Psychological approaches for the management of persistent postconcussion symptoms after mild traumatic brain injury: a systematic review
Abstract
Background: To evaluate the evidence for psychological treatments for persistent postconcussion symptoms following mild traumatic brain injury. There is scant evidence from limited clinical trials to direct the psychological management of persistent symptoms.Method: Databases were searched for studies that: (1) included adults (≥ aged 16 years) following injury (from any cause); (2) tested interventions for postconcussion symptoms after the acute injury period (e.g., after hospital discharge), but prior to established chronicity (e.g., not more than 12 months post-injury), and; (3) applied one of five broadly-defined psychological interventions (cognitive behavioural therapy, counselling, psychoeducation, education/reassurance, or mindfulness). All controlled trials were eligible for inclusion.Results: Of the 20,945 articles identified, 10 underwent risk-of-bias analysis by two independent reviewers. Nine were retained for data extraction. They used: cognitive behaviour therapy (n = 2), counselling (n = 2), psychoeducation (n = 2), education/reassurance (n = 2), or compared cognitive behaviour therapy to counselling (n = 1).Conclusion: Counselling or cognitive behaviour therapy have the most support but the evidence remains limited. We encourage further randomized controlled trials of early interventions in samples at risk for persistent symptoms, including closer study of psychological risk-factors and the ‘active’ ingredient. To advance the field, future trials must include additional methodological controls and improved reporting.Implications for rehabilitationPersistent symptoms following mild traumatic brain injury can be disabling and psychological management for rehabilitation may be proposed.However, Controlled trials show that while some psychological approaches hold promise for this purpose, there are significant gaps in the underpinning evidence.The best results are seen when postconcussion programs use counselling or cognitive behaviour therapy and are targetted for people with an increased risk of persistent symptoms.
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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 [28]
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 [28]
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- Authors
- Sullivan, K. A., Kaye, S.-A., Blaine, H., Edmed, S. L., Meares, S., Rossa, K., & Haden, C.
- Affiliations
- Queensland University of Technology (AU)
- Westmead Hospital (AU)
- Corresponding author
- Sullivan, Karen A.
- ORCID
- Venue
- Disability and Rehabilitation
- Publisher
- Informa UK Limited
- Published
- 2019-02-11
- Volume
- 42
- Issue
- 16
- Pages
- 2243-2251
- ISSN
- 0963-8288 (ISSN-L)
- 1464-5165
- OpenAlex
- W2914896802
- Cited by
- 48
- References
- 44
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 9 · 2023: 8 · 2022: 4 · 2021: 8 · 2020: 6 · 2019: 2
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Disability and Rehabilitation (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
- mild traumatic brain injury, psychological intervention, cognitive behavioral therapy, counseling, psychoeducation, mindfulness, early intervention, rehabilitation
- MeSH terms
- Adult, Brain Concussion, Humans, Psychotherapy, Group, Cognitive Behavioral Therapy, Post-Concussion Syndrome, Mindfulness
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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