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

Published online by Cambridge University Press:  28 December 2015

J. Ponsford ,
N. K. Lee ,
D. Wong ,
A. McKay ,
K. Haines ,
Y. Alway ,
M. Downing ,
C. Furtado  and
M. L. O'Donnell
J. Ponsford*
Affiliation:
Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
N. K. Lee
Affiliation:
National Centre for Education and Training on Addiction, Flinders University, SA, Australia National Drug Research Institute, Curtin University, WA, Australia
D. Wong
Affiliation:
Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
A. McKay
Affiliation:
Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
K. Haines
Affiliation:
Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
Y. Alway
Affiliation:
Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
M. Downing
Affiliation:
Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
C. Furtado
Affiliation:
Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
M. L. O'Donnell
Affiliation:
Phoenix Australia, University of Melbourne, Victoria, Australia
*
*Address for correspondence: Professor J. Ponsford, Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia. (Email: jennie.ponsford@monash.edu)
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Abstract

Background

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.

Method

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.

Results

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.

Conclusions

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

Keywords

Anxietycognitive behavioral therapydepressionmotivational interviewingtraumatic brain injury
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 5 , April 2016 , pp. 1079 - 1090
Copyright
Copyright © Cambridge University Press 2015 

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