More than half of adults with traumatic brain injury (TBI) report sexual dysfunction and/or poor sexual wellbeing post-injury. Despite widespread awareness that sexuality changes persist long term, no evidence-based interventions exist to promote positive sexual adjustment after TBI. Using both quantitative and qualitative methods, this study aimed to evaluate the efficacy, feasibility, adherence, and acceptability of CBT-SWELL, a novel, individualised Cognitive Behavioural Therapy treatment for Sexual-WELLbeing after TBI.

A nonconcurrent multiple baseline single-case experimental design with an 8-week follow-up phase and randomisation to multiple baseline lengths was repeated across nine participants (5 female) with moderate to severe TBI (mean age=40.44-years (SD=14.15), mean PTA=34.50-days (SD=29.25), mean time post-injury=7.92-years (SD=11.09)). The primary outcome measure was a rating scale measuring participants' subjective satisfaction with their sexuality completed three times weekly. Secondary outcome measures of mood, self-esteem, social participation, and functional goal attainment were also completed at three time points (pre-treatment, post-treatment, follow-up). Offered to both individuals and couples, CBT-SWELL comprised eight weekly, individual sessions and one booster session with a clinical psychologist. The CBT-SWELL treatment guide was organised into 12 modules with accompanying handouts. The overarching aims of CBT-SWELL were to (1) foster shifts in cognition and/or behaviour that allow individuals/couples to feel more in control of their sexuality, (2) improve satisfaction with sexuality in the individual with TBI, and (3) help individuals with TBI accept and manage changes in sexuality.

Quantitative results provided preliminary support for the efficacy of CBT-SWELL, with 8/9 participants showing significantly improved sexuality satisfaction either during treatment, or shortly thereafter, with improved sexuality satisfaction maintained at follow up. All participants demonstrated clinically significant improvement in at least one goal. Adequate treatment adherence and good feasibility were also shown. Qualitatively, participants experienced multiple benefits from the treatment, with high levels of enjoyment, satisfaction, and acceptability reported.

The results offer preliminary evidence of efficacy for CBT-SWELL in treating complex and diverse sexuality problems after TBI, with larger trials warranted. The unique participant perspectives illustrated in this research not only provide valuable insight into the experience of the intervention but offer important considerations for future research.