Dr O’Neill has recently evaluated the effectiveness of two treatment approaches* that build on his innovative slant to delivering neurobehavioural rehabilitation. The first was grounded on principles of positive psychology, a branch of psychological science that focuses on aiding achievement of a satisfactory life, rather than simply treating difficulties.

In this study, Dr O’Neill and his colleagues Holly Andrewes and Vicky Walker measured the effectiveness of two interventions on anxiety and depression (Hospital Anxiety and Depression Scale, Snaith & Zigmond, 1994), happiness (Authentic Happiness Index, Seligman, 2006) self-identity (Head Injury Semantic Differential Scale, Tyerman & Humphrey, 1987), and core strengths (Brief Strengths Test, Peterson & Seligman, 2004). Participants were randomly assigned to experimental and standard care control groups. They completed the measures immediately before and after two interventions, drawn from positive psychology and combined into a group treatment. The first, 'three good things in life', encouraged and helped participants to write down three positive events that occurred each day. The second, 'signature strengths' asked participants to complete the 'brief strengths test' to identify five key strengths. Participants then met individually with the session facilitators to explore how these strengths were used before the brain injury, and how they could be used now and in the future. The results revealed that both interventions were promising methods for reducing distress and improving wellbeing by promoting engagement with valued daily activities.

The second treatment method investigated how effective biofeedback devices are in reducing challenging behaviour. Participants were supervised in their 10 - 20 minute per day use ofemWave 2, a device that analyses Heart Rate Variability (HRV), a physiological marker for the experience of negative emotions like stress and anxiety (Lehrer, 2007). Participants learned to identify states of negative emotion by attending to feedback from the device. They also learned to increase their HRV, a sign of better physical and mental health, by inhaling and exhaling as the lights rose and fell. Instances of aggression were carefully recorded throughout the intervention, using a behaviour monitoring tool (Alderman et al., 1997). The intervention was a success, with a marked decrease in aggressive behaviour in both participants. They also reported less feelings of anger and increased wellbeing.


  • Alderman, N.; Knight, C. & Morgan, C. (1997). Use of a modified version of the Overt Aggression Scale in the measurement and assessment of aggressive behaviours following brain injury.Brain Injury, 11, 503-523.
  • *Andrewes, H. E., Walker, V., & O’Neill, B. (2014). Exploring the use of positive psychology interventions in brain injury survivors with challenging behaviour.Brain Injury, 28, 965-971.
  • Lehrer, P. M. (2007). Biofeedback training to increase heat rate variability. In P. M. Leher, R. L. Woolfolk & W. E. Sim (Eds.) Principles and practice of stress management (3rd Edition). (pp. 227-248). New York: Guildford
  • * O’Neill, B., & Findlay, G. (2014). Single case methodology in neurobehavioural rehabilitation: Preliminary findings on biofeedback in the treatment of challenging behaviour. Neuropsychological Rehabilitation, 24, 365-381.
  • Peterson C. & Seligman M. E. P. (2004). Character strengths and virtues: A handbook and classification. New York: Oxford University Press/Washington D. C.: American Psychological Association.
  • Seligman, M. E. P. (2006). Authentic Happiness Inventory, Pennsylvania USA: University of Pennsylvania. Retrieved from: Accessed 20 June 2013.
  • Snaith, R.P., Zigmond, A.S. (1994). Hospital Anxiety and Depression Scale.Acta Psychiatrica Scandinavica, 67,361-370.
  • Tyerman, A. & Humphrey, M. (1987). Self-concept and psychological change in the rehabilitation of the severely head injured person. Unpublished doctoral thesis, University of London, London.

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