Graduate Studies

 

First Advisor

Kathy Chiou

Degree Name

Doctor of Philosophy (Ph.D.)

Committee Members

Arthur 'Trey' Andrews, Kathryn Holland, Rebecca Wachs

Department

Psychology

Date of this Version

8-2025

Document Type

Dissertation

Citation

A dissertation presented to the Graduate College of the University of Nebraska in partial fulfillment of requirements for the degree of Doctor of Philosophy

Major: Psychology

Under the supervision of Kathy Chiou

Lincoln, Nebraska, August 2025

Comments

Copyright 2025, Rachael L. Snyder. Used by permission

Abstract

Traumatic brain injury (TBI) can contribute to changes in cognitive and emotional functioning, quality of life, and psychosocial reintegration. Chronic pain is a common consequence of TBI which can uniquely impact such outcomes. Still, the exact nature of the contribution of pain on post-TBI outcomes remains unclear, and there are few existing studies exploring the treatment journey for chronic pain and injury rehabilitation through qualitative methods, specifically individual interviews with TBI survivors. This study aimed to document these narratives and to identify precisely how the experiences of TBI survivors seeking treatments, rather than the treatments themselves, impact outcomes. It also aimed to further elucidate the relationship between pain symptomology and TBI outcomes.

Ten adult TBI survivors with injuries ranging in severity from mild to severe engaged in a semi-structured interview about their recovery journey and their perspective on how their experiences have impacted them over time. Participants then completed a comprehensive neuropsychological assessment battery followed by self-report questionnaires and structured interviews about their mood, quality of life, psychosocial reintegration, and pain symptomology. Throughout the interviews, participants discussed the experience of being deemed ‘good enough’ and the many costs of TBI, as well as independence (both forced independence and functional independence) throughout their recovery. Overall, treatment experiences did not predict cognition. Some negative experiences were associated with more symptoms of depression and anxiety; however, negative experiences also predicted higher quality of life as it pertains to psychosocial reintegration and social support. Additionally, findings indicate that there may be a relationship between pain pattern and some aspects of cognition. Pain severity and pattern predicted more pain anxiety symptoms.

Despite noted limitations, this project provides unique insight into the lived experience of TBI survivors living with chronic pain and their views on the long-term impacts of their treatment experiences. This is important information for providers to have in order to better serve the TBI community. Additionally, this project demonstrates the important contribution of pain in TBI recovery. Further research is needed to better understand how cognition is impacted by treatment experiences and the unique contribution of pain on cognition and functioning after TBI.

Advisor: Kathy Chiou

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