A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury

Objective: To test the effectiveness of a neuropsychologic rehabilitation program consisting of psychotherapy and cognitive remediation in the treatment of the affective and neuropsychologic sequelae of mild-spectrum traumatic brain injury (TBI). Design: Single-blind randomized, wait-listed controlled trial, with repeated measures and multiple baselines. Setting: Outpatient clinic in northern New Jersey. Participants: Twenty persons with persisting complaints after mild and moderate TBI (11 in treatment group, 9 controls). Interventions: The experimental group received both 50 minutes of individual cognitive-behavioral psychotherapy and 50 minutes of individual cognitive remediation, 3 times a week for I I weeks. The control group was wait-listed and received treatment after conclusion of follow-up. Main Outcome Measures: Symptom Check List-90R General Symptom Index, plus scales of depression, anxiety, coping, attention, and neuropsychologic functioning. Results: Compared with the control group, the treatment group showed significantly improved emotional functioning, including lessened anxiety and depression. Most significant improvements in emotional distress were noted at I month and 3 months posttreatment. Performance on a measure of divided auditory attention also improved, but no changes were noted in community integration scores. Conclusions: Cognitive behavioral psychotherapy and cognitive remediation appear to diminish psychologic distress and improve cognitive functioning among community-living persons with mild and moderate TBI.