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

• Published in: Psychological medicine Vol. 46; no. 5; pp. 1079 - 1090
• Main Authors: Ponsford, J., Lee, N. K., Wong, D., McKay, A., Haines, K., Alway, Y., Downing, M., Furtado, C., O'Donnell, M. L.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.04.2016
• Subjects: Adult; Amnesia; Anxiety; Anxiety Disorders - diagnosis; Anxiety Disorders - therapy; Anxiety-Depression; Australia; Brain injuries; Brain Injuries, Traumatic - psychology; Cognitive ability; Cognitive behavioral therapy; Cognitive Therapy - methods; Cognitive-behavioral factors; Comorbidity; Counseling; Demography; Depression; Depressive Disorder - diagnosis; Depressive Disorder - therapy; Diagnostic and Statistical Manual of Mental Disorders; Efficacy; Female; Humans; Injuries; Intervention; Interviews; Male; Medical diagnosis; Mental depression; Middle Aged; Motivation; Motivational interviewing; Motivational Interviewing - methods; Original Articles; Psychological trauma; Psychosocial factors; Psychosocial functioning; Regression Analysis; Reintegration; Severity; Severity of Illness Index; Social interactions; Traumatic brain injury; Treatment Outcome; Australia; Victoria Australia; cognitive behavioral therapy; traumatic brain injury; motivational interviewing; Anxiety; depression
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291715002640

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. 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. 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. Findings suggest that modified CBT with booster sessions over extended periods may alleviate anxiety and depression following TBI.