Long-term psychological outcomes in spinal cord injured persons: Results of a controlled trial using cognitive behavior therapy

Craig, Ashley; Hancock, Karen; Dickson, Hugh G; Chang, Esther

doi:10.1016/s0003-9993(97)90006-x

Cited by 83 publications

(104 citation statements)

References 24 publications

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“…9 In the absence of specialized treatment like CBT, high levels of depressive mood may well persist in many SCI persons up to 2 years making adjustment to the disorder very di cult. 11 Further research should investigate whether persistent depression leads to greater risks of suicide, re-admissions, diseases and self-neglect. Health professionals involved with SCI persons will need to be aware of this possibility.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 SCI persons with high levels of depressive mood who participated in the ®rst stage and who did not receive this therapy, maintained moderate to high levels of anxiety and depressive mood up to 2 years after the injury. 11,12 Furthermore, feelings of helplessness were signi®cantly reduced in SCI persons treated with CBT compared to the controls. 13 CBT was used as it is increasingly being recognized as an e ective technique for managing a wide range of disorders, in particular depression and anxiety.…”

Section: Introductionmentioning

confidence: 99%

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Improving the long-term adjustment of spinal cord injured persons

1999

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Study Design: The study involved the long-term assessment of persons with spinal cord injury (SCI) who previously participated in a nonrandomized longitudinal controlled trial. Objectives: The objective was to report on the e ectiveness of early psychological intervention in improving some aspects of adjustment to SCI 2 years post injury. Setting: The study was conducted in Sydney, Australia. Methods: Twenty-eight SCI persons who had participated in group Cognitive Behaviour Therapy (CBT) during hospital rehabilitation were assessed for drug usage, hospital readmissions, relationships, perceived adjustment and social discrimination 2 years after treatment. The intervention group's responses on the measures were compared with a control group of 31 SCI persons who only received traditional rehabilitation services during their hospitalization. Results: Subjects in the treatment group experienced less hospital re-admissions, used less drugs and reported higher levels of adjustment compared to the control group. Relationships were stable for both groups and there were no suicides in either group up to 2 years. There were no di erences in perceived social discrimination between the two groups. Conclusion: The study suggests the long-term adjustment for SCI persons is encouraging for the majority. However, the provision of group CBT for SCI persons appears to improve signi®cantly some aspects of adjustment to the injury in the long-term.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improving the long-term adjustment of spinal cord injured persons

1999

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“…This subgroup was targeted for intervention as research suggests that individuals with clinically significant levels of distress are at risk of poor, long-term emotional outcomes and are a priority for psychological treatment. 2,3 In comparison, patients who reported DASS-21 scores in the subclinical range, and who met the same inclusion criteria, were assigned to the standard care group. These participants were also screened to match the treatment group on age, sex and injury.…”

Section: Methodsmentioning

confidence: 99%

“…2 Research suggests that specialist psychological interventions have a role in managing these emotional outcomes. 3,4 Research also indicates that the provision of psychotherapy in spinal rehabilitation is constrained by a number of factors, including workforce issues, with limited staff resources often only allowing for a consultative service instead of comprehensive psychological assessment and intervention, 5 and service delivery models that emphasise time-limited therapy. 6,7 Although group-based programmes using cognitive-behavioural therapy (CBT) have been advocated as a time-efficient inpatient therapy model, 3,4 their effectiveness is influenced by group homogeneity, with regard to patient characteristics.…”

Section: Introductionmentioning

confidence: 99%

Psychological intervention during spinal rehabilitation: a preliminary study

2009

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Study design: A repeated measures, non-randomised controlled trial. Objective: To examine the effectiveness of individualised cognitive behaviour therapy (CBT) on the psychological adjustment of patients undergoing rehabilitation for newly acquired spinal cord injury. Setting: South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, South Australia, Australia. Methods: Eleven participants received individual CBT as part of their spinal rehabilitation. Selfreported levels of depression, anxiety and stress were assessed before the intervention, at week 12 of rehabilitation and at 3 months post-discharge, using the depression, anxiety and stress scales (DASS-21). Functional independence was also assessed, using the Functional Independence Measure (FIM). Responses were compared with 13 participants, closely matched on demographic and injury variables, who received standard psychological care (that is, assessment and monitoring only). Results: Depression scores for treatment participants showed a significant time effect, with worsening symptoms reported at three-month follow-up, after CBT was discontinued. In contrast, the DASS-21 scores of standard care participants remained at subclinical levels throughout the study. Clinical improvements in symptoms of anxiety and stress were also reported by the treatment group as inpatient therapy progressed. Conclusion: Targeted, individualised psychological treatment contributed to short-term, meaningful improvements in emotional outcomes for individuals reporting psychological morbidity after recent spinal injury. The results also highlight the need for ongoing access to specialised, psychological services post-discharge. Replication of these results with a larger sample is required before definitive conclusions can be drawn.

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“…A cut-o of 42 on the SAI was used as an indication of high anxiety and a score of 14 or above on the BDI 24,28 was seen as indicative of a high level of depression. Both depression and anxiety were closely related to post traumatic distress symptoms.…”

Section: Occurrence Of Comorbid Depression and Anxietymentioning

confidence: 99%

Evaluation of post traumatic distress in the first 6 months following SCI

Kennedy

Evans

2001

Spinal Cord

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Study design: Cross-sectional questionnaire. Objectives: To assess the degree of post traumatic stress symptomatology and its correlates amongst a group of new spinal cord injured patients. Setting: The National Spinal Injuries Centre, Stoke Mandeville Hospital NHS Trust. Method: Eighty-®ve participants with an average age of 32.6 years were assessed between 6 and 24 weeks post injury. Seventeen participants were female. Seventy per cent had complete lesions. Forty per cent had paraplegia and 60% had tetraplegia. Road tra c accidents were the most common cause of injury followed by falls and then sporting accidents. The Impact of Event Scale was used to measure the experience of intrusive thoughts about the trauma and avoidance of trauma related stimuli. Anxiety (SAI), depression (BDI) and dependency (FIM) were also measured. Results: High levels of distress were evident in 14% of the sample. Trauma-related distress was signi®cantly higher in female patients or patients with high levels of anxiety or depression. Conclusion: In this sample, the rates of trauma-related distress following spinal cord injury were comparable to those found following other traumas and are of clinical signi®cance. Spinal Cord (2001) 39, 381 ± 386

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Long-term psychological outcomes in spinal cord injured persons: Results of a controlled trial using cognitive behavior therapy

Cited by 83 publications

References 24 publications

Improving the long-term adjustment of spinal cord injured persons

Improving the long-term adjustment of spinal cord injured persons

Psychological intervention during spinal rehabilitation: a preliminary study

Evaluation of post traumatic distress in the first 6 months following SCI

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