Monash University

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

posted on 2017-01-16, 23:23 authored by Hsieh, Ming-Yun
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.


Principal supervisor

Jennie Ponsford

Year of Award


Department, School or Centre

Psychology and Psychiatry

Campus location



Doctor of Philosophy

Degree Type



Faculty of Medicine Nursing and Health Sciences