Graded exposure therapy for adults with persistent symptoms after mTBI: A historical comparison study

Mathilde Rioux; Penelope M A Brasher; Gabriel McKeown; Keith Owen Yeates; Ana-Maria Vranceanu; Deborah L Snell; Molly Cairncross; William J Panenka; Grant L Iverson; Chantel T Debert; Mark T Bayley; Cindy Hunt; Matthew J Burke; Noah D Silverberg

doi:10.1080/09602011.2024.2403647

Graded exposure therapy for adults with persistent symptoms after mTBI: A historical comparison study

Neuropsychol Rehabil. 2024 Sep 27:1-17. doi: 10.1080/09602011.2024.2403647. Online ahead of print.

Authors

Mathilde Rioux¹, Penelope M A Brasher², Gabriel McKeown¹, Keith Owen Yeates^{3

4

5}, Ana-Maria Vranceanu^{6

7}, Deborah L Snell^{8

9}, Molly Cairncross^{1

10

11

12}, William J Panenka^{13

14

15}, Grant L Iverson^{7

16

17

18

19

20}, Chantel T Debert^{4

5

21}, Mark T Bayley²², Cindy Hunt^{23

24}, Matthew J Burke^{25

26}, Noah D Silverberg^{1

10

27}

Affiliations

¹ Department of Psychology, University of British Columbia, Vancouver, BC, Canada.
² Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
³ Department of Psychology, University of Calgary, Calgary, AB, Canada.
⁴ Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
⁵ Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
⁶ Center for Health Outcomes and Interdisciplinary, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
⁷ Harvard Medical School, Boston, MA, USA.
⁸ Concussion Clinic, Canterbury District Health Board, Christchurch, New Zealand.
⁹ Department of Orthopedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand.
¹⁰ Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
¹¹ Department of Psychology, Simon Fraser University, Burnaby, BC, Canada.
¹² BC Children's Hospital Research Institute, Vancouver, BC, Canada.
¹³ British Columbia Neuropsychiatry Program, Vancouver, BC, Canada.
¹⁴ BC Mental Health and Substance Use Research Institute, Vancouver, BC, Canada.
¹⁵ Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
¹⁶ Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
¹⁷ Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA.
¹⁸ Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, USA.
¹⁹ Mass General Brigham for Children Sports Concussion Program, Boston, MA, USA.
²⁰ Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA.
²¹ Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, AB, Canada.
²² Hull-Ellis Concussion Research Clinic, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
²³ Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, ON, Canada.
²⁴ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
²⁵ Neuropsychiatry Program, Department of Psychiatry and Division of Neurology, Department of Medicine Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
²⁶ Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.
²⁷ Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, BC, Canada.

PMID: 39330946
DOI: 10.1080/09602011.2024.2403647

Abstract

Fear avoidance behaviour is associated with slow recovery from mild traumatic brain injury (mTBI). This study is a preliminary evaluation of graded exposure therapy (GET), which directly targets fear avoidance behaviour, for reducing post-concussion symptoms (PCS) and disability following mTBI. In a historical comparison design, we compared two groups from independent randomized trials. The GET + UC group (N = 34) received GET (delivered over 16 videoconference sessions) in addition to usual care (UC). The historical comparison group (N = 71) received UC only. PCS severity (Rivermead Post Concussion Symptoms Questionnaire; RPQ) and disability (World Health Organization Disability Assessment Schedule; WHODAS 2.0 12-item) were measured at clinic intake (M = 2.7, SD = 1.1 months after injury) and again at M = 4.9 (SD = 1.1) months after injury. Between-group differences were estimated using linear mixed effects regression, with a sensitivity analysis controlling for injury-to-assessment intervals. The estimated average change on the RPQ was -14.3 in the GET + UC group and -5.3 in the UC group. The estimated average change on the WHODAS was -5.3 in the GET + UC group and -3.2 in the UC group. Between-group differences post-treatment were -5.3 on the RPQ and -1.5 on the WHODAS. Treatment effects were larger in sensitivity analyses. Findings suggest that a randomized controlled trial is warranted.

Keywords: Cognitive–behavioural therapy; Concussion; Exposure therapy; Fear avoidance; mTBI.