Cognitive-Behavioral Prevention of Postconcussion Syndrome in At-Risk Patients

Abstract

Our preliminary data suggest that CBT delivered soon after mild traumatic brain injury is well tolerated and may facilitate recovery in patients who are at risk for chronic PCS. A definitive clinical trial is warranted.

Active Rehabilitation of Concussion and Post-concussion Syndrome

“…9,15 Since that review, a pilot clinical trial with 28 participants at risk for PCS compared treatment as usual (education, reassurance, and symptom management strategies) from an occupational therapist to this treatment plus CBT from a psychologist. 66 Participants at risk for PCS were identified based on a multivariate prediction model that included symptom severity and the beliefs that symptoms will persist and will have catastrophic life consequences. 67 Fewer at-risk participants who received CBT had a diagnosis of PCS at follow-up (54% vs 91%, P<.05).…”

Randomised, waiting list controlled trial of cognitive–behavioural therapy for persistent postconcussional symptoms after predominantly mild–moderate traumatic brain injury

“…Typically using single-case or case series designs, results do point to possible improvements in these domains using CBT. There is some support for prophylactic interventions in patients at risk for persistent PCS in some22 but not all studies 23. Only one randomised controlled trial (RCT) has specifically focused on persistent PCS24 randomising 20 individuals with mild–moderate TBI (seen on average between 5 and 6 years postinjury) to a waiting list group or an intensive neuropsychological rehabilitation treatment programme (5 hours per week for 11 weeks) combining CBT and cognitive remediation.…”

Collaborative Care for Adolescents With Persistent Postconcussive Symptoms: A Randomized Trial

“…However, CBT, care coordination, and psychopharmacological treatment have not yet been harnessed within a clinical intervention to target postconcussive symptoms and co-occurring depressive and anxiety symptoms. 24,25 Collaborative care is a health care delivery model that integrates medical and behavioral health care for patients with chronic disorders in which both physical and psychological symptoms are present, such as sequelae related to traumatic brain injury. 26,27 Large-scale randomized clinical trials have established the effectiveness of collaborative care interventions that combine care management, CBT, and evidencebased pharmacotherapy in treating pediatric and adult primary care patients with depressive, anxiety, and posttraumatic stress disorders.…”