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Cited by 29Traumatic Brain Injury ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

The effectiveness of cognitive behaviour therapy for reducing anxiety symptoms following traumatic brain injury: A meta-analysis and systematic review

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Little, Alice, Byrne, Christopher, Coetzer, Rudi·2021·NeuroRehabilitation
DOI 10.3233/nre-201544
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Abstract

BACKGROUND: Anxiety is a common neuropsychological sequela following traumatic brain injury (TBI). Cognitive Behaviour Therapy (CBT) is a recommended, first-line intervention for anxiety disorders in the non-TBI clinical population, however its effectiveness after TBI remains unclear and findings are inconsistent. OBJECTIVE: There are no current meta-analyses exploring the efficacy of CBT as an intervention for anxiety symptoms following TBI, using controlled trials. The aim of the current study, therefore, was to systematically review and synthesize the evidence from controlled trials for the effectiveness of CBT for anxiety, specifically within the TBI population. METHOD: Three electronic databases (Web of Science, PubMed and PsycInfo) were searched and a systematic review of intervention studies utilising CBT and anxiety related outcome measures in a TBI population was performed through searching three electronic databases. Studies were further evaluated for quality of evidence based on Reichow’s (2011) quality appraisal tool. Baseline and outcome data were extracted from the 10 controlled trials that met the inclusion criteria, and effect sizes were calculated. RESULTS: A random effects meta-analysis identified a small overall effect size (Cohen’s d) of d = –0.26 (95%CI –0.41 to –0.11) of CBT interventions reducing anxiety symptoms following TBI. CONCLUSIONS: This meta-analysis tentatively supports the view that CBT interventions may be effective in reducing anxiety symptoms in some patients following TBI, however the effect sizes are smaller than those reported for non-TBI clinical populations. Clinical implications and limitations of the current meta-analysis are discussed.

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  • Reviews found that psychotherapies for mood symptoms following acquired brain injury either have small short-term effects or the effects did not differ from control conditions.

    “Reviews found that psychotherapies for mood symptoms following acquired brain injury either have small short-term effects or the effects did not differ from control conditions.4–8”

    From Acceptance and commitment therapy for people with acquired brain injury: Rationale and description of the BrainACT treatment. (2023) · cites this paper as [8]

    The Discussion (page not available) reports a small reduction in anxiety symptoms with CBT compared with control conditions after traumatic brain injury. The review assessed CBT for anxiety after TBI, not psychotherapies for mood symptoms across all acquired brain injuries; it also says there were too few follow-up studies to assess whether effects were maintained. (LLM, conf=0.87)

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  • Cognitive behavioural therapy is less effective for people with acquired brain injury than for people without an acquired brain injury.

    “For instance, cognitive behavioural therapy which is widely used for treating depression and anxiety, however, is less effective for people with ABI than for people without an ABI [4].”

    From Acceptance and commitment therapy for people with depressive and anxiety symptoms following acquired brain injury: Results of the BrainACT randomized controlled trial. (2024) · cites this paper as [4]

    The Discussion reports a smaller effect on anxiety symptoms in TBI populations than in non-TBI clinical populations, but says this only 'could suggest' lower effectiveness. The cited paper does not establish a categorical comparison for all people with acquired brain injury or for treatment of depression. (LLM, conf=0.88)

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  • The evidence for the effectiveness of psychotherapies for depression symptoms is less robust for patients with brain injury than for depressed patients without brain injury.

    “The evidence for the effectiveness of psychotherapies for depression symptoms is less robust for patients with brain injury than for depressed patients without brain injury.”

    From Acceptance and commitment therapy for people with acquired brain injury: Rationale and description of the BrainACT treatment. (2023) · cites this paper as [8]

    Sections 1.2.2 and 1.2.3 compare the evidence for CBT treating anxiety in people without and with traumatic brain injury. Although the paper mentions studies focused on depression in section 3.1.5, our copy does not compare the robustness of psychotherapy evidence for depression between those populations (searched: depression, non-TBI populations, and evidence base). (LLM, conf=0.77)

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Cites

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1 of the 76 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. [3]3. Bandelow, B., Reitt, M., Röver, C., Michaelis, S., Görlich, Y., & Wedekind, D. (2015). Efficacy of treatments for anxiety disorders. International Clinical Psychopharmacology, 30(4), 183-192.
  2. [5]5. Beck, J.G. (1995). Cognitive Behavioural Therapy: Basics and Beyond. Guildford Press, New York: USA.
  3. [49]49. Perna, R. B., Bordini, E. J., & Newman, S. A. (2001). Pharma- cological treatment considerations in brain injury. Journal of Cognitive Rehabilitation, 19(1), 4-7.
  4. [56]56. Reichow, B. (2011). Development, procedures, and application of the evaluative method for determining evidence-based prac- tices in autism. Evidence-Based Practices and Treatments for Children with Autism (pp. 25-39) Springer.
  5. [61]61. Rydon-Grange, M. & Coetzer, R. (2015). Editorial. What do we know about Obsessive- Compulsive Disorder following Traumatic Brain Injury? CNS Spectrums, (iFirst, 25 August, pp. 1-3).

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Authors
Little, A., Byrne, C., & Coetzer, R.
Affiliations
  • Bangor University (GB)
  • Betsi Cadwaladr University Health Board (GB)
Corresponding author
Coetzer, Rudi
ORCID
Venue
NeuroRehabilitation
Publisher
SAGE Publications
Published
2021-01-22
Volume
48
Issue
1
Pages
67-82
ISSN
  • 1053-8135 (ISSN-L)
  • 1878-6448
DOI
10.3233/nre-201544
OpenAlex
W3117876190
Cited by
29
References
76
Citations by year
2026: 3 · 2025: 3 · 2024: 5 · 2023: 10 · 2022: 6 · 2021: 2
FWCI
0.66
Type
journal article
Language
en
Open access
Locations
  • Neurorehabilitation (publishedVersion)
  • PubMed (publishedVersion)
  • Bangor University Research Portal (Bangor University) (submittedVersion, other-oa)
Funders
Bangor University
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
cognitive behavioral therapy, traumatic brain injury, anxiety symptoms, anxiety disorders, neuropsychological sequelae, psychological intervention, treatment efficacy
MeSH terms
Brain Injuries, Traumatic, Adult, Anxiety, Female, Humans, Cognitive Behavioral Therapy, Databases, Factual, Treatment Outcome, Controlled Clinical Trials as Topic

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