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Barua U, Ahrens J, Shao R, MacKenzie H, Wolfe D, Sequeira K, Teasell R, Loh E, Mehta S. Cognitive behavioral therapy for managing depressive and anxiety symptoms after brain injury: a meta-analysis. Brain Inj 2024; 38:227-240. [PMID: 38318855 DOI: 10.1080/02699052.2024.2309264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 01/19/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Individuals with traumatic brain injury (TBI) are at increased risk of depression and anxiety, leading to impaired recovery. While cognitive-behavioral therapy (CBT) addresses anxiety and depression maintenance factors, its efficacy among those with TBI has not been clearly demonstrated. This review aims to bridge this gap in the literature. METHODS Several databases, including Medline, PsycInfo and EMBASE, were used to identify studies published between 1990 and 2021. Studies were included if: (1) trials were randomized controlled trials (RCT) involving CBT-based intervention targeting anxiety and/or depression; (2) participants experienced brain injury at least 3-months previous; (3) participants were ≥18 years old. An SMD ± SE, 95% CI and heterogeneity were calculated for each outcome. RESULTS Thirteen RCTs were included in this meta-analysis. The pooled-sample analyses suggest that CBT interventions had small immediate post-treatment effects on reducing depression (SMD ± SE: 0.391 ± 0.126, p < 0.005) and anxiety (SMD ± SE: 0.247 ± 0.081, p < 0.005). Effects were sustained at a 3-months follow-up for depression. A larger effect for CBT was seen when compared with supportive therapy than control. Another sub-analysis found that individualized CBT resulted in a slightly higher effect compared to group-based CBT. CONCLUSION This meta-analysis provides substantial evidence for CBT in managing anxiety and depression post-TBI.
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Affiliation(s)
- Ujjoyinee Barua
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Jessica Ahrens
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
| | - Richard Shao
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
| | - Heather MacKenzie
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | - Dalton Wolfe
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Keith Sequeira
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | - Robert Teasell
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | - Eldon Loh
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | - Swati Mehta
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
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