The Efficacy of Cognitive Behavior Therapy in the Treatment of Emotional Distress After Acquired Brain Injury

Abstract 

Bradbury CL, Christensen BK, Lau MA, Ruttan LA, Arundine AL, Green RE. The efficacy of cognitive behavior therapy in the treatment of emotional distress after acquired brain injury.

Objective

To evaluate the efficacy of cognitive behavior therapy (CBT), adapted to meet the unique needs of individuals with acquired brain injury (ABI), and modified for both group and telephone delivery.

Design

Matched-controlled trial, with multiple measurements across participants, including pretreatment baseline assessment plus posttreatment and 1-month follow-up.

Setting

Outpatient community brain injury center.

Participants

Participants (N=20) with chronic ABI. Ten were assigned to the CBT treatment group and 10 to education control. All were experiencing significant emotional distress at the onset of the study.

Intervention

Eleven sessions of CBT (or education control), including 1 introductory individual session plus 10 further sessions administered in either group format or by telephone. The CBT was designed to decrease psychologic distress and improve coping. Specific adaptations were made to the CBT in order to better accommodate individuals with cognitive difficulties.

Main Outcome Measures

Primary outcome measures included the Symptom Checklist-90-Revised (SCL-90-R) and the Depression Anxiety Stress Scales (DASS-21). Secondary outcome measures included the Community Integration Questionnaire (CIQ) and the Ways of Coping Scale, Revised.

Results

Significant CBT treatment effects (in both group and telephone formats) were observed on the SCL-90-R and the DASS-21, whereas no significant effects were observed in the education control group. No significant effects of treatment were observed on the CIQ or Ways of Coping Scale, Revised.

Conclusions

Results suggest that adapted CBT—administered by telephone or in a face-to-face group setting—can significantly improve emotional well-being in chronic ABI.

Key Words: Anxiety, Brain injuries, Depression, Psychotherapy, Rehabilitation

List of Abbreviations: ABI, acquired brain injury, ANOVA, analysis of variance, CBT, cognitive behavioral therapy, CIQ, Community Integration Questionnaire, DASS-21, Depression Anxiety Stress Scales, short form, GSI, Global Severity Index, RBANS, Repeatable Battery of Adult Neuropsychological Status, SCL-90-R, Symptom Checklist-90-Revised, TBI, traumatic brain injury, WTAR, Wechsler Test of Adult Reading