Table 8.2 Cognitive Behavioural Therapy for the Treatment of Depression Post ABI
|
Author Year Country Research Design PEDro Sample Size |
Methods |
Outcomes |
|
Ponsford et al. (2016) Australia RCT PEDro=7 NStart=75 NEnd=51 |
Population: TBI. CBT+MI Group (n=26): Mean Age=46.69yr; Gender: Male=18, Female=8; Mean Time Post Injury=4.88yr; Mean GCS=10.43. CBT+NDC Group (n=26): Mean Age=39.88yr; Gender: Male=20, Female=6; Mean Time Post Injury=3.58yr; Mean GCS=10.48. WC Group (n=23): Mean Age=39.87yr; Gender: Male=17, Female=6; Mean Time Post Injury=2.61yr; Mean GCS=8.23. Intervention: Participants diagnosed with depression and/or anxiety were allocated to receive cognitive behavioural therapy (CBT) with either motivational interviewing (CBT+MI) or non-directive counseling (CBT+NDC), or to a waitlist control (WC). MI and NDC were each delivered for 3wk, followed by 9wk of CBT, with three CBT booster sessions 21-30wk from baseline. Assessments were conducted at baseline, 3wk, 12wk, 21wk, and 30wk. Outcome Measure: Depression, Anxiety & Stress Scale (DASS), Hospital & Anxiety Depression Scale (HADS), Sydney Psychosocial Reintegration Scale 2 (SPRS-2). | 1. All groups demonstrated significant improvements on the DASS-Depression, HADS-Anxiety, and SPRS-2 over time. 2. On the DASS-Depression, there was a significantly greater reduction in score over time in CBT+MI versus WC (p<0.005) but not CBT+NDC versus WC; there was no significant difference between CBT+MI and CBT+NDC. 3. On the HADS-Anxiety, there was a significantly greater reduction in score over time in CBT+NDC versus WC (p<0.05) but not CBT+MI versus WC; there was no significant difference between CBT+MI and CBT+NDC. 4. On the SPRS-2, there was no significant difference in improvement between groups over time. 5. Higher baseline DASS-Depression and HADS-Anxiety scores were significantly associated with greater response to treatment (r=0.34, p<0.05 and r=0.37, p<0.05, respectively). 6. When combining CBT+MI and CBT+NDC groups, there were significantly greater improvements on HADS-Anxiety (p<0.05), DASS-Depression (p<0.005), and SPRS-2 (p<0.05) in the combined group versus WC. |
|
Ashman et al. (2014) USA RCT PEDro=7 NInitial=54 NFinal=43 |
Population: TBI. CBT Group (n=28): Mean Age=47.5yr; Gender: Male=10, Female=18; Mean Time Post Injury=7.8yr; Severity: Mild=10, Moderate/Severe=17. SPT (n=26): Mean Age=47.1yr; Gender: Male=12, Female=14; Mean Time Post Injury=13.2yr; Severity: Mild=9, Moderate/Severe=12. Intervention: Participants diagnosed with depression were randomized to receive cognitive behavioural therapy (CBT) or supportive psychotherapy (SPT). The CBT group received treatment based on standard techniques with focus on cognitive restructuring and reshaping automatic thoughts. The SPT group received client-centered treatment to improve ability to deal with daily problems effectively. Both groups had 90min sessions 2 day/wk for the first week, followed by 50min sessions 1 day/wk for 3mo. Assessments were conducted before and after each treatment session. Outcome Measure: Beck Depression Inventory-Second Edition (BDI-II), State-Trait Anxiety Inventory (STAI), Life-3. | 1. Rate of remission of depression between groups was not statistically significant (p=0.16), but 35% in CBT group were no longer depressed at end of treatment compared to 17% in SPT group. 2. Within groups, there was a significant improvement on BDI-II scores in the CBT group (p=0.03) and a marginal improvement in the SPT group(p=0.06). 3. No significant differences in anxiety between groups were found at the end of treatment (p=0.12). 4. No significant differences in quality of life as measured by Life-3 were found at the end of treatment (p>0.05). |
|
D’Antonio et al. (2013) USA RCT PEDro=6 N=44 |
Population: TBI; Mean Age=48.8yr; Gender: Male=19, Female=25; Mean Time Post Injury=7.7yr. Treatment: Participants diagnosed with depression were randomized to receive 16 sessions of cognitive behavioural therapy (CBT) or supportive psychotherapy (SPT) for over 3mo. For both groups, the first session lasted 90min and each subsequent session was 50min. Assessments were conducted at baseline and 3mo. Outcome Measure: Beck Depression Inventory-II (BDI-II). |
1. The CBT group reported significant decreases in sadness, loss of interest, and loss of interest in sex (p<0.05). 2. The SPT reported decreases in agitation (p<0.05), irritability (p<0.01), and the somatic factor of the BDI-II (p<0.05). 3. Overall BDI-II scores significantly decreased compared to baseline for both groups (p<0.05). 4. No significant differences were found for individual items or total score of the BDI-II between groups after treatment. |
|
Anson & Ponsford (2006) Australia RCT PEDro=5 N=31 |
Population: TBI; Gender: Male=26, Female=5. Group A (n=15): Mean Age=38.9yr; Mean Time Post Injury=755.8d. Group B (n=16): Mean Age=37.8yr; Mean Time Post Injury=340.8d. Intervention: For Group A (n=15), baseline phase was 5wk, followed by 5wk of intervention, and a 5wk follow-up phase. For Group B (n=16), baseline was 10wk, followed by 5wk of intervention and a 10wk follow-up phase. The CSG consisted of 10 group sessions and ran for 900min 2×/wk.Outcome Measure: Coping Scale for Adults, Hospital Anxiety and Depression Scale, Rosenberg Self Esteem scale. | 1. No significant changes in anxiety or self-esteem scores were noted following the CSG (p>0.05). 2. Although levels of depression and psychosocial dysfunction were significantly different between the two groups (p<0.05) participation in the CSG did not have an effect on their scores. 3. Both groups significantly increased their adaptive coping skills following the CSG (p<0.01). |
|
Hodgson et al. (2005) Australia RCT PEDro=5 N=12 |
Population: ABI; Gender: Male=7, Female=5. Treatment Group (n=6): Mean Age=44.2yr; Mean Time Post Injury=96.7mo. Waitlist Group (n=6): Mean Age=33.8yr; Mean Time Post Injury=150.5mo. Intervention: Participants were randomized to receive cognitive behavioural therapy (CBT) or waitlist control. The CBT treatment program consisted of relaxation training, cognitive strategies, graded exposure, and assertiveness skills training. CBT was delivered in 1hr sessions 1 day/wk for 9-14wk. Assessments were conducted before and after treatment, and at 1mo follow-up.Outcome Measure: Hospital Anxiety and Depression Scale (HADS), Social Phobia and Anxiety Inventory (SPAI), Coppersmith Self Esteem Inventory. | 1. After treatment, the CBT group had significantly lower scores on HADS-Depression, HADS-Anxiety, and SPAI than the control group (p<0.05). 2. At follow-up, the treatment group maintained improvement relative to the control group. |
|
Fann et al. (2015) USA PCT NInitial=100 NFinal=72 |
Population: TBI; Mean Age=45.8yr; Gender: Male=63, Female=37; Mean Time Post Injury=3.33yr; Severity: Moderate=69, Severe=31. Intervention: Participants diagnosed with depression received cognitive behavioural therapy (CBT) on telephone (CBT-T), CBT in person (CBT-IP), or usual care (UC). Both CBT treatments consisted of 30-60 min weekly sessions for 12wk, where in-session work and inter-session homework was assigned. UC group received a phone call encouraging them to continue rehabilitation and directing them towards community resources. Assessments were conducted at baseline, 8wk, 16wk, and 24wk. Outcome Measure: Structured Clinical Interview for DSM (SCID), Hamilton Rating Scale for Depression (HAM-D), Symptom Checklist-20 (SCL-20), Patient Global Impression (PGI), Satisfaction with Depression Care (SDC). | 1. On SCID, there were no significant differences in rate of depression diagnosis for CBT-T versus UC, CBT-IP versus UC, or combined CBT versus UC at 16wk or 24wk (p>0.05). 2. On HAM-D, there were no significant differences for CBT-T versus UC, CBT-IP versus UC, or combined CBT versus UC at baseline, 8wk, 16wk, or 24wk (p>0.05). 3. On SCL-20, CBT-T showed significantly greater improvement than UC at 8wk (p=0.002) and 16wk (p=0.043), but not 24wk (p=0.065). 4. On SCL-20, there were no significant differences between CBT-IP and UC at baseline, 8wk, 16wk, or 24wk (p>0.05). 5. On SCL-20, combined CBT showed significantly greater improvement than UC at 8wk (p=0.001), but not at 16wk (p=0.074) or 24wk (p=0.250). 6. On PGI at 16wk, there was significantly greater satisfaction with combined CBT (p=0.010) and CBT-T (p=0.012), but not CBT-IP (p=0.133), than UC. 7. On PGI at 24wk, there was significantly greater satisfaction with combined CBT (p=0.040) and CBT-T (p=0.026), but not CBT-IP (p=0.633), than UC. 8. On SDC at 16wk, there was significantly greater satisfaction with combined CBT (p<0.001), CBT-T (p<0.001), and CBT-IP (p=0.007) than UC. 9. Participants without pre-TBI depression had a significantly larger decrease in HAM-D score (p=0.036) and SCL-20 score (p=0.008) when randomized to CBT than UC, whereas those with prior depression did not show a difference. |
|
Ashworth et al. (2015) UK Pre-Post N=12 |
Population: TBI=7, Stroke=3, ABI=2; Mean Age=40.9yr; Gender: Male=7, Female=5. Intervention: Participants received two phases of compassion-focused therapy (CFT) 1 day/wk for 18wk. Group sessions focused on identifying emotions that encompass ABI and strategies to manage them. Individual sessions addressed content from mood groups and in-depth development of CFT skills. Inter-session homework was encouraged. Assessments were conducted at baseline, 18wk, and 3mo follow-up. Outcome Measure: Hospital Depression and Anxiety Scale (HADS), Forms of Self-Criticism/Self-Attacking and Self-Reassuring Scale (FSCRS). | 1. Significant decreases in depression and anxiety on the HADS from baseline to post treatment and baseline to follow-up (p<0.05). 2. Significant increase in reassured self and reductions in hatred and inadequate self, according to FSCRS, from baseline to post-treatment and baseline to follow-up (p<0.05). |
|
Arundine et al. (2012) Canada PCT NInitial=20 NFinal=17 Follow up to Bradbury et al. (2008) |
Population: TBI=10, ABI=10, Severity: Moderate-Severe. CBT Group (n=10): Mean age=39.8yr; Gender: Male=5, Female=5; Mean Time Post Injury=7.00yr. EC Group (n=10): Mean age=42.5yr; Gender: Male=5, Female=5; Mean Time Post Injury=11.4yr. Intervention: Participants with psychological distress were randomized to receive cognitive behavioural therapy (CBT) or education control (EC). CBT involved one individual introductory session, and then 10 sessions either in a group (CBT-G) or individually by telephone (CBT-T). EC group received CBT after initial group. Assessments were conducted at baseline, post treatment, 1mo follow-up, and 6mo follow-up. Outcome Measure: Depression Anxiety Stress Scales 21 (DASS-21), Symptom Checklist 90 Revised (SCL-90-R). | 1. At 6mo follow-up, all participants showed significant improvements from baseline on DASS-21 (p<0.01) and SCL-90-R (p<0.01); CBT-G and CBT-T were comparable. |
|
Bradbury et al. (2008) Canada PCT N=20 |
Population: TBI=10, ABI=10, Severity: Moderate-Severe. CBT Group (n=10): Mean age=39.8yr; Gender: Male=5, Female=5; Mean Time Post Injury=7.00yr. EC Group (n=10): Mean age=42.5yr; Gender: Male=5, Female=5; Mean Time Post Injury=11.4yr. Intervention: Participants with psychological distress received cognitive behavioural therapy (CBT) or education control (EC). CBT involved one individual introductory session, and then 10 sessions either in a group (CBT-G) or individually by telephone (CBT-T). Assessments were conducted at baseline, post treatment, and 1mo follow-up. Outcome Measure: Depression Anxiety Stress Scales 21 (DASS-21), Symptom Checklist 90 Revised (SCL-90-R). | 1. At post treatment and 1mo follow-up, combined CBT showed significantly greater improvement from baseline than EC on DASS-21 (p<0.001) and SCL-90-R (p<0.01). 2. On DASS-21 and SCL-90-R, there were significant improvements from baseline to post treatment and to 1mo follow-up for CBT-G (p<0.01) and CBT-T (p<0.05), but there were no there were no significant improvements from post treatment to 1mo follow-up (p>0.05). 3. There were no significant differences between CBT-G and CBT-T at any time point on DASS-21 or SCL-90-R (p>0.05). |