Cognitive behavioral therapy for managing depressive and anxiety symptoms after brain injury: a meta-analysis

Background: Individuals with traumatic brain injury (TBI) are at increased risk of depression and anxiety, leading to impaired recovery. While cognitive-behavioral therapy (CBT) addresses anxiety and depression maintenance factors, its efficacy among those with TBI has not been clearly demonstrated. This review aims to bridge this gap in the literature. Methods: Several databases, including Medline, PsycInfo and EMBASE, were used to identify studies published between 1990 and 2021. Studies were included if: (1) trials were randomized controlled trials (RCT) involving CBT-based intervention targeting anxiety and/or depression; (2) participants experienced brain injury at least 3-months previous; (3) participants were >= 18 years old. An SMD +/- SE, 95% CI and heterogeneity were calculated for each outcome. Results: Thirteen RCTs were included in this meta-analysis. The pooled-sample analyses suggest that CBT interventions had small immediate post-treatment effects on reducing depression (SMD +/- SE: 0.391 +/- 0.126, p < 0.005) and anxiety (SMD +/- SE: 0.247 +/- 0.081, p < 0.005). Effects were sustained at a 3-months follow-up for depression. A larger effect for CBT was seen when compared with supportive therapy than control. Another sub-analysis found that individualized CBT resulted in a slightly higher effect compared to group-based CBT. Conclusion: This meta-analysis provides substantial evidence for CBT in managing anxiety and depression post-TBI.