Cognitive behavioural therapy and persistent post-concussional symptoms: Integrating conceptual issues and practical aspects in treatment

Abstract

This paper seeks to integrate research findings in mild traumatic brain injury (MTBI) around three central themes relevant to psychological therapies for persistent post-concussional symptoms (PCS). These are (1) the relative lack of symptom specificity, (2) the extent to which subjective (but not necessarily objective) cognitive difficulties predominate, and (3) the role of psychological (especially cognitive-behavioural) processes in the evolution and maintenance of symptoms. Evidence-based models guiding cognitive-behavioural therapy (CBT) for similar symptoms in other clinical groups are considered in relation to persistent PCS, as well as some of the practical considerations in applying CBT with this client group. Outstanding research issues are identified and discussed, including the opportunities and risks of combining CBT and cognitive rehabilitation approaches.

Keywords:

• Traumatic brain injury
• Post-concussion syndrome
• Cognitive-behavioural therapy

Acknowledgments

The authors would like to thank Ionie Lyon for her assistance in preparing this manuscript. The authors acknowledge support from the NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust (SLaM) and Institute of Psychiatry, King's College London.