Selbstkonzept nach erworbenen Hirnschädigungen. Klinische Relevanz, Inhalte und Strukturen.

This publication-based dissertation examined the role of self-concept, its contents and structures for adjustment processes after acquired brain injury. It is situated within a project evaluating outpatient neuropsychological psychotherapy for patients after acquired brain injury. Additionally, the current studies also included inpatient participants. Acquired brain injury entails often chronic neurological and neuropsychological impairments und requires great adaptive effort of the survivor. Co-morbid mental diseases are frequent. Based on models describing adaptation after acquired brain injury (Moore & Stambrook, 1995) and predicting quality of life (Brown, et al., 2000), a mediating role of self-evaluations was hypothesized. Disease-specific sequelae were assumed to affect psychological well-being mediated by changed perceptions of self. The first study supported this hypothesis concerning self-concept of achievement, while demonstrating a greater influence of subjective complaints than objective cognitive deficits on self-concept. A second study examined the extent of negative change in self-concept content comparing patients of inpatient and outpatient rehabilitation. Even shortly after injury, survivors reported negative changes in self-concept which were comparable to data of patients with significantly longer time since injury. In the acute sample, factors of self-concept content could be identified that were differentially impacted by these changes. Negative post-injury self-concepts were related to reduced subjective well-being. The third study investigated structural aspects of self-knowledge organization and their impact on depression and self-esteem, based on Showers’ (2002) model of Evaluative Organization. Patients who were frequently confronted with negative self-perceptions due to the injury profited from an integrated self-structure of self-aspects containing positive and negative attributes simultaneously. Overall, the studies highlight the relevance of self-concept after acquired brain injury for survivors’ subjective well-being. Interventions aiming at influencing the self-concept seem especially indicated for patients of the post-acute rehabilitation phase and are discussed regarding their therapeutic practicability.