Cognitive behaviour therapy and motivational interviewing for anxiety disorders following moderate-severe traumatic brain injury

Background: This doctoral thesis aimed to develop and evaluate in a randomised controlled trial (RCT), a cognitive behaviour therapy (CBT)-based anxiety treatment program adapted for a community sample with moderate-severe TBI. It also aimed to evaluate the application of Motivational Interviewing (MI) as a preparatory intervention, focusing on facilitating engagement in and response to CBT. Method: Treatment manuals were developed to guide the delivery of CBT and MI for anxiety management and the materials were adapted to tailor to the characteristics of individuals with moderate-severe TBI. The MI and CBT programmes were delivered to individual participants to assess the feasibility of the treatment protocol. The pilot RCT involved 27 participants with moderate-severe TBI, who were randomly assigned to one of three treatment conditions, (1) three sessions of MI followed by CBT (MI+CBT), (2) non-directive counselling (NDC)+CBT and (3) treatment-as-usual (control). Assessment included a structured clinical interview to determine psychiatric diagnoses; self-report measures of anxiety, mood, psychosocial functioning and coping style; and measures of cognitive functioning. Results: Single case studies provided preliminary support for the feasibility of the MI and CBT programmes in individual clients with moderate-severe TBI. The results of the pilot RCT showed that the two active treatment groups (MI+CBT and NDC+CBT) demonstrated significantly greater reduction in anxiety compared to the control group. In addition, participants receiving the MI pre-treatment showed greater reduction in anxiety and stress from pre- to post-CBT, compared to participants who received NDC. Exploration of the variables associated with positive response to the CBT programme, revealed a trend indicating that injury severity may be associated with response to CBT. Conclusion: The results have provided preliminary support for the effectiveness of the CBT programme adapted for individuals with moderate-severe TBI, and the potential utility of MI as a prelude to CBT. A number of limitations were noted as caveat for the interpretation of the results, and areas for further research were discussed.