Cognitive behavioural therapy and persistent post-concussional symptoms: Integrating conceptual issues and practical aspects in treatment

Abstract

This paper seeks to integrate research findings in mild traumatic brain injury (MTBI) around three central themes relevant to psychological therapies for persistent post-concussional symptoms (PCS). These are (1) the relative lack of symptom specificity, (2) the extent to which subjective (but not necessarily objective) cognitive difficulties predominate, and (3) the role of psychological (especially cognitive-behavioural) processes in the evolution and maintenance of symptoms. Evidence-based models guiding cognitive-behavioural therapy (CBT) for similar symptoms in other clinical groups are considered in relation to persistent PCS, as well as some of the practical considerations in applying CBT with this client group. Outstanding research issues are identified and discussed, including the opportunities and risks of combining CBT and cognitive rehabilitation approaches.

A systematic review of age and gender factors in prolonged post-concussion symptoms after mild head injury

“…If the age factor is indicative of longerlasting neuropathological factors, this might also imply that older patients are more likely to develop symptomatology not amenable to psychological intervention. This might explain some of the limitations in the efficacy of CBT for long-term PCS which are now emerging in the literature [46]. It might suggest that in such circumstances cognitive rehabilitation adjuncts to intervention may enhance treatment potency.…”

Active Rehabilitation of Concussion and Post-concussion Syndrome

“…9,57,58 The potential benefit of integrating cognitive behavioral therapy (CBT) to address thoughts and activities with cognitive rehabilitation to address difficulties with cognitive abilities, such as attention and memory, has also been noted. 59 These approaches to active rehabilitation are grouped into psychoeducational, psychological, and cognitive interventions and reviewed in later discussion. A comprehensive and multidisciplinary approach to treatment, consistent with the concept that PCS can involve more than one disorder, appears promising.…”

Providing Psychotherapy to People with Neuropsychological Impairment: Complexities and Issues Raised by the Case of "Judith"

“…Other questions in this vein might also include the potential for cognitive rehabilitation strategies to manifest as safety behaviors within a cognitive behavioral framework of working, leading to a reduction in the effectiveness of such a treatment modality in this type of case. For example, a diary might be used to minimize memory failures but could become a safety behavior that helps a client to avoid confronting maladaptive cognitions around not succeeding or the likelihood of it occurring in the first place (Potter & Brown, 2012).…”