Effects of cognitive behavioral therapy for adults with post-concussion syndrome: A systematic review and meta-analysis of randomized controlled trials
Abstract
Objective Although the mechanism of post-concussion syndrome remains unclear, psychological factors are thought to be associated with its development. Cognitive behavioral therapy is the gold standard for psychological disorders; however, its effects on post-concussion syndrome remain unclear. Through this meta-analysis, we assessed the effects of cognitive behavioral therapy on post-concussion syndrome following traumatic brain injury.Methods Six electronic databases were searched from inception to September 15, 2019, for randomized controlled trials evaluating the effects of cognitive behavioral therapy for adults with post-concussion syndrome. Primary outcomes included the severity of symptoms of post-concussion syndrome, depression, anxiety, and social integration. Secondary outcomes were fatigue, cognitive function, and quality of life. Effects were estimated through the calculation of Hedge's g and 95% confidence interval using a random effects model. Sensitivity analyses were conducted by excluding studies in which an intention-to-treat analysis was not employed.Results In total, 24 studies were included. Most studies had risk of bias. Significant effects were found for most outcomes, except for severity of symptoms of post-concussion syndrome, fatigue, executive function, and problem solving. After sensitivity analyses, the effects of cognitive behavioral therapy remained significant for immediate and mid-term effects on depression, anxiety, and social integration.Conclusions This study does not support the effectiveness of cognitive behavioral therapy for severity of symptoms of post-concussion syndrome; however, it might be an effective treatment option for improving depression, anxiety, and social integration in individuals with traumatic brain injury.
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Two systematic reviews found no support for the effectiveness of CBT on PPCS and functional disability.
“two systematic reviews27 34 both found no support for the effectiveness of CBT on PPCS and functional disability.”
From Acceptance and commitment therapy for mild traumatic brain injury (ACTion-mTBI): a quasiexperimental feasibility study (2025) · cites this paper as [27]
Evidence of the effectiveness of CBT in mTBI is mixed.
“Evidence of the effectiveness of CBT in mTBI is mixed.”
From Acceptance and commitment therapy for mild traumatic brain injury (ACTion-mTBI): a quasiexperimental feasibility study (2025) · cites this paper as [27]
Chen et al found that CBT was an effective treatment for anxiety, depression and social integration after mTBI.
“in a recent systematic review, Chen et al27 found that CBT was an effective treatment for anxiety, depression and social integration after mTBI.”
From Acceptance and commitment therapy for mild traumatic brain injury (ACTion-mTBI): a quasiexperimental feasibility study (2025) · cites this paper as [27]
These findings are also consistent with previous evidence suggesting the effects of CBT may be more specific to mental health and do not generalise to improve mTBI outcomes.
“These findings are also consistent with previous evidence suggesting the effects of CBT may be more specific to mental health and do not generalise to improve mTBI outcomes.27 28 34”
From Acceptance and commitment therapy for mild traumatic brain injury (ACTion-mTBI): a quasiexperimental feasibility study (2025) · cites this paper as [27]
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- Authors
- Chen, C.-L., Lin, M.-Y., Huda, M. H., & Tsai, P.-S.
- Affiliations
- Taipei Medical University-Shuang Ho Hospital (TW)
- Taipei Medical University (TW)
- Taipei Medical University Hospital (TW)
- Corresponding author
- Tsai, Pei-Shan
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 136
- Pages
- 110190
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W3043454521
- Cited by
- 34
- References
- 42
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 9 · 2023: 7 · 2022: 7 · 2021: 2 · 2020: 2
- FWCI
- 0.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
- Keywords
- cognitive behavioral therapy, post-concussion syndrome, traumatic brain injury, depression, anxiety, social integration, fatigue, cognitive function, quality of life, psychological intervention
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Quality of Life, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Post-Concussion Syndrome
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