Silverberg Noah D, Mikolić Ana
Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, V5Z 1M9, Canada.
Curr Neurol Neurosci Rep. 2023 Mar;23(3):49-58. doi: 10.1007/s11910-023-01251-9. Epub 2023 Feb 10.
It has been clear for decades that psychological factors often contribute to mild traumatic brain injury (mTBI) outcome, but an emerging literature has begun to clarify which specific factors are important, when, for whom, and how they impact recovery. This review aims to summarize the contemporary evidence on psychological determinants of recovery from mTBI and its implications for clinical management.
Comorbid mental health disorders and specific illness beliefs and coping behaviors (e.g., fear avoidance) are associated with worse recovery from mTBI. Proactive assessment and intervention for psychological complications can improve clinical outcomes. Evidence-based treatments for primary mental health disorders are likely also effective for treating mental health disorders after mTBI, and can reduce overall post-concussion symptoms. Broad-spectrum cognitive-behavioral therapy may modestly improve post-concussion symptoms, but tailoring delivery to individual psychological risk factors and/or symptoms may improve its efficacy. Addressing psychological factors in treatments delivered primarily by non-psychologists is a promising and cost-effective approach for enhancing clinical management of mTBI. Recent literature emphasizes a bio-psycho-socio-ecological framework for understanding mTBI recovery and a precision rehabilitation approach to maximize recovery. Integrating psychological principles into rehabilitation and tailoring interventions to specific risk factors may improve clinical management of mTBI.
几十年来，心理因素常对轻度创伤性脑损伤（mTBI）的预后产生影响已为人所知，但新兴文献已开始阐明哪些具体因素重要、在何时、对何人以及如何影响恢复。本综述旨在总结当代关于mTBI恢复的心理决定因素的证据及其对临床管理的意义。
共病精神健康障碍以及特定的疾病信念和应对行为（如恐惧回避）与mTBI恢复较差有关。对心理并发症进行积极评估和干预可改善临床结局。针对原发性精神健康障碍的循证治疗可能对治疗mTBI后的精神健康障碍也有效，并可减轻总体脑震荡后症状。广谱认知行为疗法可能会适度改善脑震荡后症状，但根据个体心理风险因素和/或症状进行调整可能会提高其疗效。在主要由非心理学家提供的治疗中解决心理因素是加强mTBI临床管理的一种有前景且具成本效益的方法。最近的文献强调了一个生物 - 心理 - 社会 - 生态框架来理解mTBI恢复以及一种精准康复方法以实现最大程度的恢复。将心理原则融入康复并根据特定风险因素调整干预措施可能会改善mTBI的临床管理。
