Randomised, waiting list controlled trial of cognitive–behavioural therapy for persistent postconcussional symptoms after predominantly mild–moderate traumatic brain injury

Abstract

BackgroundPersistent post-concussional symptoms (PCS) can be a source of distress and disability following traumatic brain (TBI). Such symptoms have been viewed as difficult to treat but may be amenable to psychological approaches such as cognitive behaviour therapy (CBT). ObjectivesTo evaluate the effectiveness of a 12-session individualised, formulation-based CBT program. MethodTwo-centre randomised waiting list controlled trial with 46 adults with persistent PCS after predominantly mild-to-moderate TBI (52% with PTA ≤ 24 hours), but including some with severe TBIs (20% with PTA > 7 days). ResultsImprovements associated with CBT were found on the primary outcome measures relating to quality of life (using the Quality of Life Assessment Schedule and the Brain Injury Community Rehabilitation Outcome scale). Treatment effects after covarying for treatment duration were also found for postconcussional symptoms and several secondary outcomes including measures of anxiety and fatigue (but not depression or PTSD). Improvements were more apparent for those completing CBT sessions over a shorter period of time, but were unrelated to medicolegal status, injury severity or length of time since injury. ConclusionsThis study suggests that CBT can improve quality of life for adults with persistent PCS, and potentially reduce symptoms for some, in the context of outpatient brain injury rehabilitation services.Trial registration ISRCTN49540320

Behavioral Therapies and Mind‐Body Interventions for Posttraumatic Headache and Post‐Concussive Symptoms: A Systematic Review

“…From the 7 studies meeting the inclusion criteria, there was a total of 1108 adult participants of which 68.8% (n = 763) were male. The participants ranged from 18 to 80 years of age and were mostly from the United States (n = 919), Denmark (n = 155), the Netherlands (n = 91), and England (n = 46) . Of the 7 studies, 3 studies focused on military staff and 4 focused on nonmilitary persons .…”

“…The participants ranged from 18 to 80 years of age and were mostly from the United States (n = 919), Denmark (n = 155), the Netherlands (n = 91), and England (n = 46) . Of the 7 studies, 3 studies focused on military staff and 4 focused on nonmilitary persons . Of the studies that focused on military staff, 2 studies enrolled active duty or active reserve/guard duty service members with confirmed or suspected mTBI and one study focused on veteran military staff.…”

“…). Some were assessed for study inclusion at 48 hours post‐injury, within 4–10 weeks post‐injury, greater than 3 months post‐injury, at 6 months post‐injury, or within 2 years post‐injury . One study recruited patients with a history of TBI, though the specific time post‐TBI was not controlled for in the inclusion criteria .…”

“…One study recruited patients with a history of TBI, though the specific time post‐TBI was not controlled for in the inclusion criteria . Subjects were recruited either directly from the emergency department or through outpatient referrals for a history of mTBI . In contrast, another study recruited participants from the Danish Headache Center who were diagnosed with chronic PTH associated with an mTBI related to traffic accidents …”

“…Both groups received 12 educational brochures describing common problems with both TBI and post‐deployment upon recruitment, though the EO group also received a second copy of the brochures by mail with 1 brochure being mailed every other week. The Potter study, like the Kjeldgaard and Scheenen studies, also used in‐person CBT as an intervention, though this study did individual, as opposed to group, sessions . Twelve weekly 1‐hour sessions of individual, in‐person CBT were conducted focusing on psychoeducation, problem identification, and relapse prevention.…”