Psychoeducation as Precision Health in Military-Related Mild Traumatic Brain Injury

Published:September 10, 2021DOI:


      A significant proportion of Service Members and Veterans (SMVs) experience at least 1 mild traumatic brain injury during military activities (mil-mTBI), which can result in enduring cognitive symptoms. Although multiple cognitive rehabilitation (CR) interventions have been developed for this population, patient psychoeducation focusing on biopsychosocial relationships and health behaviors is often cited as the first line of defense for mil-mTBI sequelae. However, theoretical and conceptual foundations of these psychoeducational techniques are not well articulated. This raises questions about the potency of attempts to boost health literacy in affected SMVs, who represent a highly heterogeneous patient population within a special cultural milieu. To elucidate the significance of this problem and identify opportunities for improvement, we view the psychoeducation of SMVs through the lens of educational principles described in serious mental illness, where “psychoeducation” was first formally defined, as well as contextual and phenomenological aspects of mil-mTBI that may complicate treatment efforts. To advance psychoeducation research and practice in mil-mTBI, we discuss how treatment theory, which seeks to link active treatment ingredients with specific therapeutic targets, and an associated conceptual framework for medical rehabilitation—the Rehabilitation Treatment Specification System—can be leveraged to personalize educational content, integrate it into multicomponent CR interventions, and evaluate its effectiveness.


      List of abbreviations:

      CR (cognitive rehabilitation), mil-mTBI (military mild traumatic brain injury), mTBI (mild traumatic brain injury), RTSS (Rehabilitation Treatment Specification System), SMI (serious mental illness), SMV (Service Members and Veterans), TBI (traumatic brain injury), VA (Veterans Affairs)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Defense and Veterans Brain Injury Center (DVBIC). DoD worldwide numbers for TBI. Available at: Accessed November 27, 2020.

        • McMahon P
        • Hricik A
        • Yue JK
        • et al.
        Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study.
        J Neurotrauma. 2014; 31: 26-33
        • Cassidy JD
        • Cancelliere C
        • Carroll LJ
        • et al.
        Systematic review of self-reported prognosis in adults after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis.
        Arch Phys Med Rehabil. 2014; 95: S132-S151
        • Hou R
        • Moss-Morris R
        • Peveler R
        • Mogg K
        • Bradley BP
        • Belli A.
        When a minor head injury results in enduring symptoms: a prospective investigation of risk factors for postconcussional syndrome after mild traumatic brain injury.
        J Neurol Neurosurg Psychiatry. 2012; 83: 217-223
        • Schwab K
        • Terrio HP
        • Brenner LA
        • et al.
        Epidemiology and prognosis of mild traumatic brain injury in returning soldiers: a cohort study.
        Neurology. 2017; 88: 1571-1579
        • Vanderploeg RD
        • Curtiss G
        • Luis CA
        • Salazar AM.
        Long-term morbidities following self-reported mild traumatic brain injury.
        J Clin Exp Neuropsychol. 2007; 29: 585-598
        • O'Neil ME
        • Carlson K
        • Storzbach D
        • et al.
        Complications of mild traumatic brain injury in veterans and military personnel: a systematic review.
        Department of Veterans Affairs, Washington (DC)2013
        • Soble JR
        • Cooper DB
        • Lu LH
        • Eapen BC
        • Kennedy JE.
        Symptom reporting and management of chronic post-concussive symptoms in military service members and veterans.
        Curr Phys Med Rehabil Rep. 2018; 6: 62-73
        • Romeu-Mejia R
        • Giza CC
        • Goldman JT.
        Concussion pathophysiology and injury biomechanics.
        Curr Rev Musculoskelet Med. 2019; 12: 105-116
        • Giza CC
        • Hovda DA.
        The new neurometabolic cascade of concussion.
        Neurosurgery. 2014; 75: S24-S33
        • Barkhoudarian G
        • Hovda DA
        • Giza CC.
        The molecular pathophysiology of concussive brain injury-an update.
        Phys Med Rehabil Clin N Am. 2016; 27: 373-393
        • Bigler ED
        • Maxwell WL.
        Neuropathology of mild traumatic brain injury: relationship to neuroimaging findings.
        Brain Imaging Behav. 2012; 6: 108-136
        • Bailes JE
        • Dashnaw ML
        • Petraglia AL
        • Turner RC.
        Cumulative effects of repetitive mild traumatic brain injury.
        Prog Neurol Surg. 2014; 28: 50-62
        • Fehily B
        • Fitzgerald M.
        Repeated mild traumatic brain injury: potential mechanisms of damage.
        Cell Transplant. 2017; 26: 1131-1155
        • Koerte IK
        • Lin AP
        • Willems A
        • et al.
        A review of neuroimaging findings in repetitive brain trauma.
        Brain Pathol. 2015; 25: 318-349
        • Bennett ER
        • Reuter-Rice K
        • Laskowitz DT.
        Genetic influences in traumatic brain injury.
        in: Laskowitz D Grant G Translational research in traumatic brain injury. CRC Press/Taylor and Francis Group, Boca Raton2016
        • Lawrence DW
        • Comper P
        • Hutchison MG
        • Sharma B.
        The role of apolipoprotein E episilon (ε)-4 allele on outcome following traumatic brain injury: a systematic review.
        Brain Inj. 2015; 29: 1018-1031
        • Combs HL
        • Berry DTR
        • Pape T
        • et al.
        The effects of mild traumatic brain injury, post-traumatic stress disorder, and combined mild traumatic brain injury/post-traumatic stress disorder on returning veterans.
        J Neurotrauma. 2015; 32: 956-966
        • Donnelly K
        • Donnelly JP
        • Warner GC
        • Kittleson CJ
        • King PR.
        Longitudinal study of objective and subjective cognitive performance and psychological distress in OEF/OIF Veterans with and without traumatic brain injury.
        Clin Neuropsychol. 2018; 32: 436-455
        • Jak AJ
        • Gregory A
        • Orff HJ
        • et al.
        Neuropsychological performance in treatment-seeking Operation Enduring Freedom/Operation Iraqi Freedom Veterans with a history of mild traumatic brain injury.
        J Clin Exp Neuropsychol. 2015; 37: 379-388
        • Merritt VC
        • Jurick SM
        • Crocker LD
        • et al.
        Evaluation of objective and subjective clinical outcomes in combat veterans with and without mild TBI and PTSD: a four-group design.
        J Clin Exp Neuropsychol. 2019; 41: 665-679
        • Shandera-Ochsner AL
        • Berry DTR
        • Harp JP
        • et al.
        Neuropsychological effects of self-reported deployment-related mild TBI and current PTSD in OIF/OEF veterans.
        Clin Neuropsychol. 2013; 27: 881-907
        • Walker WC
        • Hirsch S
        • Carne W
        • et al.
        Chronic effects of neurotrauma consortium (CENC) multicentre study interim analysis: differences between participants with positive versus negative mild TBI histories.
        Brain Inj. 2018; 32: 1079-1089
        • Silverberg ND
        • Crane PK
        • Dams-O'Connor K
        • et al.
        Developing a cognition endpoint for traumatic brain injury clinical trials.
        J Neurotrauma. 2017; 34: 363-371
        • Stulemeijer M
        • Vos PE
        • Bleijenberg G
        • van der Werf SP.
        Cognitive complaints after mild traumatic brain injury: things are not always what they seem.
        J Psychosom Res. 2007; 63: 637-645
        • de Guise E
        • LeBlanc J
        • Tinawi S
        • Lamoureux J
        • Feyz M.
        Acute relationship between cognitive and psychological symptoms of patients with mild traumatic brain injury.
        Int Schol Res Notices Rehabil. 2012; 2012147285
        • Baker MT
        • Moring JC
        • Hale WJ
        • et al.
        Acute assessment of traumatic brain injury and post-traumatic stress after exposure to a deployment-related explosive blast.
        Mil Med. 2018; 183: e555-e563
        • Belanger HG
        • Kretzmer T
        • Vanderploeg RD
        • French LM.
        Symptom complaints following combat-related traumatic brain injury: relationship to traumatic brain injury severity and posttraumatic stress disorder.
        J Int Neuropsychol Soc. 2010; 16: 194-199
        • Cooper DB
        • Kennedy JE
        • Cullen MA
        • Critchfield E
        • Amador RR
        • Bowles AO.
        Association between combat stress and post-concussive symptom reporting in OEF/OIF service members with mild traumatic brain injuries.
        Brain Inj. 2011; 25: 1-7
        • Hoge CW
        • McGurk D
        • Thomas JL
        • Cox AL
        • Engel CC
        • Castro CA.
        Mild traumatic brain injury in U.S. Soldiers returning from Iraq.
        N Engl J Med. 2008; 358: 453-463
        • McAllister TW
        • Stein MB.
        Effects of psychological and biomechanical trauma on brain and behavior.
        Ann N Y Acad Sci. 2010; 1208: 46-57
        • Schneiderman AI
        • Braver ER
        • Kang HK.
        Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: persistent postconcussive symptoms and posttraumatic stress disorder.
        Am J Epidemiol. 2008; 167: 1446-1452
        • Lee JEC
        • Garber B
        • Zamorski MA.
        Prospective analysis of premilitary mental health, somatic symptoms, and postdeployment postconcussive symptoms.
        Psychosom Med. 2015; 77: 1006-1017
        • Stein MB
        • Ursano RJ
        • Campbell-Sills L
        • et al.
        Prognostic indicators of persistent post-concussive symptoms after deployment-related mild traumatic brain injury: a prospective longitudinal study in U.S. army soldiers.
        J Neurotrauma. 2016; 33: 2125-2132
        • Yue JK
        • Cnossen MC
        • Winkler EA
        • et al.
        Pre-injury comorbidities are associated with functional impairment and post-concussive symptoms at 3- and 6-months after mild traumatic brain injury: a TRACK-TBI Study.
        Front Neurol. 2019; 10: 343
        • Stein MB
        • Kessler RC
        • Heeringa SG
        • et al.
        Prospective longitudinal evaluation of the effect of deployment-acquired traumatic brain injury on posttraumatic stress and related disorders: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).
        Am J Psychiatry. 2015; 172: 1101-1111
        • Aase DM
        • Babione JM
        • Proescher E
        • et al.
        Impact of PTSD on post-concussive symptoms, neuropsychological functioning, and pain in post-9/11 veterans with mild traumatic brain injury.
        Psychiatry Res. 2018; 268: 460-466
        • Andrews RJ
        • Fonda JR
        • Levin LK
        • McGlinchey RE
        • Milberg WP.
        Comprehensive analysis of the predictors of neurobehavioral symptom reporting in veterans.
        Neurology. 2018; 91: e732-e745
        • Brenner LA
        • Ivins BJ
        • Schwab K
        • et al.
        Traumatic brain injury, posttraumatic stress disorder, and postconcussive symptom reporting among troops returning from iraq.
        J Head Trauma Rehabil. 2010; 25: 307-312
        • Prince C
        • Bruhns ME.
        Evaluation and treatment of mild traumatic brain injury: the role of neuropsychology.
        Brain Sci. 2017; 7: 105
      2. Management of Concussion/mTBI Working Group. VA/DoD clinical practice guideline for management of concussion/mild traumatic brain injury.
        J Rehabil Res Dev. 2009; 46 (CP1-68)
        • Cooper DB
        • Bunner AE
        • Kennedy JE
        • et al.
        Treatment of persistent post-concussive symptoms after mild traumatic brain injury: a systematic review of cognitive rehabilitation and behavioral health interventions in military service members and veterans.
        Brain Imaging Behav. 2015; 9: 403-420
        • Ruff RL
        • Riechers RG
        • Wang X-F
        • Piero T
        • Ruff SS.
        For veterans with mild traumatic brain injury, improved posttraumatic stress disorder severity and sleep correlated with symptomatic improvement.
        J Rehabil Res Dev. 2012; 49: 1305-1320
        • Bisbee C
        • Vickar G.
        A review of psychoeducation for patients with schizophrenia.
        Psychiatric Annals. 2012; 42: 205-210
        • Lyman DR
        • Braude L
        • George P
        • et al.
        Consumer and family psychoeducation: assessing the evidence.
        Psychiatr Serv. 2014; 65: 416-428
        • Rouget BW
        • Aubry J-M.
        Efficacy of psychoeducational approaches on bipolar disorders: a review of the literature.
        J Affect Disord. 2007; 98: 11-27
        • Soo SA
        • Zhang ZW
        • Khong SJ
        • et al.
        Randomized controlled trials of psychoeducation modalities in the management of bipolar disorder: a systematic review.
        J Clin Psychiatry. 2018; 79: 17r11750
        • Xia J
        • Merinder LB
        • Belgamwar MR.
        Psychoeducation for schizophrenia.
        Cochrane Database Syst Rev. 2011; 2011CD002831
        • Whyte J.
        Using treatment theories to refine the designs of brain injury rehabilitation treatment effectiveness studies.
        J Head Trauma Rehabil. 2006; 21: 99-106
        • Whyte J.
        Contributions of treatment theory and enablement theory to rehabilitation research and practice.
        Arch Phys Med Rehabil. 2014; 95 (S17-23.e2)
        • Whyte J
        • Barrett AM.
        Advancing the evidence base of rehabilitation treatments: a developmental approach.
        Arch Phys Med Rehabil. 2012; 93 (S101-10)
        • Anderson CM
        • Hogarty GE
        • Reiss DJ.
        Family treatment of adult schizophrenic patients: a psycho-educational approach.
        Schizophr Bull. 1980; 6: 490-505
        • Bäuml J
        • Pitschel-Walz G.
        [Psychoeducation in schizophrenic diseases] [German]. Erkrankungen.
        Schattauer, Stuttgart, Germany2003
        • Bäuml J
        • Froböse T
        • Kraemer S
        • Rentrop M
        • Pitschel-Walz G.
        Psychoeducation: a basic psychotherapeutic intervention for patients with schizophrenia and their families.
        Schizophr Bull. 2006; 32: S1-S9
        • Lukens EP
        • McFarlane WR.
        Psychoeducation as evidence-based practice: considerations for practice, research, and policy.
        Brief Treat Crisis Interv. 2004; 4: 205-225
        • Mueser KT
        • Bellack AS
        • Wade JH
        • Sayers SL
        • Rosenthal CK.
        An assessment of the educational needs of chronic psychiatric patients and their relatives.
        Br J Psychiatry. 1992; 160: 674-680
        • Tarrier N
        • Barrowclough C.
        Providing information to relatives about schizophrenia: some comments.
        Br J Psychiatry. 1986; 149: 458-463
        • Kilkku N
        • Munnukka T
        • Lehtinen K.
        From information to knowledge: the meaning of information-giving to patients who had experienced first-episode psychosis.
        J Psychiatr Ment Health Nurs. 2003; 10: 57-64
        • Telles C
        • Karno M
        • Mintz J
        • et al.
        Immigrant families coping with schizophrenia. Behavioral family intervention v. case management with a low-income Spanish-speaking population.
        Br J Psychiatry. 1995; 167: 473-479
        • Bedi H
        • Andermann L
        • Chow W
        • Law S.
        Assessment of caregiver experiences and psychoeducational needs of chinese families for patients with chronic mental illnesses: a pilot study.
        Univ Tor Med. 2015; 92: 66-71
        • Chien WT
        • Wong K-F.
        A family psychoeducation group program for chinese people with schizophrenia in Hong Kong.
        Psychiatr Serv. 2007; 58: 1003-1006
        • Chien WT
        • Leung S-F
        • Chu CS.
        A nurse-led, needs-based psycho-education intervention for Chinese patients with first-onset mental illness.
        Contemp Nurse. 2012; 40: 194-209
        • Hackethal V
        • Spiegel S
        • Lewis-Fernández R
        • Kealey E
        • Salerno A
        • Finnerty M.
        Towards a cultural adaptation of family psychoeducation: findings from three Latino focus groups.
        Community Ment Health J. 2013; 49: 587-598
        • Omranifard V
        • Yari A
        • Kheirabadi GR
        • Rafizadeh M
        • Maracy MR
        • Sadri S.
        Effect of needs-assessment-based psychoeducation for families of patients with schizophrenia on quality of life of patients and their families: a controlled study.
        J Educ Health Promot. 2014; 3: 125
        • Colom F.
        Keeping therapies simple: psychoeducation in the prevention of relapse in affective disorders.
        Br J Psychiatry. 2011; 198: 338-340
        • Harvey C.
        Family psychoeducation for people living with schizophrenia and their families.
        BJPsych Adv. 2018; 24: 9-19
        • Motlova LB
        • Balon R
        • Beresin EV
        • et al.
        Psychoeducation as an opportunity for patients, psychiatrists, and psychiatric educators: why do we ignore it?.
        Acad Psychiatry. 2017; 41: 447-451
        • Sarkhel S
        • Singh OP
        • Arora M.
        Clinical practice guidelines for psychoeducation in psychiatric disorders general principles of psychoeducation.
        Indian J Psychiatry. 2020; 62: S319-S323
        • Britt TW
        • Jennings KS
        • Cheung JH
        • Pury CLS
        • Zinzow HM.
        The role of different stigma perceptions in treatment seeking and dropout among active duty military personnel.
        Psychiatr Rehabil J. 2015; 38: 142-149
        • Richards LK
        • Goetter EM
        • Wojtowicz M
        • Simon NM.
        Stigma and health services use among veterans and military personnel. In: Stigma and prejudice: touchstones in understanding diversity in healthcare. Current clinical psychiatry.
        Humana Press, Totowa, NJ2016: 203-226
        • Seidman AJ
        • Wade NG
        • Vogel DL
        • Armistead-Jehle P.
        The impact of stigma on behavioral health care utilization among active duty service members.
        Mil Psychology. 2019; 31: 11-17
        • Cheney AM
        • Koenig CJ
        • Miller CJ
        • et al.
        Veteran-centered barriers to VA mental healthcare services use. BMC.
        Health Serv Res. 2018; 18: 591
        • Moore AD
        • Hamilton JB
        • Pierre-Louis BJ
        • Jennings BM.
        Increasing access to care and reducing mistrust: important considerations when implementing the patient-centered medical home in army health clinics.
        Mil Med. 2013; 178: 291-298
        • Devonish JA
        • Homish DL
        • Vest BM
        • Daws RC
        • Hoopsick RA
        • Homish GG.
        The impact of military service and traumatic brain injury on the substance use norms of Army Reserve and National Guard Soldiers and their spouses.
        Addict Behav. 2017; 72: 51-56
        • Winter L
        • Moriarty H
        • Robinson KM
        • Newhart B.
        Rating competency in everyday activities in patients with TBI: clinical insights from a close look at patient-family differences.
        Disabil Rehabil. 2016; 38: 1280-1290
        • Dillahunt-Aspillaga C
        • Powell-Cope G.
        Community reintegration, participation, and employment issues in veterans and service members with traumatic brain injury.
        Arch Phys Med Rehabil. 2018; 99: S1-S3
        • Brown NB
        • Bruce SE.
        Stigma, career worry, and mental illness symptomatology: factors influencing treatment-seeking for Operation Enduring Freedom and Operation Iraqi Freedom soldiers and veterans.
        Psychol Trauma. 2016; 8: 276-283
        • Jennings KS
        • Zinzow HM
        • Britt TW
        • Cheung JH
        • Pury CLS.
        Correlates and reasons for mental health treatment dropout among active duty soldiers.
        Psychol Serv. 2016; 13: 356-363
        • Blosnich JR
        • Dichter ME
        • Cerulli C
        • Batten SV
        • Bossarte RM.
        Disparities in adverse childhood experiences among individuals with a history of military service.
        JAMA Psychiatry. 2014; 71: 1041-1048
        • James LM
        • Strom TQ
        • Leskela J.
        Risk-taking behaviors and impulsivity among veterans with and without PTSD and mild TBI.
        Mil Med. 2014; 179: 357-363
        • Youssef NA
        • Green KT
        • Dedert EA
        • et al.
        Exploration of the influence of childhood trauma, combat exposure, and the resilience construct on depression and suicidal ideation among U.S. Iraq/Afghanistan era military personnel and veterans.
        Arch Suicide Res. 2013; 17: 106-122
        • Black AC
        • Meshberg-Cohen S
        • Perez-Ortiz AC
        • Thornhill TA
        • Rosen MI.
        Veterans’ compensation claims beliefs predict timing of PTSD treatment use relative to compensation and pension exam.
        PLoS One. 2018; 13e0209488
        • Lu LH
        • Cooper DB
        • Reid MW
        • Khokhar B
        • Tsagaratos JE
        • Kennedy JE.
        Symptom reporting patterns of US military service members with a history of concussion according to duty status.
        Arch Clin Neuropsychol. 2019; 34: 236-242
        • Block CK
        • Fabrizio K
        • Bagley B
        • et al.
        Assessment of veteran and caregiver knowledge about mild traumatic brain injury in a VA Medical Center.
        J Head Trauma Rehabil. 2014; 29: 76-88
        • Bradford LS.
        Misconceptions about traumatic brain injury among U.S. Army behavioral health professionals.
        Rehabil Psychol. 2015; 60: 344-352
        • King PR
        • Beehler GP
        • Vest BM
        • Donnelly K
        • Wray LO.
        Qualitative exploration of traumatic brain injury-related beliefs among U.S. military veterans.
        Rehabil Psychol. 2018; 63: 121-130
        • Remigio-Baker RA
        • Gregory E
        • Cole WR
        • et al.
        Beliefs about the influence of rest during concussion recovery may predict activity and symptom progression within an active duty military population.
        Arch Phys Med Rehabil. 2020; 101: 1204-1211
        • Iverson GL
        • Lange RT.
        Examination of “postconcussion-like” symptoms in a healthy sample.
        Appl Neuropsychol. 2003; 10: 137-144
        • Garden N
        • Sullivan KA.
        An examination of the base rates of post-concussion symptoms: the influence of demographics and depression.
        Appl Neuropsychol. 2010; 17: 1-7
        • Voormolen DC
        • Cnossen MC
        • Polinder S
        • et al.
        Prevalence of post-concussion-like symptoms in the general population in Italy, the Netherlands and the United Kingdom.
        Brain Inj. 2019; 33: 1078-1086
        • Block CK
        • West SE
        • Goldin Y.
        Misconceptions and misattributions about traumatic brain injury: an integrated conceptual framework.
        PM R. 2016; 8 (58-68.e4)
        • Broshek DK
        • De Marco AP
        • Freeman JR.
        A review of post-concussion syndrome and psychological factors associated with concussion.
        Brain Inj. 2015; 29: 228-237
        • Hardy MS
        • Kennedy JE
        • Cooper DB.
        Patient attribution of posttraumatic symptoms to brain injury versus PTSD in military-related mild TBI.
        J Neuropsychiatry Clin Neurosci. 2020; 32: 252-258
        • Suhr JA
        • Gunstad J.
        Diagnosis threat”: the effect of negative expectations on cognitive performance in head injury.
        J Clin Exp Neuropsychol. 2002; 24: 448-457
        • Suhr JA
        • Gunstad J.
        Further exploration of the effect of “diagnosis threat” on cognitive performance in individuals with mild head injury.
        J Int Neuropsychol Soc. 2005; 11: 23-29
        • Silverberg ND
        • Panenka WJ
        • Iverson GL.
        Fear avoidance and clinical outcomes from mild traumatic brain injury.
        J Neurotrauma. 2018; 35: 1864-1873
        • Wijenberg MLM
        • Stapert SZ
        • Verbunt JA
        • Ponsford JL
        • Van Heugten CM.
        Does the fear avoidance model explain persistent symptoms after traumatic brain injury?.
        Brain Inj. 2017; 31: 1597-1604
        • Mah K
        • Hickling A
        • Reed N.
        Perceptions of mild traumatic brain injury in adults: a scoping review.
        Disabil Rehabil. 2018; 40: 960-973
        • Weinman J
        • Petrie KJ.
        Illness perceptions: a new paradigm for psychosomatics?.
        J Psychosom Res. 1997; 42: 113-116
        • Whittaker R
        • Kemp S
        • House A.
        Illness perceptions and outcome in mild head injury: a longitudinal study.
        J Neurol Neurosurg Psychiatry. 2007; 78: 644-646
        • Snell DL
        • Martin R
        • Surgenor LJ
        • Siegert RJ
        Hay-Smith EJC. What's wrong with me? seeking a coherent understanding of recovery after mild traumatic brain injury.
        Disabil Rehabil. 2017; 39: 1968-1975
        • Landsverk SS
        • Kane CF.
        Antonovsky's sense of coherence: theoretical basis of psychoeducation in schizophrenia.
        Issues Ment Health Nurs. 1998; 19: 419-431
        • Armistead-Jehle P
        • Soble JR
        • Cooper DB
        • Belanger HG.
        Unique aspects of traumatic brain injury in military and veteran populations.
        Phys Med Rehabil Clin N Am. 2017; 28: 323-337
        • Coll JE
        • Weiss EL
        • Yarvis JS.
        No one leaves unchanged: insights for civilian mental health care professionals into the military experience and culture.
        Soc Work Health Care. 2011; 50: 487-500
        • Tanielian T
        • Farris C
        • Batka C
        • et al.
        Ready to serve: community-based provider capacity to deliver culturally competent, quality mental health care to veterans and their families.
        RAND Corporation, Santa Monica, CA2014
        • Meyer EG
        • Writer BW
        • Brim W.
        The importance of military cultural competence.
        Curr Psychiatry Rep. 2016; 18: 26
        • Alves W
        • Macciocchi SN
        • Barth JT.
        Postconcussive symptoms after uncomplicated mild head injury.
        J Head Trauma Rehabil. 1993; 8: 48-59
        • Comper P
        • Bisschop SM
        • Carnide N
        • Tricco A.
        A systematic review of treatments for mild traumatic brain injury.
        Brain Inj. 2005; 19: 863-880
        • Gronwall D.
        Rehabilitation programs for patients with mild head injury: components, problems, and evaluation.
        J Head Trauma Rehabil. 1986; 1: 53-62
        • Kelly R.
        The post-traumatic syndrome: an iatrogenic disease.
        Forensic Sci. 1975; 6: 17-24
        • Minderhoud JM
        • Boelens ME
        • Huizenga J
        • Saan RJ.
        Treatment of minor head injuries.
        Clin Neurol Neurosurg. 1980; 82: 127-140
        • Mittenberg W
        • Burton DB.
        A survey of treatments for post-concussion syndrome.
        Brain Inj. 1994; 8: 429-437
        • Nygren-de Boussard C
        • Holm LW
        • Cancelliere C
        • et al.
        Nonsurgical interventions after mild traumatic brain injury: a systematic review. Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis.
        Arch Phys Med Rehabil. 2014; 95: S257-S264
        • Paniak C
        • Toller-Lobe G
        • Durand A
        • Nagy J.
        A randomized trial of two treatments for mild traumatic brain injury.
        Brain Inj. 1998; 12: 1011-1023
        • Paniak C
        • Toller-Lobe G
        • Reynolds S
        • Melnyk A
        • Nagy J.
        A randomized trial of two treatments for mild traumatic brain injury: 1 year follow-up.
        Brain Inj. 2000; 14: 219-226
        • Ponsford JL
        • Willmott C
        • Rothwell A
        • et al.
        Impact of early intervention on outcome following mild head injury in adults.
        J Neurol Neurosurg Psychiatry. 2002; 73: 330-332
        • Snell DL
        • Surgenor LJ
        • Hay-Smith EJC
        • Siegert RJ.
        A systematic review of psychological treatments for mild traumatic brain injury: an update on the evidence.
        J Clin Exp Neuropsychol. 2009; 31: 20-38
        • Wade DT
        • King NS
        • Wenden FJ
        • Crawford S
        • Caldwell FE.
        Routine follow up after head injury: a second randomised controlled trial.
        J Neurol Neurosurg Psychiatry. 1998; 65: 177-183
        • Mittenberg W
        • Tremont G
        • Zielinski RE
        • Fichera S
        • Rayls KR.
        Cognitive-behavioral prevention of postconcussion syndrome.
        Arch Clin Neuropsychol. 1996; 11: 139-145
        • Mittenberg W
        • Zielinski R
        • Fichera S.
        Recovery from mild head injury: a treatment manual for patients.
        Psychotherapy Priv Pract. 1993; 12: 37-52
      3. Torbay and South Devon NHS Foundation Trust. Mild traumatic brain injury and concussion: patient information and self-management. Available at: Accessed November 28, 2020.

      4. Brain Injury Association of Michigan. TBI recovery guide. Available at: Accessed November 28, 2020.

        • Storzbach D
        • Twamley EW
        • Roost MS
        • et al.
        Compensatory cognitive training for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans with mild traumatic brain injury.
        J Head Trauma Rehabil. 2017; 32: 16-24
        • Twamley EW
        • Jak AJ
        • Delis DC
        • Bondi MW
        • Lohr JB.
        Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) for veterans with traumatic brain injury: pilot randomized controlled trial.
        J Rehabil Res Dev. 2014; 51: 59-70
        • Twamley EW
        • Thomas KR
        • Gregory AM
        • et al.
        CogSMART compensatory cognitive training for traumatic brain injury: effects over 1 year.
        J Head Trauma Rehabil. 2015; 30: 391-401
        • Cooper DB
        • Bowles AO
        • Kennedy JE
        • et al.
        Cognitive rehabilitation for military service members with mild traumatic brain injury: a randomized clinical trial.
        J Head Trauma Rehabil. 2017; 32: E1-15
      5. CogSMART. CogSMART manuals and resources. Available at: Accessed May 7, 2021.

      6. Belanger HG, Kretzmer TS, Vanderploeg RD, Bowles AO, Lindsay MA, Cooper DB. Chapter 2: psychoeducational interventions for persistent post-concussion symptoms following combat-related mild traumatic brain injury. In: The study of cognitive rehabilitation effectiveness. Available at: Accessed May 7, 2021.

        • Belanger HG
        • Wortzel HS
        • Vanderploeg RD
        • Cooper DB.
        A model for intervening with veterans and service members who are concerned about developing chronic traumatic encephalopathy (CTE).
        Clin Neuropsychol. 2020; 34: 1105-1123
        • Snell DL
        • Martin R
        • Surgenor LJ
        • et al.
        Wrestling with uncertainty after mild traumatic brain injury: a mixed methods study.
        Disabil Rehabil. 2020; 42: 1942-1953
        • Dijkers MP
        • Ferraro MK
        • Hart T
        • Packel A
        • Whyte J
        • Zanca JM.
        Toward a rehabilitation treatment taxonomy: summary of work in progress.
        Phys Ther. 2014; 94: 319-321
        • Hart T.
        Treatment definition in complex rehabilitation interventions.
        Neuropsychol Rehabil. 2009; 19: 824-840
        • Hart T
        • Tsaousides T
        • Zanca JM
        • et al.
        Toward a theory-driven classification of rehabilitation treatments.
        Arch Phys Med Rehabil. 2014; 95 (S33-44.e2)
        • Hart T
        • Dijkers MP
        • Whyte J
        • et al.
        A theory-driven system for the specification of rehabilitation treatments.
        Arch Phys Med Rehabil. 2019; 100: 172-180
        • Van Stan JH
        • Dijkers MP
        • Whyte J
        • et al.
        The Rehabilitation Treatment Specification System: implications for improvements in research design, reporting, replication, and synthesis.
        Arch Phys Med Rehabil. 2019; 100: 146-155
        • Zanca JM
        • Turkstra LS
        • Chen C
        • et al.
        Advancing rehabilitation practice through improved specification of interventions.
        Arch Phys Med Rehabil. 2019; 100: 164-171
        • Lequerica AH
        • Kortte K.
        Therapeutic engagement: a proposed model of engagement in medical rehabilitation.
        Am J Phys Med Rehabil. 2010; 89: 415-422