*Article* **Evaluating a Novel Treatment Adapting a Cognitive Behaviour Therapy Approach for Sexuality Problems after Traumatic Brain Injury: A Single Case Design with Nonconcurrent Multiple Baselines**

**Elinor E. Fraser 1,2,\*, Marina G. Downing 1,2, Kerrie Haines 1, Linda Bennett 1, John Olver <sup>3</sup> and Jennie L. Ponsford 1,2**


**Citation:** Fraser, E.E.; Downing, M.G.; Haines, K.; Bennett, L.; Olver, J.; Ponsford, J.L. Evaluating a Novel Treatment Adapting a Cognitive Behaviour Therapy Approach for Sexuality Problems after Traumatic Brain Injury: A Single Case Design with Nonconcurrent Multiple Baselines. *J. Clin. Med.* **2022**, *11*, 3525. https://doi.org/10.3390/ jcm11123525

Academic Editors: Nada Andelic, Cecilie Røe, Eirik Helseth, Emilie Isager Howe, Marit Vindal Forslund and Torgeir Hellstrom

Received: 26 April 2022 Accepted: 14 June 2022 Published: 19 June 2022

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**Abstract:** There has been little progress in development of evidence-based interventions to improve sexuality outcomes for individuals with traumatic brain injury (TBI). This study aimed to evaluate the preliminary efficacy of an individualised intervention using a cognitive behaviour therapy (CBT) framework to treat sexuality problems after TBI. A nonconcurrent multiple baseline single-case design with 8-week follow-up and randomisation to multiple baseline lengths (3, 4, or 6 weeks) was repeated across nine participants (five female) with complicated mild–severe TBI (mean age = 46.44 years (SD = 12.67), mean post-traumatic amnesia = 29.14 days (SD = 29.76), mean time post-injury = 6.56 years (median = 2.50 years, SD = 10.11)). Treatment comprised eight weekly, individual sessions, combining behavioural, cognitive, and educational strategies to address diverse sexuality problems. Clinical psychologists adopted a flexible, patient-centred, and goal-orientated approach whilst following a treatment guide and accommodating TBI-related impairments. Target behaviour was subjective ratings of satisfaction with sexuality, measured three times weekly. Secondary outcomes included measures of sexuality, mood, self-esteem, and participation. Goal attainment scaling (GAS) was used to measure personally meaningful goals. Preliminary support was shown for intervention effectiveness, with most cases demonstrating sustained improvements in subjective sexuality satisfaction and GAS goal attainment. Based on the current findings, larger clinical trials are warranted.

**Keywords:** Sexuality; cognitive behaviour therapy; traumatic brain injury; Rehabilitation
