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Predictors of Anxiety and Depression Symptom Improvement in CBT Adapted for Traumatic Brain Injury: Pre/Post-Injury and Therapy Process Factors

Published online by Cambridge University Press:  27 January 2020

Leah M. Zelencich Open the ORCID record for Leah M. Zelencich [Opens in a new window] ,
Dana Wong Open the ORCID record for Dana Wong [Opens in a new window] ,
Nikolaos Kazantzis Open the ORCID record for Nikolaos Kazantzis [Opens in a new window] ,
Dean P. McKenzie Open the ORCID record for Dean P. McKenzie [Opens in a new window] ,
Marina Downing Open the ORCID record for Marina Downing [Opens in a new window]  and
Jennie L. Ponsford Open the ORCID record for Jennie L. Ponsford [Opens in a new window]
Leah M. Zelencich
Affiliation:
School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia
Dana Wong
Affiliation:
School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia School of Psychology and Public Health, La Trobe University, Bundoora, Victoria 3800, Australia Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Victoria 3121, Australia
Nikolaos Kazantzis
Affiliation:
School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia
Dean P. McKenzie
Affiliation:
Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Victoria 3121, Australia Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria 3800, Australia
Marina Downing
Affiliation:
Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Victoria 3121, Australia
Jennie L. Ponsford*
Affiliation:
School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Victoria 3121, Australia
*
Correspondence and reprint requests to: Jennie L. Ponsford, Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia. E-mail: jennie.ponsford@monash.edu
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Abstract

Objectives:

The current study examined the association of demographic/preinjury, injury-related, and cognitive behavior therapy (CBT) process variables, with anxiety and depression symptom change in traumatic brain injury (TBI)-adapted CBT (CBT-ABI).

Methods:

The audio recordings of 177 CBT-ABI sessions representing 31 therapist–client dyads were assessed from the independent observer perspective on measures of working alliance, homework engagement, and therapist competency in using homework.

Results:

Linear regressions showed that older client age, longer post-TBI recovery period, better executive functioning, higher levels of client homework engagement, as well as higher levels of therapist competence in reviewing homework were associated with greater improvement in anxiety and/or depression symptoms.

Conclusions:

CBT-ABI is a promising treatment for post-TBI depression and anxiety. The current study highlights how therapists can enhance CBT-ABI effectiveness, specifically: comprehensive facilitation of client homework engagement with emphasis on homework review, and accommodation of executive deficits. The current study also suggests that the role of client age and the length of post-TBI recovery period require further investigation.

Keywords

Psychotherapeutic processesTreatment outcomeWorking allianceHomeworkTherapist competenceHead injuryMood disorders
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 26 , Special Issue 1: Rehabilitation , January 2020 , pp. 97 - 107
Copyright
Copyright © INS. Published by Cambridge University Press, 2020. 

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