Adapted CBT Effective Following Traumatic Brain Injuries

Jennie Ponsford, PhD

A form of cognitive behavioral therapy (CBT) could be effective in reducing both anxiety and depressive symptoms after a traumatic brain injury (TBI).

A team, led by Jennie Ponsford, PhD, Monash-Epworth Rehabilitation Research Center at the School of Psychological Sciences at Monash University, examined the factors linked to positive responses to CBT adapted for cognitive impairments for individuals with anxiety and depression for patients with a traumatic brain injury.

Both anxiety and depression symptoms frequently occur following a traumatic brain injury, increasing the need to evaluate the efficacy of psychological interventions and understand factors influencing response to these interventions.

The current study included demographic and injury-related factors, pretreatment levels of anxiety and depression, working alliance, and change expectancy as predictors.

The investigators enrolled 45 participants in an active treatment condition within a randomized controlled trial to examine the efficacy of a 9-session CBT-adapted for anxiety and depression following a traumatic brain injury.

Using mixed-effects regressions controlling for baseline anxiety and depression, the investigators discovered for anxiety, older age at injury and a higher level of baseline anxiety was linked to greater symptom reduction.

For depression, the results show longer time since injury and higher expectancy for change, as well as a higher baseline level of depression, was significantly associated with a greater reduction in depression symptoms.

The authors said the study should yield more detailed studies on the therapeutic processes involved in alleviating anxiety and depression following a traumatic brain injury.

One way to reduce depressive symptoms following a mild traumatic brain injury is using blue light therapy.

A team from the University of Arizona College of Medicine examined 35 individuals who had been diagnosed with a concussion within the past 18 months in a double-blind, randomized study. The average age in the study was 26 years old.

“Patients with mild traumatic brain injury, like concussion, often develop persistent problems associated with sleep, concentration and depression,” study author William D. Killgore, PhD, from the University of Arizona College of Medicine said in a statement. “Morning blue light exposure has been shown to lead to improved circadian rhythm of the body’s sleep-wake cycle, which is linked to improved sleep, better mood and daytime alertness.”

In the study, each participant used a tabletop device that shines bright light for 30 minutes each morning for a total of 6 weeks. Overall, 17 participants received the blue light therapy and 18 people received a placebo amber light therapy.

Both groups completed tests at baseline and the conclusion of the study to measure the symptoms of depression and other concussion symptoms, including headache, fatigue, and issues with sleep, memory, and concentration.

The investigators found that the participants who received the blue light therapy had lower scores on the Beck Depression Inventory than the individuals who received the placebo light therapy.

Raw depression scores also showed a significant decline in only the blue light group, where the participants in the blue light group improved by 22% on the test for depression, while there was a 4% worsening in mood for the people in the placebo group.

The improvement in depression scores for the blue light was also linked to improvements in other concussion symptoms including sleep disturbance, fatigue, concentration, restlessness, and irritability. However, there was no relationship for people in the placebo group.

The study, “Factors Associated With Response to Adapted Cognitive Behavioral Therapy for Anxiety and Depression Following Traumatic Brain Injury,” was published online in The Journal of Head Trauma Rehabilitation.