Can acceptance and commitment therapy facilitate psychological adjustment after a severe traumatic brain injury? A pilot randomized controlled trial

Abstract

This study sought to determine if an Acceptance and Commitment Therapy (ACT) intervention (ACT-Adjust) can facilitate psychological adjustment and reduce psychological distress following a severe traumatic brain injury (TBI). The study design comprised a single centre, two-armed, Phase II pilot randomised controlled trial. Nineteen individuals with a severe TBI (PTA ≥7 days) who met a clinical threshold for psychological distress (Depression Anxiety Stress Scales 21; DASS>9) were randomly allocated to either ACT-Adjust (n =10) or an active control, Befriending Therapy (n = 9), in conjunction with a holistic rehabilitation programme. Primary (psychological flexibility, rehabilitation participation) and secondary (depression, anxiety & stress) outcomes were measured at three-time points (pre, post and follow up). Significant decreases were found for DASS-depression (group by time interaction, F1,17 = 5.35, p = .03) and DASS-stress (group by time interaction, F1,17 = 5.69, p = .03) in comparison to the Befriending group, but not for the primary outcome measures of rehabilitation participation or psychological flexibility. The reduction in stress post-treatment was classed as clinically significant, however the interaction differences for both stress and depression were not maintained at one month follow up. Preliminary investigations indicate some promise for ACT in decreasing psychological distress for individuals with a severe TBI with further sessions being required to maintain treatment gains. The pilot results suggest that further investigation is warranted in a larger scale clinical trial.

Anxiety, depression, and quality of life among subgroups of individuals with acquired brain injury: The role of anxiety sensitivity and experiential avoidance

“…Studying the effectiveness of ACT among individuals after ABI has been described as an important area of study for future research (Kangas & McDonald, 2011). Preliminary findings of ACT among pilot studies of individuals with TBI have been promising (Whiting, Deane, McLeod, Ciarrochi, & Simpson, 2019). Providing individuals with heightened distress the appropriate referrals and interventions to address the psychosocial aspects of rehabilitation is an important component in ensuring a person-centred approach is taken for those with brain injury.…”

Protocol for a Phase Two, Parallel Three-Armed Non-inferiority Randomized Controlled Trial of Acceptance and Commitment Therapy (ACT-Adjust) Comparing Face-to-Face and Video Conferencing Delivery to Individuals With Traumatic Brain Injury Experiencing Psychological Distress

“…The ACT-Adjust project aims to build on the success of the original feasibility trial (Whiting et al, 2020) and evaluate the benefits of utilizing eHealth for delivery of a psychological intervention to people with a TBI. This pre-registered, multi-center, three-arm, parallel, non-inferiority, single-blind randomized controlled trial (RCT) will test the efficacy of two modes of delivery of the ACT-Adjust intervention; face-to-face (FtF) and video consulting (VC), in comparison to a waitlist control group (see Figure 1).…”

“…It has been specifically designed to facilitate psychological adjustment after a severe TBI. In a recent clinical trial testing the feasibility of the program, ACT-Adjust achieved both statistically and clinically significant reductions in levels of depression and stress amongst clients with a moderate to severe TBI, compared to an active control group (Whiting et al, 2020).…”

“…Despite the growing evidence-base for interventions treating psychological distress following a TBI (Medd and Tate, 2000;Simpson et al, 2011;Hsieh et al, 2012;Fann et al, 2015;Ponsford et al, 2016;Abel et al, 2017;Brenner et al, 2018;Dindo et al, 2020;Whiting et al, 2020), access to psychological services is limited for regional and remote people across Australia (Bourne et al, 2017), resulting in high levels of unmet needs (Simpson et al, 2016). eHealth, the provision of healthcare at a distance via technology, has the potential to increase access to services and has seen burgeoning research with a growing evidence base (Backhaus et al, 2012).…”

An Integrative Neuro-Psychotherapy Treatment to Foster the Adjustment in Acquired Brain Injury Patients—A Randomized Controlled Study

“…Furthermore, a recent published pilot randomized controlled trial showed that acceptance and commitment therapy (ACT) may facilitate adjustment after traumatic brain injury and revealed significant changes regarding stress and depressive symptoms after post-assessment compared to an active control condition. However, this reduction of stress and depressive symptoms was not maintained at follow-up assessment nor did the primary outcome (psychological flexibility) differ significantly at any assessment point between the two groups [ 45 ]. In a non-controlled pilot study, Hofer and colleagues [ 46 ] tested an integrated treatment program in which neuropsychological interventions are supplemented by psychotherapeutic interventions to foster the adjustment process.…”