases in the flexibility of discourse during therapy. These procedures can be of particular value in the examination of therapies following traumatic brain injury because, in some presentations, these therapies are complicated by deficits that result in subtle distortions of language that produce significant post-injury social impairment. Independently of the mathematical analysis applied to the investigation of therapy-generated symbol sequences, our experience suggests that the procedures presented here are of value in training therapists.

【 授权许可】

   
2011 Rapp et al; licensee BioMed Central Ltd.

【 图 表 】

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