Efficacy of motivational interviewing and cognitive behavioral therapy for anxiety and depression symptoms following traumatic brain injury

Ponsford, J.; Lee, N. K.; Wong, D.; McKay, A.; Haines, K.; Alway, Y.; Downing, M.; Furtado, C.; O'Donnell, M. L.

doi:10.1017/s0033291715002640

Cited by 173Traumatic Brain Injury ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

Efficacy of motivational interviewing and cognitive behavioral therapy for anxiety and depression symptoms following traumatic brain injury

Ponsford, J., Lee, N. K., Wong, D., McKay, A., Haines, K., Alway, Y., Downing, M., Furtado, C. +1 more·2016·Psychological Medicine

DOI 10.1017/s0033291715002640

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Abstract

Background: Anxiety and depression are common following traumatic brain injury (TBI), often co-occurring. This study evaluated the efficacy of a 9-week cognitive behavioral therapy (CBT) program in reducing anxiety and depression and whether a three-session motivational interviewing (MI) preparatory intervention increased treatment response. Method: A randomized parallel three-group design was employed. Following diagnosis of anxiety and/or depression using the Structured Clinical Interview for DSM-IV, 75 participants with mild-severe TBI (mean age 42.2 years, mean post-traumatic amnesia 22 days) were randomly assigned to an Adapted CBT group: (1) MI + CBT (n = 26), or (2) non-directive counseling (NDC) + CBT (n = 26); or a (3) waitlist control (WC, n = 23) group. Groups did not differ in baseline demographics, injury severity, anxiety or depression. MI and CBT interventions were guided by manuals adapted for individuals with TBI. Three CBT booster sessions were provided at week 21 to intervention groups. Results: Using intention-to-treat analyses, random-effects regressions controlling for baseline scores revealed that Adapted CBT groups (MI + CBT and NDC + CBT) showed significantly greater reduction in anxiety on the Hospital Anxiety and Depression Scale [95% confidence interval (CI) −2.07 to −0.06] and depression on the Depression Anxiety and Stress Scale (95% CI −5.61 to −0.12) (primary outcomes), and greater gains in psychosocial functioning on Sydney Psychosocial Reintegration Scale (95% CI 0.04–3.69) (secondary outcome) over 30 weeks post-baseline relative to WC. The group receiving MI + CBT did not show greater gains than the group receiving NDC + CBT. Conclusions: Findings suggest that modified CBT with booster sessions over extended periods may alleviate anxiety and depression following TBI.

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Cognitive Behavioural Therapy for depression and/or anxiety has been shown to improve mood in some studies but not others, with some indication that trial design and dose of therapy may impact outcomes.
“Similarly, Cognitive Behavioural Therapy (CBT) for depression and/or anxiety has been shown to improve mood in some studies but not others, with some indication that trial design and dose of therapy may impact outcomes (Gertler et al., 2015;Ponsford et al., 2016;Wang et al., 2018).”
From A single-case experimental evaluation of a new group-based intervention to enhance adjustment to life with acquired brain injury: VaLiANT (valued living after neurological trauma) (2022) · cites this paper as Ponsford et al., 2016
Evidence for the efficacy of rehabilitation programs targeting cognition and mood separately remains mixed.
“However, evidence for the efficacy of rehabilitation programs targeting cognition and mood separately remains mixed (Gertler et al., 2015;Lincoln & Flannaghan, 2003;Ponsford et al., 2016;Rogers et al., 2018).”
From A single-case experimental evaluation of a new group-based intervention to enhance adjustment to life with acquired brain injury: VaLiANT (valued living after neurological trauma) (2022) · cites this paper as Ponsford et al., 2016
CBT for depression and/or anxiety has been shown to improve mood in some studies but not others, with some indication that trial design and dose of therapy may impact outcomes.
“Cognitive Behavioural Therapy (CBT) for depression and/or anxiety has been shown to improve mood in some studies but not others, with some indication that trial design and dose of therapy may impact outcomes (Gertler et al., 2015;Ponsford et al., 2016;Wang et al., 2018).”
From A single-case experimental evaluation of a new group-based intervention to enhance adjustment to life with acquired brain injury: VaLiANT (valued living after neurological trauma) (2022) · cites this paper as Ponsford et al., 2016
Cognitive behavioural therapy is widely used for treating depression and anxiety, but there is no strong evidence for its post-stroke effectiveness, and research into its effectiveness following traumatic brain injury is inconclusive.
“Cognitive behavioural therapy is widely used for treating depression and anxiety, but there is no strong evidence for its post-stroke effectiveness [10, 11], and research into its effectiveness following TBI is inconclusive [12–15].”
From The BrainACT study: acceptance and commitment therapy for depressive and anxiety symptoms following acquired brain injury: study protocol for a randomized controlled trial. (2019) · cites this paper as [12]
CBT interventions applied in a research environment typically target single psychological conditions.
“Furthermore, CBT interventions applied in a research environment typically target single psychological conditions, although interventions targeting mixed psychological presentations including both anxiety and depression are emerging (Ponsford et al., 2016).”
From Can acceptance and commitment therapy facilitate psychological adjustment after a severe traumatic brain injury? A pilot randomized controlled trial. (2020) · cites this paper as Ponsford et al., 2016

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Authors: Ponsford, J., Lee, N. K., Wong, D., McKay, A., Haines, K., Alway, Y., Downing, M., Furtado, C., & O'Donnell, M. L.
Affiliations: Monash University (AU)
Flinders University (AU)
The University of Melbourne (AU)
Corresponding author: Ponsford, J.
ORCID: Ponsford, J.
Lee, N. K.
Wong, D.
McKay, A.
Downing, M.
O'Donnell, M. L.
Venue: Psychological Medicine
Publisher: Cambridge University Press (CUP)
Published: 2015-12-28
Volume: 46
Issue: 5
Pages: 1079-1090
ISSN: 0033-2917 (ISSN-L)
1469-8978
DOI: 10.1017/s0033291715002640
OpenAlex: W2229032733
Cited by: 173
References: 50
Citations by year: 2026: 8 · 2025: 19 · 2024: 18 · 2023: 12 · 2022: 31 · 2021: 17 · 2020: 18 · 2019: 22 · 2018: 17 · 2017: 8 · 2016: 3
FWCI: 7.32
Type: journal article
Language: en
Open access: closed
Licence: www.cambridge.org/core/terms (unspecified)
Locations: Psychological Medicine (publishedVersion)
PubMed (publishedVersion)
eSpace (Curtin University) (submittedVersion)
Funders: National Health and Medical Research Council
Topics: Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords: traumatic brain injury, anxiety, depression, motivational interviewing, cognitive behavioral therapy, booster sessions, non-directive counseling, psychosocial functioning, post-traumatic stress, treatment response
MeSH terms: Brain Injuries, Traumatic, Adult, Anxiety, Anxiety Disorders, Australia, Depression, Depressive Disorder, Female, Humans, Male, Middle Aged, Regression Analysis, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome, Diagnostic and Statistical Manual of Mental Disorders, Motivational Interviewing

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Efficacy of motivational interviewing and cognitive behavioral therapy for anxiety and depression symptoms following traumatic brain injury

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