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Page 1: Courtney_Assignment 3_CBruun-Andersen (1)

Running Head: MENTAL ILLNESS AND PSYCHOSIS FOLLOWING TRAUMATIC BRAIN INJURY 1

Mental Illness and Psychosis Following Traumatic Brain Injury

Courtney Bruun-Andersen

Dr. Rohini Pahwa

December 14, 2015

Assignment 3

New York University

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MENTAL ILLNESS AND PSYCHOSIS FOLLOWING TRAUMATIC BRAIN INJURY 2

A psychosocial problem affecting many traumatic brain injury (TBI) patients is mental

illness. Certain types of mental illness post-TBI, such as psychosis, can be severely disabling.

Before a psychiatric illness hits, most survivors undergo rehabilitation which includes cognitive,

speech and physical therapy. Large proportions of survivors are now also undergoing

psychotherapy to best handle psychological distress. Psychiatric medication is common.

A common misconception about TBI and mental illness is that they are the same

diagnoses. According to Silver, (2011), the mental illness is separate from the TBI rather than

actually stemming from the injury to the brain. Other problems and symptoms of brain injury

may be more understood, such as cognitive problems. People do not appreciate that an injury to

the brain produces problems in behavior and emotions such as being irritable, depressed and

anxious (Silver, 2011).

Psychiatric disorders are common and debilitating after traumatic brain injury. Post-

injury psychiatric disorders were associated with unemployment, pain, poor quality of life and

lack of coping skills. “Psychiatric disorders are common and present themselves in 12-51% of

individuals in the first year post-injury” (Gould, Ponsford, Johnston, & Schonberger, 2011,

p .1155). Common disorders include PTSD, anxiety, depression and sometimes psychosis

(Gould, et al. 2011). The relationship between pre-injury and post-injury psychiatric disorders is

unclear. This may be due to a focus on milder injuries. According to a study by Gould, the

percentage of psychiatric disorders was higher post-TBI than pre-TBI (Gould, et al. 2011).

Individuals without pre-injury psychiatric issues were less likely to have a psychiatric disorder,

such as depression, post injury (Gould, et al. 2011).

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It has been estimated that up to ten percent of traumatic brain injured patients go on to

experience symptoms of psychosis (Batty, Rossell, Francis, & Ponsford, 2010). These patients

suffer a clinically complex dual diagnosis accompanied by distress and disability (Batty, Rossell,

Francis, Ponsford, 2010). TBI and psychotic disorders share risk factors that may help explain

dual diagnosis. These factors include male gender, substance abuse and existing psychiatric

sequalae (Batty et al. 2010). A higher rate of psychosis post-TBI is seen in young males.

“Continuing cognitive and behavioral impairments and symptoms such as reduced behavioral

control, aggression, impulsivity may be documented in both TBI and psychosis” (Batty et al.

2010, p. 30).

There may be as high as 70% prevalence of both depression and anxiety post TBI (Batty

et al. 2010). Another study has found that 45.8% of participants without any psychiatric history

developed a post-injury psychiatric disorder (Batty et al. 2010). Psychiatric illnesses such as

depression and anxiety have recently been associated with the development of psychosis,

especially in cases with comorbid substance misuse (Batty et al. 2010). Brain regions and

associated circuitry in the neurogenesis of psychotic symptoms overlap with those affected by

TBI (Batty et al. 2010). The frontal lobe and temporal lobe have increased vulnerability to

traumatic brain injury. In addition, “hippocampal dysfunction has been demonstrated during

language and memory encoding in schizophrenia” (Batty et al. 2010). Hippocampal morphology

may further underlie positive symptoms such as hallucinations and delusions (Batty et al. 2010).

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MENTAL ILLNESS AND PSYCHOSIS FOLLOWING TRAUMATIC BRAIN INJURY 4

Current Interventions

A current intervention for psychosis and mental illness post-TBI includes mindfulness,

meditation and prayer. Melissa Felteau suffered a TBI in a cart crash in 1993. After meditating

regularly, she felt benefits and was less moody and tired (Felteau, Gainer, 2014). She desired to

learn more about the power of meditation and mindfulness as they relate to healing after TBI

(Felteau et al. 2014). She has worked on studies that look at how mindfulness-based cognitive

therapy can reduce symptoms of depression and mental illness in people with TBI. In a pilot

study, Felteau worked with twenty people recovering from TBI (Felteau et al. 2014). Sixty

percent of study participants recovered from clinical depression after mindfulness meditation

(Felteau et al. 2011, p 22). Studies show that meditation changes the brain physiologically by

reducing cortisol levels (Felteau et al. 2014).

A study concerning the medical treatment of psychosis was done comparing Resperidone

versus Quetiapine in management of acute phase of psychosis. The study revealed that both

drugs could reduce the severity of acute psychosis significantly (Moosavi, Ahmadi, Mohjtehdi,

Yazdani, Monajemi, 2015). Differences in reducing total, positive and negative scores were not

significant and both drugs had the same therapeutic effect (Mossavi et al. 2015).

These sources indicate that mental illness following TBI is separate from injury and that

psychiatric disorders are common post-injury. The majority of survivors will experience anxiety

and depression, but a unique ten percent of survivors will also experience a psychotic episode.

Several risk factors for TBI and psychosis even overlap. Interventions to improve mental health

in TBI patients following a psychotic episode may include mindfulness and meditation.

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Psychiatric medication is very effective. Examples of these medications include Resperidone and

Quitiapine.

Ramifications

There are ramifications surrounding mental illnesses post-traumatic brain injury. Some of

these ramifications include lower socioeconomic groups, homelessness, difficulty maintaining a

job or difficulty staying in school.

Without the ability to stay in school and obtain higher degrees, survivors that have not

been fully rehabilitated will not graduate and obtain quality work. This will lead to lower

socioeconomic status and possible homelessness.

After studying a cohort of ninety homeless men in Wisconsin, 80% of which had

cognitive impairment, Solliday-McRoy, Campbell, Melchert, Young and Cisler (2004) stated

that “underdiagnosis and inappropriate treatment problem of crisis proportions may exist in the

homeless population.”

Research also indicates that mental illness and high use of inpatient psychiatric services

serve as common risk factors for homelessness One of the most common sequelae for these

experiences is traumatic brain injury (Highley, 2008). Identification of cognitive impairment in

homeless persons will increase SSI/SSD disability entitlements, guaranteeing stable health

insurance (Highley, 2008).

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MENTAL ILLNESS AND PSYCHOSIS FOLLOWING TRAUMATIC BRAIN INJURY 6

Emotional Intelligence

Emotional intelligence is a psychological theory developed by Salovey and Mayer (Hein,

2005.) This theory is the ability to perceive emotions, access and generate emotions to assist

thought, understand emotions and regulate emotions to promote growth (Golematn, 1999).

Daniel Goleman described five components of emotional intelligence (Goleman, 1999). These

components include self-awareness, self-regulation, internal motivation, empathy, and social

skills (Goleman, 1999).

These component also includes the ability to correctly identify one’s emotions. Self-

regulation, another component of emotional intelligence, is the ability to control impulses and

think before acting. It also includes the ability to control moods. Aspects of this component

include openness to change and trustworthiness (Goleman, 1999). Internal motivation is a

passion to work for internal reasons that go beyond money and status. Aspects of internal

motivation include drive to achieve, optimism in the face of failure and organizational

commitment (Goleman, 1999). Empathy is the ability to understand the emotions of others.

Aspects of empathy include cross-cultural sensitivity, expertise in building and retaining talent

and service to clients and customers (Goleman, 1999). Social skills are abilities in managing

relationships and building networks. Important hallmarks of this component of emotional

intelligence include persuasiveness and the ability to lead and manage teams (Goleman, 1999).

In 1985, Wayne Leon Payne included the term “emotional intelligence” in his doctoral

dissertation (Hein, 2005). Later, in 1990, John Mayer and Peter Salovey published journal

articles measuring ability in the area of emotions. Theses researchers found that some people

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were better at identifying emotion of self and others and solving problems involving emotional

issues (Hein, 2005). The title of the Mayer and Salovey paper was “Emotional Intelligence.”

Salovey and Mayer have developed two tests to measure emotional intelligence (Hein,

2005). In addition, Daniel Goleman, a New York writer and consultant, used the term in a book

about emotional literacy. His book was titled “Emotional Intelligence” in 1995. (Hein, 2005). He

appeared on talk shows with Oprah Winfrey and Phil Donahue. In 1998, he published another

book titled “Working with Emotional Intelligence.”

The model for the emotional intelligence theory is the current “Mayer Salovey

Definition.” There are four branches to this definition: emotional identification, emotional

facilitation of thought, emotional understanding, and emotional management (Hein, 2005). This

definition was stated in 2000. In 2004, colleague David Caruso went further and defined

emotional intelligence as the ability to: identify emotions accurately, use emotions to help you

think, understand what causes emotions, ability to stay open to the emotions in order to capture

wisdom (Hein, 2005).

There are several gaps or limitations to this theory. Emotional intelligence is also

considered potential, which is not discussed in the Mayer-Salovey definition. For example,

young children do not display the abilities of intelligence, but may harbor strong potential. (Hein,

2005). The potential of the toddler may be considered an undeveloped ability.

The definition fails to discuss the fact that the child may start with high innate emotional

intelligence and later become emotionally damaged (Hein, 2005). The Mayer-Salovey definition

also fails to explain how emotional intelligence also should include the ability to use the correct

feeling words in a situation. Another criticism is that the definition fails to call emotional

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understanding “knowledge of emotions.” Others believe that you cannot measure emotional

management with a paper and pencil test.

Many professional fields value emotional intelligence. Both social service workers and

medical practitioners can benefits from learning EI skills. For example, one dean of a medical

school valued emotional intelligence and considered the clinical safety of its graduates. Lack of

safety could lead to dissatisfaction and complaints (Ogle, Bushnell, 2014). It has also been

accepted that this field of work requires students to develop interpersonal and academic skills

(Ogle et al, 2014).

Emotional intelligence is relevant to all aspects of medicine and healthcare. Patients may

also benefit from EI skills. During illness, individuals may experience isolation, anxiety and

distress. This may lead them to seek out human connection and other social affiliations (Ogle et

al, 2014). Emotional intelligence skills promote connection, rapport and trust in clinical

interactions between health care workers and clients.

It is important to note that emotional intelligence (EI) is measured by more than a paper

and pencil test. EI traits are also composed of observable behaviors (Ogle et al, 2014). For

example, there are usually differences between self-reported and observed levels of empathy.

Ethics may also be considered when discussing emotional intelligence. There is not

necessarily a positive correlation between ethical practices and emotional intelligence. A review

of high profile leaders has shown that these individuals may have acted unethically while being

highly emotionally intelligent (Segon, Booth, 2014).

One aspect of emotional intelligence in leaders is competency. Leaders should assess

competence in order to identify developmental needs (Segon, et al, 2014). Goleman, an

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important figure in EI studies, defines emotional competence as a learned capability based on

emotional intelligence resulting in outstanding performance at work. This definition relates to a

similar definition of job competency.

The emotional intelligence framework has been altered over the years. Trustworthiness

was altered to transparency because transparency is associated with clarity and openness while

trustworthiness is associated with honesty and responsibility (Segon et al, 2014).

Emotional Intelligence may also play a role in working towards change. It is concluded

that emotional intelligence leads to strong psychological resources, which play a role in ones

attitude towards change (Malik, 2014). People tend to avoid change because change requires

adjustments and losses. Those who are involved in change display different types of emotions

that vary in intensity (Malik, 2014). The success or failure of change depends on emotional

dynamics (Malik, 2014). According to the study, the hypothesis that there is a relationship

between emotional intelligence and resistance to change is supported

Impairments in emotional intelligence have been found in those with general and social

anxiety. These studies have not been examined in reference to the clinically depressed population

(Nolidin, Downey, Hansen, Schweitzer, Stough, 2013). The control group in this study, those

without anxiety and depression, scored higher on the dimensions of emotional recognition,

understanding emotions, emotional management and emotional control.

In regards to social phobia, it has been confirmed that intrapersonal EI skills were lower

in social phobia patients than obsessive compulsive disorder or panic disorder (Nolidin et al,

2013). Depression also lowers EI skills. The ability to manage and control emotions is related to

the severity of the depression (Nolidin et al, 2013).

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Applying the Emotional Intelligence Lens

The issue of mental illness following traumatic brain injury may be looked at through the

emotional intelligence lens. The emotional intelligence lens directs my attentions to several

issues that brain injury survivors face when recovering from a mental illness like psychosis.

Issues survivors may face include difficulty staying in school or difficulty maintaining

employment.

The emotional intelligence theory includes five components: self-awareness, self-

regulation, internal motivation, empathy, and social skills. Each of these components is needed

for a TBI survivor to stay in school while simultaneously managing their new health conditions,

such as a mental illness, associated with brain injury. Self-regulation and internal motivation will

help with time management skills that are needed in academic settings. Social skills and empathy

are also important for those returning to school and work because these are social settings. The

survivor will be surrounded by other classmates, coworkers, professors and bosses. Self-

awareness and self-regulation will help the survivor manage the stress associated with their

health concerns while keeping up with classwork or work assignments.

This theory can help researchers understand the development of mental illness post-TBI.

Psychosis, PTSD and depression are related to severe stress post-injury. The Emotional

Intelligence Theory focuses on specific skills that can reduce this stress and help the survivor

stay healthy. After a mental illness has occurred and treatment has begun, emotional intelligence

will aid in relapse prevention so that the survivor does not return to the hospital. With specific

resources, such as a support group, care team of doctors, social workers and nursing staff,

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survivors will stay healthy and chronic mental illness will not develop. Existing illness will not

perpetuate and treatment will become more effective.

The emotional intelligence theory has an impact on the ramifications of mental illness

post-TBI. As described earlier, some of the ramifications of mental illness following a brain

injury include inability to hold down a job or stay in school, poverty and homelessness. Those

with higher emotional intelligence will have the skills to return to school and work. This will

lead to increased employment rates and in turn lower levels of poverty and homelessness.

A client that can be used to apply the emotional intelligence lens is TC, a hypothetical

character. The family system may also be applied to our client, TC. TC expresses suspicion and

distrust to his wife following a traumatic brain injury. His unusual behavior is sudden and out of

character. She explains that no one warned her that her husband could possibly develop

psychiatric sequelae following his traumatic brain injury.

The system to be applied to TC and this problem is the family system. The family system

is one of many systems that TC is a part of. Several of the other systems include individual,

friends, community and culture. The family system focuses on family membership and

household structure, emotional and relational patterns such as boundaries, communication,

triangles, secrets, myths, legacies, themes, loss and trauma. The family system can also focus on

dysfunctions, values, beliefs, rituals and practices (McGoldrick, 2015).

TC is a member of a family, serving as a male spouse. He has been disabled for eighteen

months, as his injury was eighteen months ago and his wife has been his primary caretaker.

Before his injury, the household structure was different and he was on a more even playing field

with his wife, holding down a full-time job. Now that TC is disabled, the relationship between

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TC and his wife has become difficult. Ever since TC developed psychiatric sequalea and

paranoia, communication has been especially difficult between him and his wife. His wife

remains faithful to him even while he is experiencing these symptoms of psychosis. While TC is

ill, his wife must harbor certain secrets from the public about her husband’s controversial

symptoms and diagnosis to avoid stigma often associated with this type of mental illness.

TC’s main challenge over his lifespan has been his traumatic brain injury, caused by a car

accident eighteen months ago. He was in the hospital for nearly three months for inpatient

rehabilitation and attended another outpatient rehabilitation program for another six months. In

outpatient rehabilitation, the goal was to get TC back to his full-time position. TC previously

worked as a computer programmer, but needs to recover more before returning to this position.

Once he is treated for his mental illness, the goal is for him to take on a part-time role at his

previous company so that he can ease back into the working world.

Certain aspects of the Emotional Intelligence Theory are relevant to the client system’s

(family system) current situation with TC’s mental illness and brain injury. The specific aspects

of this theory that are critically important include regulating emotions to promote growth,

regulation of impulses, ability to control moods and internal motivation. Regulating emotions

will help TC improve his relationships and internal motivation will help him return to work.

By regulating emotions to promote growth, TC will be able to control his anxiety and

symptoms of psychosis. For example, by carefully monitoring his thoughts and actions, he will

improve his relationships with his wife and his personal relationships will continue to grow. He

may even be able to make new friends during his recovery with these new social skills.

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By regulating impulses, he will avoid offending others. For example, he may choose to

swear at or say disturbing things to family and friends. His psychosis even led him to accuse his

wife of breaking apart the family, which never actually happened. By controlling impulsive and

intrusive thoughts, TC will improve his odds at achieving a full recovery.

Another aspect of Emotional Intelligence Theory that is relevant includes the ability to

control moods. By learning how to harness negative energy in a positive manner, TC will

improve his marriage. Rather than making accusations against his wife, TC can try other

techniques to lessen frustrations in his daily life such as meditation. Simple practices such as

meditation are done by those with high emotional intelligence to control moods and avoid severe

mood swings during times of stress.

The last portion of this theory that is relevant is internal motivation. Internal motivation

will encourage TC to attend therapy sessions with his psychiatrist or social worker to control

symptoms of psychosis and see other doctors for his brain injury recovery. Internal motivation

will help TC return to his job as a computer programmer as well. Although he may have lost

some of his cognitive abilities after the TBI, TC can use internal motivation to contact previous

employers and begin some training modules on his computer at home. By slowly working his

way back to his career, TC will find meaning and purpose in his day-to-day life.

TC is currently in the middle of his career and is around forty years old. His current life

span position would qualify as “middle-aged.” The emotional intelligence theory is relevant to

any portion of the lifespan, however it is more closely relevant to the various stages of

adulthood. This makes the emotional intelligence lens especially useful to TC because he is in

the midst of serious relationships and a demanding career.

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The critical literature informs our understanding of the client system. The first piece of

literature explains that the mental illness that is produced from a traumatic brain injury is a

separate and different diagnosis. This piece of literature informs us that the client system is no

longer just handling the stress of a TBI, but also the challenges of TC’s new mental illness and

psychotic symptoms.

The next pieces of literature explain that a certain proportion of TBI survivors, like TC,

will go on to experience symptoms of psychosis, depression and anxiety. Like the previous

literature mentioned, this informs us of the stress being placed upon TC’s family system. This

stress is especially difficult on his marriage.

Certain treatments and interventions for psychosis, such as meditation, prayer and

medication also impact TC’s family system. For example, his wife, as a caretaker, will have to

take important steps to make sure TC follows his prescribed treatment plan and attends doctor’s

appointments. She may assist him by helping him pick up prescriptions at the pharmacy or

putting together pill boxes. She may drive him to and accompany him to appointments with his

social worker and psychiatrist. She may even partner up with him at a meditation or yoga club in

an attempt to manage his stress levels.

The five components of emotional intelligence, self-awareness, self-regulation, internal

motivation, empathy, and social skills, mentioned in our research indicate that the TC’s family

system can thrive and return to normalcy. One very important aspect of the fact that emotional

intelligence leads to strong psychological resources which play a role in ones attitude towards

change. TC’s ability to return to his former life is highly dependent on this emotional intelligence

skill. His ability and willingness to work towards change will help him to recover from his

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physical and psychological illnesses. By having a positive outlook on his recovery, he will take

the important steps needed to improve his health. Psychological resources such as internal

motivation and the ability to control his mood will lead him to work towards that change. He

may for example, work harder in outpatient therapy, religiously attend psychotherapy, be in

consistent communication with his former boss and attend couples therapy with his wife.

Overall, the Emotional Intelligence lens furthers our understanding of TC and his family

system. TC will be able to use this lens to improve his marriage by regulating emotions and

impulses. TC will also be able to use this lens to return to his previous career as a computer

programmer by harnessing his internal motivation. Further, TC is of an ideal age for the use of

this unique theory because he is in the peak of his love life and working life.

TC fits this theory in a few ways. As previously stated, his family system most certainly

fits the theory because of his marriage and TC’s life span position. TC may face difficulty with

this theory for several other reasons, however. TC may be so focused on his survival and day-to-

day living that maintaining a marriage and returning to work may be especially difficult. These

types of goals may only be achievable after TC has overcome the initial stages of his recovery

from mental illness. For example, it would not be wise for him to show up for work with positive

symptoms of psychosis. He would need to be cleared by his medical care team first.

This is not to say that setting goals is unachievable for TC, but he will need to work step-

by-step. Some of his other goals, such as maintaining a marriage after mental illness, may be

better to work on during his early recovery. Later, he can focus on the challenges of returning to

the work place.

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One thing to note is that many aspects of emotional intelligence surely will prepare TC to

return to work. For example, several aspects of EI include regulating impulses and emotions.

Once TC has mastered these skills, he can slowly start participating in public events and visiting

friends in the community. Only after he has mastered these skills would it be wise for him to

show up to his work place. This is critical because his type of mental illness carries a heavy

stigma in society. He could put his employment on the line by acting out at work. Although he is

protected by the “Americans with Disabilities Act”, workplace discrimination is still very real in

today’s society.

I would modify the Emotional Intelligence Lens to include a critical warning to those

recovering from psychiatric illness. I am specifically focusing on the portion about internal

motivation. The goals a client is internally motivated to achieve should only be pursued once the

other aspects of the emotional intelligence lens, such as regulating emotions and impulses, have

been addressed.

Emotional Intelligence and Social Work Values

The Emotional Intelligence lens corresponds to social work values. Social Work values

are clearly outlined in the Code of Ethics. The core values of the Code of Ethics include service,

social justice, dignity and worth of a person, importance of human relationships, integrity and

competence.

One aspect of EI includes the ability to maintain composure and control impulses and

emotions. These ideas directly relate to several values in the Code of ethics such as importance

of human relationships and dignity and worth of a person. By controlling ones impulses, a client

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will be able to maintain human relationships. The client will also be able understand the worth of

a person and show respectful behavior towards that person.

“Integrity and Competence” are another core value in the Code of Ethics. The emotional

intelligence theory strives is not dependent on being ethical and truthful. For example, there are

many world leaders who are unethical yet have high emotional intelligence. The integrity portion

of the Code of Ethics may not directly relate. However, competence does, as all highly emotional

intelligent people show a high degree of competence in their relationships and careers.

The last two values to be discussed are social justice and service. Highly emotionally

intelligent people are highly organized and would have the ability to organize social justice

movements and serve others. Leadership ability is very common in those with high emotional

intelligence. As previously mentioned, ethical practice is not positively correlated to high

emotional intelligence. This is not to say that those with high emotional intelligence would be

unwilling to serve others and participate in social justice efforts, but not all individual with high

EI would apply to these Code of Ethics values.

Overall, the Emotional Intelligence lens is most directly aligned with several Social Work

Code of Ethics values such as dignity and worth of a person and importance of human

relationships. Those with high EI have strong social skills and thus strong relationships with

others. Because the lens is not dependent on ethical behavior, social justice and service will not

be as important.

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References

Batty, R.A., Rossell, S.L., Francis, A.J., & Ponsford, J (2013). Psychosis Following Traumatic

Brain Injury. Brain Impairment. 14(1), 21-41.

Bedard, M., Felteau, M., Marshall, S., Cullen, N., Dubois, S., Moustgaard, A., (n.d.).

Mindfulness-Based Cognitive Therapy Reduces Symptoms of Depression in

People with Traumatic Brain Injury: Results From a Randomized Controlled Trial.Journal of

Head Trauma Rehabilitation, 29(4), E13-E22.

Golemans Five Components of Emotional Intelligence. (n.d.). Retrieved November 13, 2015,

from https://www.sonoma.edu/users/s/swijtink/teaching/philosophy_101/paper1/goleman.htm

Gould, KR, Ponsford, JL, Johnston, L & Schonberger M.(2012). Why Do Some People Develop

Psychiatric Disorders After a Brain injury? Journal of Neuratrauma (28) p1155-1163.

Hein, S. (2005). Introduction to Emotional Intelligence. Retrieved November 9, 2015, from

http://eqi.org/history.htm

Highley, J.L. (2008). Traumatic brain injury among homeless persons: Etiology, prevalence and

severity. Nashville: Health Care for the Homeless Council.

Malik, S. Z., & Masood, S. (2015). Emotional Intelligence and Resistance to Change: Mediating

role of Psychological Capital in Telecom Sector of Pakistan. Pakistan Journal of

Commerse & Social Sciences, 9(2), 485-502.

McGoldrick, M., Carter, E., & Garcia-Preto, N. (2015). Chapter 1: The Life Cycle In Its

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life cycle: Individual, family and social perspectives (pp. 1-40). Pearson.

Moosavi, S., Mohamad, Mahshid Ahmadi, Dianoosh Mojtahedi, Jamshid Yazdani, J. &

Monajemi, M. B., (2015). Comparison of Quetiapine and Risperidone in Treatment of Acute

Psychosis: A Double-Blind, Randomized-Controlled Study. Global Journal of Heath

Science7(5), 359-363.

Nolidin, K., Downey, L. A., Hansen, K., Schweitzer, I., & Stough, C. (2013). Associations

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between social anxiety and emotional intelligence within clinically depressed patients.

The Psychiatric Quarterly, 84(4), 513-521.

Ogle, J. A., & Bushnell, J.A. (2014). The appeal of emotional intelligence. Medical Education,

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