Cognitive Behavioral Intervention Compared to Telephone Counseling Early after Mild Traumatic Brain Injury: A Randomized Trial

Abstract

Many patients do not return to work (RTW) after mild traumatic brain injury (mTBI) because of persistent complaints that are often resistant to therapy in the chronic phase. Recent studies suggest that psychological interventions should be implemented early post-injury to prevent patients from developing chronic complaints. This study is a randomized, controlled trial that examines the effectiveness of a newly developed cognitive behavioral therapy (CBT) intervention (CBTi) compared to telephonic counseling (TC) in at-risk mTBI patients (patients with high reports of early complaints). Patients underwent either five sessions of CBT treatment or five phone conversations starting 4-6 weeks post-trauma. The main outcome measure was RTW 6 and 12 months post-trauma. Secondary measures comprised functional outcome at 6 and 12 months, and depression, anxiety, and reported post-traumatic complaints at 3, 6, and 12 months post-injury. After excluding dropouts, CBTi consisted of 39 patients and TC of 45 patients. No significant differences were found with regard to RTW, with 65% of CBTi patients and 67% of TC patients reporting a RTW at previous level. However, TC patients reported fewer complaints at 3 (8 vs. 6; p = 0.010) and 12 months post-injury (9 vs. 5; p = 0.006), and more patients in the TC group showed a full recovery 12 months post-injury compared to the CBTi group (62% vs. 39%). The results of this study suggest that early follow-up of at-risk patients can have a positive influence on patients' well-being, and that a low-intensive, low-cost telephonic intervention might be more effective than a CBT intervention at improving outcome in at-risk patients.

Behavioral Therapies and Mind‐Body Interventions for Posttraumatic Headache and Post‐Concussive Symptoms: A Systematic Review

“…From the 7 studies meeting the inclusion criteria, there was a total of 1108 adult participants of which 68.8% (n = 763) were male. The participants ranged from 18 to 80 years of age and were mostly from the United States (n = 919), Denmark (n = 155), the Netherlands (n = 91), and England (n = 46) . Of the 7 studies, 3 studies focused on military staff and 4 focused on nonmilitary persons .…”

“…The participants ranged from 18 to 80 years of age and were mostly from the United States (n = 919), Denmark (n = 155), the Netherlands (n = 91), and England (n = 46) . Of the 7 studies, 3 studies focused on military staff and 4 focused on nonmilitary persons . Of the studies that focused on military staff, 2 studies enrolled active duty or active reserve/guard duty service members with confirmed or suspected mTBI and one study focused on veteran military staff.…”

“…). Some were assessed for study inclusion at 48 hours post‐injury, within 4–10 weeks post‐injury, greater than 3 months post‐injury, at 6 months post‐injury, or within 2 years post‐injury . One study recruited patients with a history of TBI, though the specific time post‐TBI was not controlled for in the inclusion criteria .…”

“…One study recruited patients with a history of TBI, though the specific time post‐TBI was not controlled for in the inclusion criteria . Subjects were recruited either directly from the emergency department or through outpatient referrals for a history of mTBI . In contrast, another study recruited participants from the Danish Headache Center who were diagnosed with chronic PTH associated with an mTBI related to traffic accidents …”

“…While some studies used similar intervention methods such as group CBT sessions and telephonic counseling, overall the studies differed greatly in their approaches. In the Kjeldgaard and Scheenen studies, CBT group intervention was used. The Kjeldgaard study involved a 9‐week CBT group intervention with 8 patients per session .…”