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Cognitive Behavior Therapy After Acquired Brain Injury: Maintenance of Therapeutic Benefits at 6 Months Posttreatment

Arundine, April MSc; Bradbury, Cheryl L. PsyD; Dupuis, Kate MA; Dawson, Deirdre R. PhD; Ruttan, Lesley A. PhD; Green, Robin E. A. PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

Journal of Head Trauma Rehabilitation: March/April 2012 - Volume 27 - Issue 2 - p 104–112
doi: 10.1097/HTR.0b013e3182125591
Focus on Clinical Research and Practice, Part 1

Objectives: To examine whether 6-month posttreatment acquired brain injury (ABI) patients receiving cognitive behavior therapy (CBT) adapted for ABI would demonstrate (1) maintenance of psychological benefits, (2) better community integration, and (3) commensurate benefits for both teletherapy and face-to-face group therapy. A secondary objective was to examine the relationship between coping strategies and mood and community integration.

Participants: Seventeen chronic ABI patients with elevated psychological distress.

Outcome Measures: Symptom Checklist-90-Revised (SCL-90-R), Depression Anxiety Stress Scales-21 (DASS-21), Community Integration Questionnaire, and the Ways of Coping questionnaire, revised.

Procedures: Eleven CBT sessions provided either in a face-to-face group format or individually by telephone with outcomes measured pretreatment, posttreatment, and at 6-month follow-up.

Results: At 6-month follow-up, full-group scores were significantly better than pretreatment for psychological distress (t16 = 6.22, P < .01, SCL-90-R; t16 = 7.32, P < .01, DASS-21) and for community integration (t16 = −6.15, P < .01), with negligible decrements from immediately posttreatment. Subgroup scores were comparable. Coping also improved but was uncorrelated with mood or community integration.

Conclusion: The CBT adapted for ABI shows enduring benefits for mood and community integration. The efficacy of teletherapy obviates service access problems related to geographical remoteness and mobility restrictions. A larger, randomized, control trial that examines underlying mechanisms of efficacy is needed.

Peel Halton Dufferin Acquired Brain Injury Services, Mississauga, Canada (Ms Arundine); Toronto Rehabilitation Institute, Toronto, Canada (Mss Arundine and Dupuis and Drs Bradbury, Ruttan, and Green); Kunin-Lunenfeld Applied Research Unit, Baycrest, Toronto, Canada (Dr Dawson); and Department of Psychiatry, University of Toronto, Toronto, Canada (Drs Bradbury and Green).

Corresponding Author: April Arundine, MSc, Peel Halton Dufferin Acquired Brain Injury Services, 176 Robert Speck, Mississauga, ON, Canada, L4Z 3G1 (

The authors thank all of the participants and the administrative and clinical staff from the Peel Halton Dufferin Acquired Brain Injury Services. This research program was made possible by a grant from the Ontario Neurotrauma Foundation to R. G., C. B., L. R., and their coinvestigators.

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.