A randomized controlled trial of cognitive behavioural therapy for managing anxiety in adolescents with acquired brain injury

ABSTRACT

The aim of this randomized controlled trial was to evaluate an adapted cognitive behavioural therapy (CBT) programme for treating anxiety in adolescents with acquired brain injury (ABI). Participants with ABI (12–19 years, N = 36) recruited from two sites were randomly allocated into either the intervention receiving 11 sessions of CBT (n = 19) or a wait-list control group (n = 17). The primary outcome was participants’ anxiety and secondary outcomes were participants’ depression, self-perception, and participation in daily activities, and parental stress, measured at (i) pre-intervention, (ii) immediately post-intervention, (iii) 2 months post-intervention and (iv) 6 months post-intervention. Repeated measures ANOVAs revealed significant treatment effects with the intervention group demonstrating greater improvements in self-reported anxiety, as well as self- and parent-reported depression from pre- to immediately post-treatment, compared to wait-list controls. Little evidence of treatment effects was found for the remaining outcomes (parent-reported anxiety, self-perception, daily participation, and parental stress). Significant improvement in self-reported anxiety found immediately post-treatment was maintained at two- and six-month follow-up. Findings provide support for adapted CBT as an effective means of reducing anxious and depressive symptomatology in adolescents with ABI compared to waitlist controls, and offer support for the use of these techniques to manage anxiety in this population.

KEYWORDS:

• Anxiety
• Cognitive behavioural therapy
• Acquired brain injury
• Adolescents
• Randomized controlled trial

Acknowledgements

We would like to thank the research team who assisted in various stages of the trial including project co-ordination, delivery of the intervention, data collection, and data entry: Irene Dinatale, Melissa Lai, Karen Hancock, Vivienne Champness, Coralie Bastin, Phoebe Kho, Laura Punaro, Tamera Clancy, Grace Gordon, Georgina Avery, and Brooke Ledner. Thanks are also due to Mary-Clare Waugh and Katherine Lee for their assistance in the initial planning stages of the project, Rowena Conroy who was involved in adapting the intervention programme for ABI and Natasha Dean who helped recruit participants at the Royal Children's Hospital. We thank all the families who participated in this study.

Disclosure statement

Prof Ron Rapee is an author of the Cool Kids anxiety program which is available for purchase but he receives no personal royalties. The other authors declare no financial interest or benefit arising from the direct applications of this research.

Funding statement

This work was supported by the National Health and Medical Research Council (grant number 008690) and an early career research fellowship awarded to Dr Soo from the Victorian Neurotrauma Initiative and the Victorian government Operational Infrastructure Scheme.