Hecker Lynn, King Skye, Stapert Sven, Geusgens Chantal, den Hollander Marlies, Fleischeuer Britt, van Heugten Caroline
Author Affiliations: Department of Clinical and Medical Psychology (Ms Hecker and Drs Stapert and Geusgens), Zuyderland Medical Centre, Sittard-Geleen, the Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (Ms King and Dr van Heugten), Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience (Ms Fleischeuer), Limburg Brain Injury Centre (Ms King and Dr van Heugten), Maastricht University, Maastricht, the Netherlands; and Adelante Zorggroep, Center of Rehabilitation Medicine, Hoensbroek, the Netherlands (Dr den Hollander).
J Head Trauma Rehabil. 2025;40(4):269-278. doi: 10.1097/HTR.0000000000001023. Epub 2024 Nov 18.
After a concussion, some patients develop persistent post-concussion symptoms, which interferes with functioning in daily life. A biopsychosocial explanation for the development and continuation of persistent post-concussion symptoms is the fear avoidance model (FAM). This study aimed to investigate the effectiveness and feasibility of an individual 14-week exposure therapy for patients with persistent symptoms after concussion.
Four participants from a medical psychology outpatient clinic participated in the study. Their age ranged between 51 and 68 years old ( M = 62.8, SD = 7). The average length of time since the concussion was 10 months.
A single-case experimental design (SCED) with nonconcurrent multiple baselines was used. Participants were randomly assigned to a baseline period (A phase) length between 21 and 42 days. The intervention phase (B phase) consisted of 14 treatment sessions in 14 weeks. The follow-up phase was 12 weeks.
Participants answered questions on a visual analogue scale about their satisfaction with functioning in daily life, avoidance behavior, and symptoms experience on a daily basis during baseline and on a weekly basis during intervention and follow-up. Additional outcomes included symptom severity, catastrophizing, quality of life, participation, avoidance behavior, and feasibility interviews.
Tau-U yielded significant effects ( P < .05) on all measures when comparing intervention and follow-up with the baseline in 3 out of 4 participants. Satisfaction with daily life increased and avoidance behavior and post-concussion symptoms experienced decreased. Participants and therapists rated the intervention protocol with an average of 8.8 out of 10.
The findings suggest that exposure therapy seems effective and feasible in treating patients with persistent symptoms after concussion in a clinical setting. Larger randomized controlled trials or replication with SCED studies are advised to obtain additional evidence on the effectiveness of exposure for individuals with persistent symptoms after concussion.
脑震荡后，一些患者会出现持续的脑震荡后症状，这会干扰日常生活功能。恐惧回避模型（FAM）是对持续脑震荡后症状的发生和持续存在的一种生物心理社会学解释。本研究旨在调查针对脑震荡后有持续症状患者的为期14周的个体暴露疗法的有效性和可行性。
来自医学心理学门诊的4名参与者参加了该研究。他们的年龄在51岁至68岁之间（M = 62.8，标准差 = 7）。自脑震荡以来的平均时间为10个月。
采用非同期多基线单病例实验设计（SCED）。参与者被随机分配到21至42天的基线期（A阶段）。干预阶段（B阶段）包括在14周内进行14次治疗。随访阶段为12周。
参与者在基线期间每天以及在干预和随访期间每周以视觉模拟量表回答关于他们对日常生活功能、回避行为和症状体验的满意度的问题。其他结果包括症状严重程度、灾难化思维、生活质量、参与度、回避行为和可行性访谈。
与基线相比，在4名参与者中的3名中，当将干预和随访与基线进行比较时，Tau-U在所有测量指标上均产生了显著影响（P <.05）。对日常生活的满意度提高，回避行为和经历的脑震荡后症状减少。参与者和治疗师对干预方案的平均评分为8.8分（满分10分）。
研究结果表明，在临床环境中，暴露疗法对于治疗脑震荡后有持续症状的患者似乎是有效且可行的。建议进行更大规模的随机对照试验或重复SCED研究，以获取关于暴露疗法对脑震荡后有持续症状个体有效性的更多证据。
