BEST Treatment, principal investigator Dawn Neuman, PhD.

INDIANAPOLIS -- Indiana University School of Medicine and National Intrepid Center of Excellence (NICoE) researchers are collaborating to study a new treatment method for traumatic brain injury (TBI) thanks to a grant from the United States Department of Defense, Congressionally Directed Medical Research Programs (CDMRP). The treatment will be tested on civilians and service members who have experienced a concussion or mild traumatic brain injury (mTBI).

The project is called Building Emotional Self-awareness Teletherapy (BEST): A Tool to Optimize Psychological Health Outcomes for Persons with Traumatic Brain Injury. NICoE is headquarters for the Defense Intrepid Network and a directorate for the Walter Reed National Military Medical Center (WRNMMC). The NICoE is focused on improving the lives of service members with TBI and other invisible wounds of war. Researchers will deliver the BEST method of treatment remotely to patients with mild traumatic brain injury who have an emotional processing problem called alexithymia. Alexithymia often causes poor emotional self-awareness and difficulty labeling, differentiating, and expressing emotions. 

"People must be able to recognize their emotions in order to manage and effectively work through them, which is why studies show that people with alexithymia often have problems managing their emotions (emotion regulation) and frequently struggle with anxiety, anger, depression, and post-traumatic stress," said Dawn Neumann, PhD, associated professor of physical medicine and rehabilitation and principal investigator of the study. Neumann is also the research director of the Rehabilitation Hospital of Indiana. "Given the prevalence of alexithymia and problems associated with in, we created this treatment to improve emotional self-awareness."

In a previous study, research tested the new treatment in-person with civilians who had moderate to severe TBI and saw improvements in their ability to label emotions as well as their emotion regulation, anxiety, and anger. Participants also reported feeling more positive emotions. Now, they want to know if the treatment could also be successful when delivered remotely via teletherapy.

"Teletherapy has become more important than ever since the COVID-19 pandemic," Neumann said. "Remote therapy could also mitigate transportation and geographical barriers to care, as well as reduce stigma associated with going to an office known for mental health treatment."

Researchers will also test the BEST treatment in those with mild TBI as opposed to moderate or severe TBI. Mild TBI is common in the military, and half of the participants in the new study will be service members. Researchers will observe any improvements in participants' ability to manage their emotions as well as their resilience, anxiety, depression, anger, and posttraumatic stress immediately after treatment and three months later.

"Because of high frequency of concussions and the prevalence of alexithymia after mild TBI, it is likely to be impacting a large portion of individuals," Neumann said. "We expect BEST training to strengthen emotional resiliency and well-being."

The NICoE will facilitate BEST treatment by helping the refer service members from its associated military rehabilitation facilities. 

Co-principal investigators include Flora Hammond, MD, chair of the IU School of Medicine Department of Physical Medicine and Rehabilitation, Jie Ren, PhD, Assistant Professor of IU School of Medicine Department of Biostatistics and Health Date Science, and Treven Pickett, PsyD, department chief of research for the National Intrepid Center of Excellence (NICoE).


IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research, and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs and the Defense Health Agency J9, Research and Development Directorate, or the U.S. Army Medical Research Acquisition Activity at the U.S. Army Medical Research and Development Command, in the amount of $749,166 (IU: $715,319 and WRNMMC: $33,847) through the Traumatic Brain Injury and Psychological Health Research Program under Award No. W81XWH-22-2-0064. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense.

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