This paper reviews treatment outcome studies on cognitive behavioural therapy (CBT) for depression and anxiety following acquired brain injury (ABI), including traumatic brain injury (TBI), cerebral vascular accident (CVA), anoxia and neurosurgery. Studies are included for review when the published paper included an anxiety disorder or depression as the treatment focus, or as part of outcome measurement. Relaxed criteria were used to select studies including relevant single-cases, case series and single group studies along with studies that employed control groups. Twenty-four studies were identified. Twelve papers were of a single-case design (with or without replication). Two papers used uncontrolled single groups and ten studies used a control group. There were a total of 507 people in the various treatment and control groups, which ranged in size from 6 to 67 persons. All participants in the study had an ABI. Our review indicates CBT often shows a within-group pre- to post-treatment statistical difference for depression and anxiety problems, or a statistical difference between CBT-treated and non-treated groups. For studies that targeted the treatment of depression with CBT, effect-sizes ranged from 0 to 2.39 with an average effect-size of 1.15 for depression (large effect). For studies that targeted the treatment of anxiety with CBT, effect-sizes ranged from 0 to 3.47 with an average effect-size of 1.04 for anxiety (large effect). However, it was not possible to submit all twenty-four studies identified to effect-size analysis. Additionally, it is clear that CBT is not a panacea, as studies frequently indicate only partial reduction in anxiety and depression symptoms. This review suggests that if CBT is aimed at, for example, anger management or coping, it can be effective for anger or coping, but will not generalise to have an effect on anxiety or depression. CBT interventions that target anxiety and depression specifically appear to generate better therapeutic effects on anxiety and depression. Gaps in the literature are highlighted with suggestions for future research.

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SummaryMental health is crucial for public health and prosperity. Yet, mental health was first brought to the EU agenda only in late 1990s. To put mental health firmly on the political agenda, the focus was placed on the positive mental health at a population level. The European Pact for Mental Health and Wellbeing is the most recent mental health policy initiative of the European Commission. It aims at promotion of mental health and prevention of mental disorders, by putting emphasis on five priority areas: prevention of depression and suicide; youth and education; workplace settings; older people; and combating stigma and social exclusion. The Pact calls for co-operation between the EU Member States and the Commission, to identify best practices to tackle the problems in the priority areas and to develop recommendations and action plans. The Pact is currently being implemented by a series of conferences on the priority areas. The European Parliament called for a European Strategy on Mental Health in 2009, but it is unclear whether there is sufficient support for a strategy level document in the Member States and Commission. The implementation process is however expected to culminate in an overall reference framework for promoting mental capital during the Hungarian EU Presidency in 2011. Irrespective of the final outcome, the ongoing process has already increased awareness in Europe of the need for actions to promote mental health.