Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on interventions that address psychosocial, behavioral, and emotional skills for people with traumatic brain injury (TBI).
Full Systematic Review Question
This systematic review addressed the question “What is the evidence for effectiveness of interventions that address psychosocial, behavioral, and/or emotional skills to improve social participation and other everyday activities and occupations for persons with TBI?”
Current Theme Reported
The main theme of the studies included in this systematic review brief is cognitive behavioral therapy (CBT) interventions for adults with traumatic brain injury.
Clinical Scenario
Traumatic brain injury (TBI) is a leading cause of death and disability that affects about 2.5 million Americans each year. Although the symptoms and severity of TBI vary among individuals, psychosocial, behavioral, and emotional changes are common and significantly impact successful and satisfying community participation. The increased prevalence of psychological problems in people with TBI, including depression, anxiety, suicidal ideation, substance abuse, sleep disorders, and posttraumatic stress disorder, highlights the need for appropriate and empirically based interventions. Psychological issues are commonly cited among those unmet rehabilitation needs (Mahoney et al., 2021), and these directly fall within occupational therapy’s scope of practice. Occupational therapy practitioners have knowledge, skills, and training in assessing and treating psychological impairments to improve occupational performance following TBI, making their role in the rehabilitation process vital across the continuum of recovery. Efficacy for the use of cognitive behavioral therapy (CBT) for individuals with TBI has been demonstrated in prior research with persons at each level of injury severity (mild, moderate, and severe) to improve coping and mood-related conditions, including depression and anxiety. The approach has also been effectively used for anger management, suicide prevention, and the treatment of postconcussive symptoms. CBT techniques emphasize challenging and altering cognitive distortions and behaviors to facilitate more effective coping strategies and improved functioning (Potter et al., 2016). The approach can be combined with occupational therapy individual and group interventions to support occupational performance outcomes for persons with TBI.
Summary of Key Findings
Six articles were included in the review related to interventions using cognitive behavioral therapy. These 6 articles were further divided into two categories, depending on method of delivery (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009).
Evidence Table for CBT Interventions for Adults with Traumatic Brain Injury
Note. BDI = Beck Depression Inventory; CBT = cognitive behavioral therapy; CommCope-I = Communication-specific Coping Intervention; mTBI = mild traumatic brain injury; PCS = post-concussion syndrome; RCTs = randomized control trials; TBI = traumatic brain injury.
Bottom Line for Occupational Therapy Practice
CBT-based interventions are implemented with persons with TBI in both individual and part of group treatment. Common across CBT interventions is the general notion of cognitive restructuring, identifying negative or maladaptive thoughts and developing new coping skills consistent with identified goals. The findings of this review indicate moderate strength of evidence to support CBT interventions in a one-to-one format. Such one-to-one treatment is conducive to tailoring programs to the unique and varying needs of the individual, an important consideration given the tremendous heterogeneity of symptoms and severity across the population of TBI survivors. Across studies, individual CBT-based interventions resulted in significantly improved psychological well-being and quality of life for both mild and moderate to severe TBI conditions. It’s possible, given the low strength of evidence in this review for group-based CBT, that the group setting is less sensitive to the specific goals and needs of the individual client. Brenner et al. (2018) used small groups, an approach which may increase some level of individualization while preserving the social benefits from the group setting. It is important that occupational therapy practitioners have achieved appropriate competency in CBT prior to using it as part of the occupational therapy plan of care (Slepecky et al., 2017).
Footnotes
*
Indicates articles included in the systematic review brief.