Integrated neuropsychological and cognitive behavioural therapy after acquired brain injury: A pragmatic randomized clinical trial

ABSTRACT

After acquired brain injury (ABI) many patients suffer from persistent cognitive and emotional disturbances. The aim of this study was to investigate the treatment outcome of an integrated intervention, combining neuropsychological and cognitive behavioural therapy (nCBT), against waitlist (WL) in outpatients with ABI. Individuals seeking outpatient treatment for cognitive and emotional problems after ABI were randomly allocated to nCBT (n = 27) or WL (n = 29) and completed assessments at baseline, post-treatment/WL and at six-month follow-up. The primary outcome measures were general psychopathology and functional activity in daily life. The nCBT group showed significant improvement for general psychopathology post-treatment when compared to WL. nCBT was also superior to WL regarding the secondary outcomes, i.e., the reduction of negative affect and the improvement of quality of life. No significant differences for functional activity and community integration were observed. Significant pre–post effect sizes ranged between small for functional activity and medium for quality of life. The positive effects were maintained at follow-up. The majority of patients with cognitive and emotional problems after ABI benefit from an integrated approach that offers cognitive remediation and psychotherapy. However, the heterogeneous sequelae of ABI and the moderate sample sizes in clinical trials present a methodological challenge to ABI research.

KEYWORDS:

• Acquired brain injury
• Neuropsychological deficits
• Cognitive remediation
• Cognitive behavioural therapy
• Rehabilitation

Acknowledgements

We would like to express our appreciation to the patients who participated in this study. We thank Anne Fritz for providing supervision to the therapists involved in the trial and Maren Böker who conducted the RASCH analyses of the ADFIQ.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1 Until 2012, when new and improved regulations came into effect, outpatient psychotherapeutic treatment for individuals suffering from psychological sequelae of ABI was not covered by statutory health insurance (90 % of the German population have statutory health insurance as opposed to private health insurance).

Additional information

Funding

The study was supported by PhD scholarships from the Psychotherapieambulanz Marburg PAM e.V. (PAM e.V.) to B. K. Doering, N. Conrad, A. Künemund and S. Zwick.