1494 – Mindfulness-based cognitive therapy reduces depression symptoms in people who have a traumatic brain injury: results from a randomized controlled trial

Abstract

IntroductionTraumatic brain injuries (TBI) may lead to persistent depression symptoms. We conducted several pilot studies to examine the efficacy of mindfulness-based interventions to deal with this issue; all showed strong effect sizes. The logical next step was to conduct a randomized controlled trial (RCT).ObjectiveWe sought to determine the efficacy of mindfulness-based cognitive therapy for people with depression symptoms post-TBI (MBCT-TBI).MethodsUsing a multi-site RCT design, participants (mean age = 47) were randomized to intervention or control arms. Treatment participants received a group-based, 10-week intervention; control participants waited. Outcome measures, administered pre- and post-intervention, and after three months, included: Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire-9 (PHQ-9), and Symptom Checklist-90-Revised (SCL-90-R). The Philadelphia Mindfulness Scale (PHLMS) captured present moment awareness and acceptance.ResultsBDI-II scores decreased from 25.47 to 18.84 in treatment groups while they stayed relatively stable in control groups (respectively 27.13 to 25.00; p = .029). We did not find statistically significant differences on the PHQ-9 and SCL-90R post- treatment. However, after three months, all scores were statistically significantly lower than at baseline (ps < .01). Increases in mindfulness were associated with decreases in BDI-II scores (r[29] = -.401, p = .025).ConclusionsMBCT-TBI may alleviate depression symptoms up to three months post-intervention. Greater mindfulness may have contributed to the reduction in depression symptoms although the association does not confirm causality. More work is required to replicate these findings, identify subgroups that may better respond to the intervention, and refine the intervention to maximize its effectiveness.

Neural correlates of reduced depressive symptoms following cognitive training for chronic traumatic brain injury

“…Average baseline BDI‐II scores for the TBI‐plus‐depressive symptoms group was approximately 24, corresponding to moderate depressive symptoms (Figure a). These baseline BDI–II scores were comparable to previous studies in psychological intervention for depression in TBI (Ashman et al, ; Bédard et al, ; D'Antonio et al, ). Baseline BDI–II scores for the TBI‐only group (7.0) was higher than those of healthy individuals (3.6) from a previous study (Han et al, ).…”

“…(Figure 1a). These baseline BDI-II scores were comparable to previous studies in psychological intervention for depression in TBI (Ashman et al, 2014;B edard et al, 2014;D'Antonio et al, 2013). Baseline BDI-II scores for the TBI-only group (7.0) was higher than those of healthy individuals (3.6) from a previous study (Han et al, 2015).…”

Telephone and In-Person Cognitive Behavioral Therapy for Major Depression after Traumatic Brain Injury: A Randomized Controlled Trial

“…Consistent with results from preliminary studies in TBI populations, 23,28,31,32 we found CBT-IP and, particularly, CBT-T are acceptable and feasible in a geographically diverse sample with complicated mild to severe TBI. There were no statistically significant differences between CBT treatments overall compared with UC on the primary outcomes.…”

“…[26][27][28][29] Structural equation modeling has shown that post-TBI depression is consistent with cognitive behavioral theory, 30 and preliminary CBT trials have been promising for decreasing depressive symptoms. 23,28,31,32 The model of treatment delivery is crucial, because of the tremendous barriers to receipt of adequate mental health services. [33][34][35][36][37] Barriers for people with TBI include stigma; difficulty coordinating care for multiple medical and psychological problems; limited transportation (e.g., because of cost, distance, seizure disorder with inability to drive); avoidance of trauma-focused components of mental health care; and other motivational (ambivalence), behavioral, cognitive, social, and financial problems that interfere with their ability to attend scheduled appointments.…”

The Relations of Cognitive, Behavioral, and Physical Activity Variables to Depression Severity in Traumatic Brain Injury: Reanalysis of Data From a Randomized Controlled Trial

“…Preliminary MBCBT trials among people with TBI and symptoms of depression suggest this treatment may be efficacious. 61–63 …”