Ponsford et al. (2016)

Australia

RCT

PEDro=7

N_Start=75, N_End=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.

Hsieh et al. (2012a)

Australia

RCT

PEDro=6

N_Initial=27, N_Final=24

Population: TBI; Mean Age=38yr; Gender: Male=21, Female=6; Mean Time Post Injury=37.9 mo.

Intervention: Participants diagnosed with anxiety received motivational interviewing followed by cognitive behavioural therapy (CBT+MI; n=9), non-directive counselling followed by CBT (CBT+NDC; n=10), or standard care (control; n=8) for 12 wk. Assessments were conducted at baseline, 3wk,12 wk, and 21wk.

Outcome Measure: Hospital Anxiety and Depression Scale (HADS), Depression Anxiety Stress Scale (DASS), Coping Style for Adults (CSA), Sydney Psychosocial Reintegration Scale (SPRS-2)

1.       CBT+MI and CBT+NDC had significantly greater reductions on HADS-Anxiety than control (both p=0.03), but not on DASS-Anxiety.

2.       CBT+NDC had significantly greater reduction on DASS-Stress than control (p=0.03), but CBT-MI did not.

3.       CBT+MI had significantly greater reduction on CSA-Non-productive than control (p=0.001), but CBT+NDC did not.

4.       There were no significant differences between CBT+MI or CBT+NDC versus control on HADS-Depression, DASS-Depression, CSA-Adaptive, or SPRS-2.

5.       CBT+MI showed significantly greater reductions on HADS-Anxiety (p=0.001), DASS-Anxiety (p=0.026), and DASS-Stress (p=0.005) than CBT+NDC; there were no significant differences on HADS-Depression or DASS-Depression.

Hsieh et al. (2012b)

Australia

RCT

PEDro=6

N_Initial=27

Population: TBI; Mean Age=38yr; Gender: Male=21, Female=6; Mean Time Post Injury=37.9 mo.

Intervention: Participants diagnosed with anxiety received motivational interviewing followed by cognitive behavioural therapy (CBT+MI; n=9), non-directive counselling followed by CBT (CBT+NDC; n=10), or standard care (control; n=8) for 12 wk. Assessments were conducted at baseline, 3wk,12 wk, and 21wk.

Outcome Measure: Anxiety Change Expectancy Scale (ACES).

1.       CBT+MI showed a significantly greater increase in ACES than CBT+NDC after CBT (p=0.04) and at 9wk follow-up (p=0.015), but not immediately after MI (p=0.22).

2.       There was a moderate, non-significant correlation between posttraumatic amnesia and ACES (r=0.485, p=0.067), suggesting that greater reduction in anxiety is associated with less severe injury.

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.

1.       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 9-14 wk. 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.

Arundine et al. (2012)

Canada

PCT

N_Initial=20, N_Final=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).

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).