A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury.

OBJECTIVE

To test the effectiveness of a neuropsychologic rehabilitation program consisting of psychotherapy and cognitive remediation in the treatment of the affective and neuropsychologic sequelae of mild-spectrum traumatic brain injury (TBI).

DESIGN

Single-blind randomized, wait-listed controlled trial, with repeated measures and multiple baselines.

SETTING

Outpatient clinic in northern New Jersey.

PARTICIPANTS

Twenty persons with persisting complaints after mild and moderate TBI (11 in treatment group, 9 controls).

INTERVENTIONS

The experimental group received both 50 minutes of individual cognitive-behavioral psychotherapy and 50 minutes of individual cognitive remediation, 3 times a week for 11 weeks. The control group was wait-listed and received treatment after conclusion of follow-up.

MAIN OUTCOME MEASURES

Symptom Check List-90R General Symptom Index, plus scales of depression, anxiety, coping, attention, and neuropsychologic functioning.

RESULTS

Compared with the control group, the treatment group showed significantly improved emotional functioning, including lessened anxiety and depression. Most significant improvements in emotional distress were noted at 1 month and 3 months posttreatment. Performance on a measure of divided auditory attention also improved, but no changes were noted in community integration scores.

CONCLUSIONS

Cognitive behavioral psychotherapy and cognitive remediation appear to diminish psychologic distress and improve cognitive functioning among community-living persons with mild and moderate TBI.