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Efficacy of motivational interviewing and cognitive behavioral therapy for anxiety and depression symptoms following traumatic brain injury
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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“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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].”
In the citing paper
“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
Citations
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The empirical status of cognitive-behavioral therapy: A review of meta-analyses
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Cuijpers, P., van Straten, A., Andersson, G., & van Oppen, P. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0013075 · Cited by 1,050 · cited 1×
“Given that CBT requires active client involvement (Cuijpers et al. 2008), client motivation is extremely important.”
BackgroundRates of Major Depressive Disorder and Clinical Outcomes Following Traumatic Brain Injury
Bombardier, C. H. (2010) · JAMA · doi:10.1001/jama.2010.599 · Cited by 746
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Cited by
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The Glasgow Outcome Scale — 40 years of application and refinement
McMillan, T. M., Wilson, L., Ponsford, J. L., Levin, H. S., Teasdale, G. M., & Bond, M. (2016) · Nature Reviews Neurology · doi:10.1038/nrneurol.2016.89 · Cited by 424
Self-citationRest and treatment/rehabilitation following sport-related concussion: a systematic review
Schneider, K., Leddy, J. J., Guskiewicz, K. M., Seifert, T., McCrea, M., Silverberg, N. D., Feddermann‐Demont, N., Iverson, G. L., Hayden, A., & Makdissi, M. (2017) · British Journal of Sports Medicine · doi:10.1136/bjsports-2016-097475 · Cited by 309
A prescription for “nature” – the potential of using virtual nature in therapeutics
White, M. P., Yeo, N. L., Vassiljev, P., Lundstedt, R., Wallergård, M., Albin, M. C., & Lõhmus, M. (2018) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s179038 · Cited by 258
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“Research suggests that CBT effectively reduces symptoms of anxiety and depression in a concussed population, particularly when using an adapted protocol for individuals with cognitive impairments and when implemented early in the recovery period (Mittenberg et al., 2001; Ponsford et al., 2016).”
Metadata
- 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.
- 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
- 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
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- eSpace (Curtin University) (submittedVersion)
- Funders
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Clinical Neurology › 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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