Research Reports - Cognitive-behavioral prevention of postconcussion syndrome in at-risk patients

J Head Trauma Rehabil. 2013 May 1

Silverberg ND, Hallam BJ, Rose A, Underwood H, Whitfield K, Thornton AE, Whittal ML

OBJECTIVE:: To examine the tolerability and estimate the treatment effect of
cognitive-behavioral therapy (CBT) delivered soon after mild traumatic brain
injury to patients at risk for chronic postconcussion syndrome (PCS). SETTING::
Tertiary rehabilitation center. PARTICIPANTS:: Twenty-eight patients with
uncomplicated mild traumatic brain injury, determined to be at risk for chronic
PCS based on a published algorithm that incorporates subacute postconcussion
symptoms and maladaptive illness beliefs (recovery expectations and perceived
consequences). They were enrolled within 6 weeks postinjury. DESIGN:: Open-label,
parallel-group, randomized controlled trial, with masked outcome assessment 3
months after enrolment. Interventions were (1) treatment as usual (education,
reassurance, and symptom management strategies) from an occupational therapist,
or (2) treatment as usual plus CBT delivered by a psychologist. MAIN MEASURES::
Rivermead Postconcussion Symptoms Questionnaire. RESULTS:: Four participants
(2:2) withdrew. Treatment credibility and satisfaction ratings were high in the
CBT group. Treatment effect sizes were moderate for postconcussion symptoms
(Cohen d = 0.74) and moderate-large for most secondary outcome measures (Cohen d
= 0.62-1.61). Fewer participants receiving CBT had a diagnosis of PCS at
follow-up (54% vs 91%, P < .05). CONCLUSION:: Our preliminary data suggest that
CBT delivered soon after mild traumatic brain injury is well tolerated and may
facilitate recovery in patients who are at risk for chronic PCS. A definitive
clinical trial is warranted.

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