Psychological treatment for anxiety in people with traumatic brain injury

Psychological interventions are commonly used in the management of anxiety and certain types of psychological treatments, such as cognitive behaviour therapy, are well suited to needs of individuals with traumatic brain injury (TBI). An advantage of these interventions is that, given their highly structured content, they are amenable to specialised adaptation for memory, attention and problem solving impairments, reflecting the difficulties people with TBI often experience. This review identified three randomised controlled trials in the area of psychological treatments for anxiety after TBI. Some evidence was found for the effectiveness of the following interventions: cognitive behavioural therapy (CBT) for treatment of acute stress disorder following mild TBI, and combining CBT and neurorehabilitation for treatment of general anxiety symptoms in people with mild to moderate TBI. The ability to make strong conclusions on the effectiveness of these approaches is limited by the small number of trials available for pooling of data, especially trials with similar conditions and participants.

Authors' conclusions: 

This review provides some evidence for the effectiveness of CBT for treatment of acute stress disorder following mild TBI and CBT combined with neurorehabilitation for targeting general anxiety symptomatology in people with mild to moderate TBI. These findings need to be viewed in light of the small number, small sample size and heterogeneous characteristics of current trials published in this area. More trials focusing on comparable psychological interventions, severity of injury of participants and diagnosis of anxiety disorder(s) are needed.

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Background: 

Psychological treatments are commonly used in the management of anxiety. Certain types of psychological treatments are well suited to needs of people with traumatic brain injury (TBI). We have systematically reviewed studies examining the effectiveness of these approaches for TBI.

Objectives: 

To assess the effects of psychological treatments for anxiety in people with TBI.

Search strategy: 

We searched the following databases up until March 2006: Cochrane Injuries Group's specialised register, Cochrane Depression, Anxiety and Neurosis Group's specialised register, Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, ERIC, and PsycBITETM. Additionally, key journals were handsearched and reference lists of included trials were examined to identify further studies meeting inclusion criteria.

Selection criteria: 

Randomised controlled trials of psychological treatments for anxiety, with or without pharmacological treatment, for people with TBI were included in the review. Pharmacological treatments for anxiety in isolation (without psychological intervention) were excluded.

Data collection and analysis: 

Two authors independently assessed methodological quality and extracted data from the included trials.

Main results: 

Three trials were identified in this review as satisfying inclusion criteria. Results of all three trials were evaluated, however, one of these trials had compromised methodological quality and, therefore the focus was placed on the other two trials. Data were not pooled due to the heterogeneity between trials. The first trial (n = 24) showed a benefit of cognitive behavioural therapy (CBT) in people with mild TBI and acute stress disorder. Fewer people receiving CBT had diagnosis of post-traumatic stress disorder (PTSD) at post-treatment compared to the control supportive counselling group, with maintenance of treatment gains found at six-month follow up. The second trial (n = 20) showed that post-treatment anxiety symptomatology of people with mild to moderate TBI was lower in the combined CBT and neurorehabilitation group compared to the no intervention control group.

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