Research Reports - Randomised, waiting list controlled trial of cognitive-behavioural therapy for persistent postconcussional symptoms after traumatic brain injury

J Neurol Neurosurg Psychiatry. 2016 Oct;87(10):1075-83. doi:
10.1136/jnnp-2015-312838. Epub 2016 Aug 5.

Potter SD(1), Brown RG(1), Fleminger S(2).

BACKGROUND: Persistent postconcussional symptoms (PCS) can be a source of
distress and disability following traumatic brain injury (TBI). Such symptoms
have been viewed as difficult to treat but may be amenable to psychological
approaches such as cognitive-behavioural therapy (CBT).
OBJECTIVES: To evaluate the effectiveness of a 12-session individualised,
formulation-based CBT programme.
METHOD: Two-centre randomised waiting list controlled trial with 46 adults with
persistent PCS after predominantly mild-to-moderate TBI (52% with post-traumatic
amnesia (PTA)≤24 hours), but including some with severe TBIs (20% with
PTA>7 days).
RESULTS: Improvements 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 PCS and
several secondary outcomes, including measures of anxiety and fatigue (but not
depression or post-traumatic stress disorder (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.
CONCLUSIONS: This 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. 

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