Cognitive-behavioral intervention in persistent postconcussion syndrome : a controlled treatment outcome study
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More than 1 million people experience a mild brain injury each year in the United States. Up to 40% of these individuals continue to report persistent postconcussion symptoms (e.g., fatigue, headache, cognitive difficulties, emotional changes) many months after injury, yet surprisingly little research has been devoted to developing beneficial treatments for this disorder. The current study sought to examine the relative efficacy of two different psychosocial treatment interventions for persistent postconcussion syndrome. Forty participants were randomly assigned to either group-based cognitivebehavioral therapy (GCBT, N = 15), group-based education and support (GEST, N = 16), or a wait-list control group (WL, N = 9). GCBT included traditional cognitivebehavioral components including education, automatic thought identification and cognitive restructuring, in vivo exposure, relaxation training, and structured homework assignments. GEST included the full education component plus nondirective psychosocial support. Treatment outcome was evaluated in four domains: postconcussion symptomatology, quality of life, cognitive functioning, and emotional distress, at two time points: pre- and post-treatment. Results revealed significant improvement for treated individuals in postconcussion symptoms, neurocognitive functioning, and emotional distress. Active treatment demonstrated significant superiority over delayed treatment in reducing postconcussion symptoms, but was not superior to delayed treatment in other outcome domains. GCBT was marginally superior to GEST in improving quality of life; no other differences between GCBT and GEST were detected. Criteria for clinically significant improvement were met for 27% of GCBT participants and 31% of GEST participants. Exploratory analyses showed that several clinical and baseline variables significantly moderated group effects on outcome, including medication use at the time of study entry and baseline level of depression. Implications of these findings are discussed.