Found in translation: 12 mantras for brain injury rehabilitation

This month we turn our attention to an initiative Brainkind has been implementing in brain injury rehabilitation services over the last few years: the rehab mantras.

Rehabilitation after an acquired brain injury is a complex process. It has several components [1], and there isn’t always clear guidance about what approach to take with whom [2]. It is also not always easy for health care staff to put all the components of a complex intervention in practice, even when they understand that it’s best to do things in a particular way [3].  

Jan McIntosh-Brown, Clinical Lead Speech and Language Therapist, had an idea to help with this problem: creating simple statements that would summarise and communicate some of the more complex principles of neurobehavioural rehabilitation… After a chat with the Brainkind research team about how this could be implemented, the Brainkind rehab mantras were born. 

Mantras versus the rehab mantras 

The Brainkind rehab mantras are short, repeatable and memorable statements intended to help anyone understand, remember and apply the key principles of the neurobehavioural approach adopted in our services.  

“Mantras” have been used in therapy settings for some time. As Oman [4] explains, mantras, often used as a meditative technique, “are a phrase or sound that has been repeated and sanctified within a spiritual tradition or religious practice for the purpose of invoking divinity or progressively aligning a person’s life with the highest reality as understood by the tradition” (p. 2). 

The Brainkind rehab mantras are not based in spiritual traditions, nor are they designed to achieve alignment of a person’s life with anything other than their own independence and aspirations. Instead, our rehab mantras are based on scientific research which highlights important aspects of rehabilitation for people with a brain injury. They communicate what works and is evidence-based in rehabilitation. For example, the mantra “consistency leads to success” is based on our knowledge about how a brain injury affects memory and ways of supporting learning by tapping into intact mechanisms [5].  

How do mantras work? 

While therapeutic mantras are an intervention for patients aimed at reducing symptoms of distress and increase mental health, the Brainkind rehab mantras are an intervention for the “rehab system”, aimed at supporting knowledge of key principles through a process of priming. Priming occurs when exposure to a stimulus influences our responses, without us being aware of the connection. Therapy mantras work in a similar way, by repetition and reflection about what an individual mantra means to the person. The rehab mantras are thought to achieve behaviour change by “spreading activation” from each rehab mantra to the principles and modes of practice that lie behind it, through exposure in short webinar presentations, posters, articles, quizzes, etc. For example, seeing a poster stating that “behaviour communicates needs” might be the catalyst that prompts staff to recall that verbal aggression is not personal, and increase their readiness to record their observations on an ABC chart to help the team supporting the person monitor their wellbeing and progress.  

The capability, opportunity and motivation model of behaviour change [6] might also be useful to help us understand the premise behind the rehab mantras. In simple terms, and using Michie and colleagues’ analogy, as a detective needs to determine that a suspect had the capability, opportunity and motive to identify them as the culprit of a crime, we also need these three ingredients for behaviour change to occur. In the context of the rehab mantras, the behaviour change we are aiming to achieve is the implementation of best practice. To do so, staff need to be able to carry out the practice (including, for example, having the appropriate training), need to have the opportunity to implement it, but also the willingness to do so. We hypothesise that the rehab mantras help with different aspects considered in the COM-B model and contribute to creating a shared understanding of what we are working towards, maximising motivation. 

Do mantras help? 

At an individual level, the answer is yes. Alvarez-Perez and colleagues [7] found that mantra-based meditation techniques (MBM) are useful in reducing anxiety, depression, post-traumatic stress, and increasing mental-health related quality of life. However, the positive effects of these techniques were comparable to those achieved with psychotherapy. In addition, there are still few studies looking at the impact of these techniques over time, so it is unclear whether MBM is effective in the long-term. 

When it comes to the Brainkind rehab mantras, the jury is still out. The evaluations we carried out so far suggest that our staff found the rehab mantras relevant and easy to understand and stated that they encouraged reflection about the importance of effective communication. However, it is too early to say if they have had a direct and sustained impact on day-to-day practice. It is also unclear if a similar approach offered directly to patients could be helpful to them. Anecdotally, a few of the people we support in our services have taken inspiration from some of the mantras. Themes of patience, persistence and hope recur when people share their lived experience of recovery from a severe brain injury, in line with the messages “things take time”, “consistency leads to success”, “it’s never too late to rehab”, “eyes on the goal”. In that way, the rehab mantras may have affected engagement, motivation, and even supported memory for some people. But we have yet no objective evidence that using mantras can increase motivation and participation in rehabilitation.  

We encourage anyone who would like to learn more about the Brainkind rehab mantras to visit the dedicated page on our website here. Or tell us what you think using this link, or dropping us a line research@brainkind.org. 

References 

[1] McMillan, T. M. & Wood, R. L. (Eds.) (2017) Neurobehavioural Disability and Social Handicap Following Traumatic Brain Injury (Second Edition). Psychology Press. 

[2] Hart, T., & Ehde, D. M. (2015). Defining the treatment targets and active ingredients of rehabilitation: Implications for rehabilitation psychology. Rehabilitation Psychology, 60(2), 126. 

[3] Davis, D., Davis, M. E., Jadad, A., Perrier, L., Rath, D., Ryan, D., … & Zwarenstein, M. (2003). The case for knowledge translation: shortening the journey from evidence to effect. BMJ, 327(7405), 33-35. 

[4] Oman, D. (2024). What is a mantra? Guidance for practitioners, researchers and editors. American Psychologist, Advance online publication. https://dx.doi.org/10.1037/amp0001368 

[5] Schmitter-Edgecombe, M. (2006). Implications of basic science research for brain injury rehabilitation: A focus on intact learning mechanisms. The Journal of Head Trauma Rehabilitation, 21(2), 131-141.  

[6] Michie, et al. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 1-12. 

[7] Alvarez-Perez, et al. (2022). Effectiveness of mantra-based meditation on mental health: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 19(6), 3380.