Assessment of Capacity using Neuropsychological Measures

Given the prevalence of cognitive deficits within brain injury the range of deficits an individual can experience has an important influence on their ability to make decisions in relation to daily activity. For example, an individual experiencing executive dysfunction may experience problems with abstract thinking and emotional regulation, which has clear implications for limited ability to engage in complex decision making such as personal care or financial management.

Cognitive impairment may have an impact on the individual’s awareness and understanding of their current circumstances. Furthermore this may have an impact on ability to understand and engage with therapeutic interventions.

A range of legislation exists in the UK that can be used to manage difficulties arising from cognitive impairment. Given the geographical anomalies within the law systems of the UK separate legislation exists in England and Wales, and Scotland:

The Mental Capacity Act (England and Wales)

Adults with Incapacity (Scotland) Act 2000

Adult Support and Protection (Scotland) Act 2007

A range of guidance is available for each of the aforementioned acts which is summarised here in terms of assessment. It is suggested the following areas are considered within assessment based around the Adults with Incapacity (Scotland) Act 2000; Perception, understanding, logical thinking, memory, motivation, planning, reasoning, suggestibility, emotional disorder, thought disorder and communication problems. All of these are included in a comprehensive neuropsychological assessment. Further to this the following points are:

  • Make sure the capacity question is specific
  • Consider evidence of impaired judgement prior to admission
  • Use vignettes to support exploration of the particular decision to be made

If you have a client that requires a capacity assessment please contact Alba Psychology.

Managing negative thinking in depression

Depression and Thoughts

One of the effects of depression is to change the way you think. When people are depressed, they tend to think the worst about everything. This way of thinking adds to the depression, and makes you feel even worse. Like inactivity, thinking in a negative way actually becomes part of the problem.

Psychologists have identified a set of ‘errors’ people make in the way they think when they are depressed. Thinking becomes distorted, and acts to keep the depression going. Look at these examples and see if you recognise yourself.

  • You think about things in black and white terms. Things are either good or bad with nothing in between. If you try to do something, and part of it is not as good as usual, you tend to write it all off as ‘hopeless’ or ‘useless’ instead of saying it was somewhere in the middle
  • You ignore the positive aspects of an experience and concentrate on what you feel worst about
  • Mindreading – you think that you know what people are thinking, e.g. “She must think I’m a rotten person”. You then act on this, perhaps by avoiding seeing the person again
  • If something goes wrong once, you assume that it will always be as bad as this in the future
  • You use the word ‘should’ a lot. You say things like ‘I should have been able to do that’ or ‘I should have known that he wouldn’t enjoy that’. This makes it seem as if you are failing all the time
  • Whenever anything goes wrong, you assume that it is your fault. If something goes well, you put it down to luck or think it is just a fluke

How to change your thinking

When you feel especially bad, try asking yourself if your way of thinking is making the problem worse. Remember that depression makes you think the worst, and things may not be as bad as they seem.

Try writing down what you have been thinking when you feel especially bad. This may seem difficult at first, but is a good way of getting things into perspective. You do not have to show what you write to anyone else if you do not want to.

When you have an idea of what you are thinking, try asking yourself these questions:

  • Do I have any actual evidence for what I am thinking or is there evidence I might be mistaken?
  • Could there be another way of thinking about this? What would someone who is not depressed think?
  • If a friend was thinking this way, what would I say to them?

Have a look at the examples of distorted thinking above, and see if you can recognise yourself in them.

If you can, write down some answers to these questions. Read over what you have written when you feel a bit better – were things as bad as you thought?

Trying to change the way you think is difficult at first, but if you can persevere, it will become easier.


Your doctor may have given you tablets to help with the depression. It is important that you follow the instructions carefully. It is possible to follow the advice given in this leaflet for tackling depression and take medication. Doing both will help you to recover more quickly.

Please contact Alba Psychology to discuss meeting with a Chartered Psychologist to offer treatment based on the principles above

Managing Depression

At Alba Psychology we regularly meet individuals who have difficulties with low mood or depression following a brain injury. People with depression or a related problem often feel as though they are the only person in the world suffering like this.  This in itself can be very distressing.  In fact, depression is very common and it can affect anyone.

Feeling fed up and a bit down is a normal part of life.  If something upsetting has happened to you then it is not unusual to feel this way and to not enjoy what is happening in your life.

Sometimes, a person’s mood may seem to drop for little or no obvious reason.  In some cases, low mood can worsen and begin to dominate someone’s life completely.  When someone feels very low for more than two weeks and feels like this day after day, week after week, this is called a depressive illness.  It affects the person’s mood and their thinking.  Their behaviour may start to change and they may experience a range of physical symptoms in their body.  Practical problems may start to build up in that person’s life.

Psychological Techniques

There are various ways of tackling your depression using psychological methods. The first step is to think about your activities and routine.


When people are depressed, they usually do less. Activities seem less enjoyable and take more effort. Sometimes people worry that if they do something they will make a mistake or do it badly. Unfortunately the less you do, the less you feel like doing. When you are not doing things you used to enjoy, you miss out on the pleasure they gave you. Also, doing less can make you feel less confident about things you used to be able to do without a second thought. Worries about being incapable of doing things creep in. This is likely to make you feel worse. There is now a vicious circle.

Breaking the vicious circle

Part of overcoming your depression is breaking this cycle of inactivity. This means gradually getting back to doing things you used to. At first this will seem very difficult, and you may predict that you will fail. If you find yourself thinking in this way, tell yourself that you can change your habits, but it will take time.

Becoming more active

The key to changing habits of inactivity is to work gradually You may have been less active for quite a while, so it is unrealistic to expect this to change overnight.

Set yourself daily targets for activity. At first you could try to do something for 10 minutes in the morning and 10 minutes in the afternoon.

Choose an activity that used to give you a sense of enjoyment or achievement, but don’t worry if you don’t find it enjoyable to begin with.

If you do manage some activity – congratulate yourself. Keep up the habit! Doing something is better than doing nothing.

Once you become more used to more activity, you can gradually increase the amount you are doing. Notice that being more active makes you feel more motivated to do things.

If you find your targets too difficult, think about what is holding you back.

Perhaps negative thoughts have crept in. You may have tried to do too much. Set yourself an easier target and try again.

Next week – how to manage negative thoughts in depression

Please do not hesitate to contact Alba Psychology if you feel you would like to discuss your own difficulties with low mood.

Alcohol Related Brain Damage – A relatively new problem?

Alcohol Related Brain Damage (ARBD) is a term used to refer to a range of conditions including Wernicke’s encephalopathy, and Korsakoff’s syndrome (Schmidt et al 2005).  What these conditions have in common is that they are all induced by chronic alcohol consumption resulting in some degree of brain damage and neuropsychological dysfunction

 There are a number of characteristics commonly associated with ARBD:

  • Confusion about time and place
  • Impaired attention and concentration
  • Difficulty learning new information
  • Problems with short-term memory
  • Confabulation (the fabrication of memories as a way of masking memory impairment)
  • Frontal lobe dysfunction (e.g. problems with planning, organising and regulating behaviour)
  • Physical problems such as ataxia (a gait disorder resulting in poor balance)
  • Depression, anxiety and irritability

Alcohol can cause damage to the brain (ARBD) through a number of mechanisms, including

  • Direct toxic effect on the brain
  • Prevents absorption of thiamine (vitamin B12) – an important brain nutrient
  • Poor nutrition & dehydration
  • Liver disease (hepatic encephalopathy)
  • Falls and accidents
  • Changes to metabolism and blood supply to the brain

ARBD severity exists on a continuum from mild to severe and will differ greatly from person to person (as does the potential for recovery)

ARBD is not the same as having an intellectual disability or having a dementia, although there are some overlaps. It has been suggested that people affected by ARBD have needs more akin to adults of similar ages with acquired brain injury than to people with other dementias (e.g. Jacques & Anderson, 2002; Mental Welfare Commission, 2010).  The main reason for this is the recognition that other dementias are progressive in nature, whereas ARBD is not (assuming alcohol consumption stops).  In fact, a significant proportion of people with ARBD will make significant improvements with the right care and conditions, with the following predicted recovery rates:

  •  25% making a complete recovery
  • 25% making a significant recovery
  • 25% making a slight recovery
  • 25% making no recovery                      (Smith & Hillman, 1999)

This suggests that over half of those with ARBD will make a significant recovery.  However, this recovery will only take place if the person with ARBD sustains abstinence from alcohol and is given access to specialist rehabilitation interventions and neuropsychological assessment.

Apps for Brain Injury Rehab

Recovery from brain injury can take time. With the advances in modern technology there a number of apps for your smartphone that can assist with this process.


 Individuals with brain injury may find it hard to communicate in early stages of recovery so it may help to use a simple “yes no” format. Apps such as Answers: YesNo for iOS and Quick Talk AAC for Android can help with a forced choice format. There are further communication aids that involve emotions such as Bla|Bla|Bla for iOS, which shows fun faces reacting to sound.

Cognitive Rehab

There’s an app to match nearly any cognitive rehab goal:

 iMazing andMatrix Game for visual problem solving

 Awesome Memory for short-term memory,

Skill Game for executive functioning.

Compensatory tools

The calendar reminder on any mobile phone is a useful function to assit with prompting. A number of apps build on this format by including photos and voices to associate to a particular task. See  Visual Schedule Planner ,  EZBuzz  and Voice Reminder for further info. Sticky Notes for iOS and the Desk Notes widget for Android are also great for making virtual notes.


Virtual check in apps such as GPS-based  Community Sidekick  and Family GPS Tracker  can help a significant other know where a person is in terms of following a daily routine.

Obviously all of the aforementioned apps are not a substitute for a targeted rehab programme but can be helpful.

Dr. Fraser Morrison, Clinical Director, Alba Psychology

Finding Nemo – psychological assessment required?

Inaccurate media portrayal of memory problems or brain injury can be frustrating for those who are living with those problems on a daily basis. Typically a character in a film will experience a head trauma, say falling off a boat as in the case of Goldie Hawn in the 1987 film ‘Overboard’ and then undergo a complete personality changes. Goldie’s character in this film goes from being a ‘bad’ mother to a doting parent overnight. Whilst an individual’s personality can change following brain injury the blanket manner in which it is often described in the movie industry is often far removed from reality. They suffer very few problems managing everyday tasks, while managing to hold down new jobs and function socially with the marked change being in their personality.

Research published in the British Medical Journal by Dr Sallie Baxendale of the National Society for Epilepsy highlighted the unlikely truth that a cartoon about a fish with memory problems actually bore more relevance than those involving humans. She said: “Unlike most films in this genre, this amnesiac character retains his identity, has little retrograde amnesia and shows several of the severe everyday memory difficulties associated with the disorder.”

Being a father of two young children I must have seen this film numerous times. With each watch I still find the tale of Dory, the fish with memory problems, moving through her daily life and finding the strength of character to help a father find his lost son heartening. Despite her obvious difficulties in recalling names or knowing where she is, Dory manages to succeed and also be happy within herself. Something that is key to recovery from any brain injury. As Dory would say………….”Just keep swimming, swimming, swimming………”

Some advice from Dory

 Dr. Fraser Morrison, Clinical Director, Alba Psychology

Morisons LLP Solicitors

“The report provided by Alba Psychology was concise and well delivered. The most important factor was the quick turnaround following assessment which can be essential within a legal setting.”

Morisons LLP Solicitors, Edinburgh

Mr. L.

“Alba Psychology provided one-to-one therapy following my accident. The help I received was invaluable and helped me move towards recovery.”

Mr. L, private patient who had experienced brain injury

Castlecraig Rehabilitation Hospital

“It is good that we have access to a Neuropsychologist – if our screening indicates that someone may be significantly cognitively impaired in order to better identify the extent of the cognitive deficits. Having access to a specialist such as Dr. Morrison enhances the quality of care planning at Castlecraig.”   Dr. McCann, Medical Director, Castlecraig Rehabilitation Hospital, Scottish Borders

Mrs L.

“I needed an assessment of Autism for my son and daughter to assist with a visa application. The report provided by Dr. Morrison was excellent and helped us achieve our goal of moving to Australia with recommendations for support for my children.”

Mrs L, Greenock, Scotland