Cognitive-Behavioral Therapy Can Help Adults After Traumatic Brain Injury

By Reuters Staff

NEW YORK – Cognitive-behavioral therapy (CBT) can improve the quality of life for adults with persistent post-concussional symptoms (PCS) and potentially reduce symptoms, researchers in the UK have found.

Persistent PCS after traumatic brain injury (TBI) can be troubling and difficult to treat, they note in the Journal of Neurology, Neurosurgery & Psychiatry, online August 5.

With psychological approaches, however, "the impact of persistent PCS, especially on individuals' quality of life, can be ameliorated even for individuals sustaining more-than-mild TBIs," write Dr. Sebastian Potter of the Institute of Psychiatry, Psychology and Neuroscience in London and colleagues.

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To evaluate the effectiveness of a 12-session individualized CBT treatment program, the team conducted a randomized waiting list-controlled trial in two centers with 46 adults between 18 and 65 years of age who had persistent PCS. Most participants had mild-to-moderate TBI (52% with post-traumatic amnesia lasting 24 hours or less), but some had severe TBI (20% with post-traumatic amnesia lasting longer than seven days).

The researchers randomized 26 participants to the treatment group and 22 to the control group. The groups were similar in gender, age, education, current occupational level and the duration of their post-traumatic amnesia. The interval between injury and randomization ranged from six to 175 months with a mean of 25 months.

CBT led to a significant improvement in quality of life as measured by the Quality of Life Assessment Schedule (difference, 5.79; p=0.02) and the psychological well-being subscale of the Brain Injury Community Rehabilitation Outcome Scale (difference, 3.11; p=0.025).

These effects were even more pronounced when including treatment duration as a covariate, and this model also revealed a significant improvement on the Rivermead Post Concussion Symptoms Questionnaire (difference, 7.46; p=0.38).

The researchers also found significant effects of CBT on PCS and secondary outcomes such as anxiety and fatigue after covarying for treatment duration. There was no effect on depression or post-traumatic stress disorder, however.

Improvements were more noticeable for patients completing CBT sessions over a shorter time period but were unrelated to medicolegal status, injury severity or time elapsed since injury.

The authors point to several limitations to their study, including the variation in time taken to complete the CBT sessions; not collecting data on other variables that might have influenced outcomes, such as homework completion, or perceptions of the usefulness of treatment; using a single therapist, which may limit the generalizability of the data; and the potential of response bias due to questionnaires being given by the treating therapist.

They call for larger, multicenter studies that include a measure of therapist competence and protocol adherence as well as outcome measures provided by a non-treating researcher.

The study did not have commercial funding.

Dr. Potter did not respond to requests for comments.

SOURCE: https://bit.ly/2bxTdKc

J Neurol Neurosurg Psychiatry 2016.

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