Research Reports - Cognitive behavioural therapy for depression and anxiety in adults with acquired brain injury. What works for whom?

Neuropsychol Rehabil. 2013 Jan;23(1):64-101

Waldron B, Casserly LM, O'Sullivan C.

This paper reviews treatment outcome studies on cognitive behavioural therapy
(CBT) for depression and anxiety following acquired brain injury (ABI), including
traumatic brain injury (TBI), cerebral vascular accident (CVA), anoxia and
neurosurgery. Studies are included for review when the published paper included
an anxiety disorder or depression as the treatment focus, or as part of outcome
measurement. Relaxed criteria were used to select studies including relevant
single-cases, case series and single group studies along with studies that
employed control groups. Twenty-four studies were identified. Twelve papers were
of a single-case design (with or without replication). Two papers used
uncontrolled single groups and ten studies used a control group. There were a
total of 507 people in the various treatment and control groups, which ranged in
size from 6 to 67 persons. All participants in the study had an ABI. Our review
indicates CBT often shows a within-group pre- to post-treatment statistical
difference for depression and anxiety problems, or a statistical difference
between CBT-treated and non-treated groups. For studies that targeted the
treatment of depression with CBT, effect-sizes ranged from 0 to 2.39 with an
average effect-size of 1.15 for depression (large effect). For studies that
targeted the treatment of anxiety with CBT, effect-sizes ranged from 0 to 3.47
with an average effect-size of 1.04 for anxiety (large effect). However, it was
not possible to submit all twenty-four studies identified to effect-size
analysis. Additionally, it is clear that CBT is not a panacea, as studies
frequently indicate only partial reduction in anxiety and depression symptoms.
This review suggests that if CBT is aimed at, for example, anger management or
coping, it can be effective for anger or coping, but will not generalise to have
an effect on anxiety or depression. CBT interventions that target anxiety and
depression specifically appear to generate better therapeutic effects on anxiety
and depression. Gaps in the literature are highlighted with suggestions for
future research.

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