Research Reports - Efficacy of motivational interviewing and cognitive behavioral therapy for anxiety and depression symptoms following traumatic brain injury

Psychol Med. 2016 Apr;46(5):1079-90. doi: 10.1017/S0033291715002640. Epub 2015
Dec 28.

Ponsford J(1), Lee NK(2), Wong D(1), McKay A(1), Haines K(1), Alway Y(1), Downing
M(1), Furtado C(1), O'Donnell ML(3).

BACKGROUND: Anxiety and depression are common following traumatic brain injury
(TBI), often co-occurring. This study evaluated the efficacy of a 9-week
cognitive behavioral therapy (CBT) program in reducing anxiety and depression and
whether a three-session motivational interviewing (MI) preparatory intervention
increased treatment response.
METHOD: A randomized parallel three-group design was employed. Following
diagnosis of anxiety and/or depression using the Structured Clinical Interview
for DSM-IV, 75 participants with mild-severe TBI (mean age 42.2 years, mean
post-traumatic amnesia 22 days) were randomly assigned to an Adapted CBT group:
(1) MI + CBT (n = 26), or (2) non-directive counseling (NDC) + CBT (n = 26); or a
(3) waitlist control (WC, n = 23) group. Groups did not differ in baseline
demographics, injury severity, anxiety or depression. MI and CBT interventions
were guided by manuals adapted for individuals with TBI. Three CBT booster
sessions were provided at week 21 to intervention groups.
RESULTS: Using intention-to-treat analyses, random-effects regressions
controlling for baseline scores revealed that Adapted CBT groups (MI + CBT and
NDC + CBT) showed significantly greater reduction in anxiety on the Hospital
Anxiety and Depression Scale [95% confidence interval (CI) -2.07 to -0.06] and
depression on the Depression Anxiety and Stress Scale (95% CI -5.61 to -0.12)
(primary outcomes), and greater gains in psychosocial functioning on Sydney
Psychosocial Reintegration Scale (95% CI 0.04-3.69) (secondary outcome) over 30
weeks post-baseline relative to WC. The group receiving MI + CBT did not show
greater gains than the group receiving NDC + CBT.
CONCLUSIONS: Findings suggest that modified CBT with booster sessions over
extended periods may alleviate anxiety and depression following TBI.

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