Author Affiliations: Departments of Neuropsychology and Psychopharmacology (Ms King and Drs Stapert, Winkens, and van Heugten) and Clinical Psychological Science (Dr Rijkeboer), Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Centre, Maastricht University, Maastricht, the Netherlands (Ms King and Drs Winkens and van Heugten); Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (Dr Stapert); and Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (Dr van der Naalt).
J Head Trauma Rehabil. 2024;39(5):E419-E429. doi: 10.1097/HTR.0000000000000942. Epub 2024 Sep 10.
After a concussion, 1 in 3 patients report persistent symptoms and experience long-term consequences interfering with daily functioning, known as persistent concussion symptoms (PCS). Evidence suggests PCS is (partly) maintained by anxious thoughts about brain functioning, recovery, and experienced symptoms, leading to avoidance behaviors, which may prevent patients from meeting life demands. We aimed to investigate the efficacy of a newly developed intensive exposure intervention for individuals with PCS after concussion aimed to tackle avoidance behavior.
Participants took part in the intervention at the Maastricht University faculty.
Four participants who experienced PCS after concussion partook in the exploratory study. Participants' age ranged between 20 and 32 (mean = 26.5, SD = 5.9) years, with an average length of time after the concussion of 9.8 months.
A concurrent multiple-baseline single-case design was conducted. The baseline period (A phase) length was randomly determined across participants (3, 4, 5, or 6 weeks). The exposure intervention (B phase) was conducted by psychologists over a 4-week period and consisted of 3 stages: exploration (2 sessions), active exposure (12 sessions conducted over 1 week), and 2 booster sessions.
Participants answered daily questions on a visual analog scale related to symptom experience, satisfaction with daily functioning, and degree of avoidance of feared activities. Additional outcomes included symptom severity, catastrophizing, fear of mental activity, anxiety, depression, and societal participation.
Tau-U yielded significant effects ( P < .05) for all participants on all measures when comparing baseline and intervention phases. The pooled standardized mean difference was high for all measures (symptom experience = 0.93, satisfaction of daily functioning = 1.86, and activity avoidance = -2.05).
The results show efficacy of the newly developed intensive exposure treatment for PCS after concussion, which is based on the fear avoidance model. Replication in a larger heterogeneous sample is warranted and needed.
脑震荡后，1/3 的患者报告持续存在症状，并经历长期后果，干扰日常功能，即持续性脑震荡症状（PCS）。有证据表明，PCS 是（部分）由对大脑功能、恢复和经历的症状的焦虑思维维持的，导致回避行为，这可能阻止患者满足生活需求。我们旨在研究一种新开发的针对脑震荡后 PCS 个体的强化暴露干预措施的疗效，旨在解决回避行为问题。
参与者在马斯特里赫特大学学院参加干预。
4 名经历过脑震荡后 PCS 的参与者参加了探索性研究。参与者的年龄在 20 至 32 岁之间（平均=26.5，标准差=5.9），脑震荡后平均时间为 9.8 个月。
采用同期多个基线单病例设计。基线期（A 期）长度在参与者之间随机确定（3、4、5 或 6 周）。暴露干预（B 期）由心理学家在 4 周内进行，包括 3 个阶段：探索（2 次会议）、主动暴露（1 周内进行 12 次会议）和 2 次强化会议。
参与者每天在视觉模拟量表上回答与症状体验、日常功能满意度和对恐惧活动回避程度相关的问题。其他结果包括症状严重程度、灾难化、对脑力活动的恐惧、焦虑、抑郁和社会参与度。
当比较基线期和干预期时，tau-U 对所有参与者的所有测量值均产生显著效果（P<0.05）。所有测量值的 pooled 标准化均差均较高（症状体验=0.93，日常功能满意度=1.86，活动回避=-2.05）。
结果表明，新开发的基于恐惧回避模型的脑震荡后 PCS 强化暴露治疗有效。需要在更大的异质样本中进行复制和验证。
