Effectiveness of Psychotherapy for Post-Traumatic Stress Disorder in Subjects Suffering from Traumatic Brain Injuries After Motor Vehicle Accidents

Background and Objectives: PTSD and traumatic brain injury (TBI) frequently co-occur in survivors of combat exposure, blasts, assaults, or motor vehicle accidents (MVAs), yet the impact of TBI on the psychotherapy outcomes for PTSD, especially in civilians, remains underexplored and frequently underestimated. Methods: This study focused on analysis of the effectiveness of psychotherapies (trauma-focused: prolonged exposure (PE); non-trauma-focused: self-efficacy-focused cognitive therapy (SEF-CT)) in individuals with PTSD, comparing those with and without TBIs. The data of 45 PTSD patients with TBIs were drawn from a clinical trial cohort, with a total of 134 completing treatment. PTSD symptoms were assessed pre- and post-treatment using CAPS-5 and PDS-5. Cognitive functioning was measured via tests of fluid and crystallized intelligence. ANCOVA models examined the level of post-treatment PTSD symptoms with the control of pretreatment symptoms and the effects of TBI, treatment type, gender, age, education, time since the MVA, and level of cognitive functioning. Results: Both psychotherapies were equally effective in reducing PTSD symptoms, regardless of TBI status. The early initiation of treatment predicted better outcomes in non-TBI patients but not in those with TBIs. The TBI participants who began treatment earlier exhibited lower fluid intelligence scores, suggesting mild cognitive impairments that may have moderated the therapy benefits. Conclusions: Patients with PTSD and TBIs can benefit from both trauma-focused and non-trauma-focused CBT. While earlier intervention is beneficial for patients with PTSD alone, cognitive impairments may reduce this advantage in those with TBIs.