Institutional members access full text with Ovid®

Share this article on:

Cognitive-Behavioral Prevention of Postconcussion Syndrome in At-Risk Patients: A Pilot Randomized Controlled Trial

Silverberg, Noah D. PhD; Hallam, Bradley J. PhD; Rose, Alice B.OT.; Underwood, Heather MD; Whitfield, Kevin MA; Thornton, Allen E. PhD; Whittal, Maureen L. PhD

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

The Journal of Head Trauma Rehabilitation: July/August 2013 - Volume 28 - Issue 4 - p 313–322
doi: 10.1097/HTR.0b013e3182915cb5
Interventions for Mild TBI

Objective: To examine the tolerability and estimate the treatment effect of cognitive-behavioral therapy (CBT) delivered soon after mild traumatic brain injury to patients at risk for chronic postconcussion syndrome (PCS).

Setting: Tertiary rehabilitation center.

Participants: Twenty-eight patients with uncomplicated mild traumatic brain injury, determined to be at risk for chronic PCS based on a published algorithm that incorporates subacute postconcussion symptoms and maladaptive illness beliefs (recovery expectations and perceived consequences). They were enrolled within 6 weeks postinjury.

Design: Open-label, parallel-group, randomized controlled trial, with masked outcome assessment 3 months after enrolment. Interventions were (1) treatment as usual (education, reassurance, and symptom management strategies) from an occupational therapist, or (2) treatment as usual plus CBT delivered by a psychologist.

Main Measures: Rivermead Postconcussion Symptoms Questionnaire.

Results: Four participants (2:2) withdrew. Treatment credibility and satisfaction ratings were high in the CBT group. Treatment effect sizes were moderate for postconcussion symptoms (Cohen d = 0.74) and moderate-large for most secondary outcome measures (Cohen d = 0.62-1.61). Fewer participants receiving CBT had a diagnosis of PCS at follow-up (54% vs 91%, P < .05).

Conclusion: Our preliminary data suggest that CBT delivered soon after mild traumatic brain injury is well tolerated and may facilitate recovery in patients who are at risk for chronic PCS. A definitive clinical trial is warranted.

Supplemental Digital Content is Available in the Text.

GF Strong Rehab Centre, Vancouver (Drs Silverberg and Hallam and Ms Rose); Divisions of Physical Medicine & Rehabilitation (Drs Silverberg and Underwood) and Neurology (Drs Silverberg and Hallam), Faculty of Medicine, and Department of Psychiatry (Dr Whittal), University of British Columbia, Vancouver; and Human Neuropsychology Laboratory, Simon Fraser University, Burnaby (Mr Whitfield and Dr Thornton), British Columbia, Canada.

Corresponding Author: Noah D. Silverberg, PhD, GF Strong Rehab Centre, 4255 Laurel St, Vancouver, BC V5Z 2G9, Canada (

A William G. Fraser Rehabilitation Research Award from the BC Rehab Foundation provided operational funds for this study. The principal investigator (N.D.S.) received salary support from the Vancouver Coastal Health Research Institute.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins