The Efficacy of a Scheduled Telephone Intervention for Ameliorating Depressive Symptoms During the First Year After Traumatic Brain Injury
Departments of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, USA. The Journal of head trauma rehabilitation
(Impact Factor: 2.92).
07/2009; 24(4):230-8. DOI: 10.1097/HTR.0b013e3181ad65f0
To determine whether an intervention designed to improve functioning after traumatic brain injury (TBI) also ameliorates depressive symptoms.
Single-blinded, randomized controlled trial comparing a scheduled telephone intervention to usual care.
One hundred seventy-one persons with TBI discharged from an inpatient rehabilitation unit.
The treatment group received up to 7 scheduled telephone sessions over 9 months designed to elicit current concerns, provide information, and facilitate problem solving in domains relevant to TBI recovery.
Brief Symptom Inventory-Depression (BSI-D) subscale, Neurobehavioral Functioning Inventory-Depression subscale, and Mental Health Index-5 from the Short-Form-36 Health Survey.
Baseline BSI-D subscale and outcome data were available on 126 (74%) participants. Randomization was effective except for greater severity of depressive symptoms in the usual care (control) group at baseline. Outcome analyses were adjusted for these differences. Overall, control participants developed greater depressive symptom severity from baseline to 1 year than did the treatment group. The treated group reported significantly lower depression symptom severity on all outcome measures. For those more depressed at baseline, the treated group demonstrated greater improvement in symptoms than did the controls.
Telephone-based interventions using problem-solving and behavioral activation approaches may be effective in ameliorating depressive symptoms following TBI. Proactive telephone calls, motivational interviewing, and including significant others in the intervention may have contributed to its effectiveness.
Available from: Hamish J Mcleod
- "This suggests they may be similar constructs but currently being viewed from different psychological perspectives. It is well established that people with a TBI often suffer from cognitive inflexibility as a result of damage to their executive processes but research also indicates that they respond positively to different forms of psychological therapy (Bombardier et al., 2009;Hodgson, McDonald, Tate, & Gertler, 2005;Hsieh et al., 2012;Medd & Tate, 2000;Simpson et al., 2011). If increases in psychological flexibility are central to improvements in such therapy outcomes, this suggests that cognitive flexibility, as measured by task-based neuropsychological tests, may not be a prerequisite for psychological flexibility. "
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ABSTRACT: This paper provides a selective review of cognitive and psychological flexibility in the context of treatment for psychological distress after traumatic brain injury, with a focus on acceptance-based therapies. Cognitive flexibility is a component of executive function that is referred to mostly in the context of neuropsychological research and practice. Psychological flexibility, from a clinical psychology perspective, is linked to health and well-being and is an identified treatment outcome for therapies such as acceptance and commitment therapy (ACT). There are a number of overlaps between the constructs. They both manifest in the ability to change behaviour (either a thought or an action) in response to environmental change, with similarities in neural substrate and mental processes. Impairments in both show a strong association with psychopathology. People with a traumatic brain injury (TBI) often suffer impairments in their cognitive flexibility as a result of damage to areas controlling executive processes but have a positive response to therapies that promote psychological flexibility. Overall, psychological flexibility appears a more overarching construct and cognitive flexibility may be a subcomponent of it but not necessarily a pre-requisite. Further research into therapies which claim to improve psychological flexibility, such as ACT, needs to be undertaken in TBI populations in order to clarify its utility in this group.
Available from: Denise Bellingham-Young
- "All but one of the studies (Powell,Heslin and Greenwood, 2002) indicates that non drug treatments are effective in the treatment of depression following brain injury. Effect size meta-analysis plot[fixed effects] -3 -2 -1 1 Tiersky, et al. 2005Pow ell, et al. 2002Ouellet, et al. 2009Ouellet, et al. 2009Medd and Tate, 2000Guetin, et al. 2009Geurtsen, et al. 2008Finset and Andersson, 2000Bradbury, et al. 2008Bradbury, et al. 2008Bombardier, et al. 2009Arundine, 2009Statistical test for heterogeneity is significant (I 2 = 47.6%, Q = 20.99, "
- "In one study, telephonically delivered CBT has been demonstrated to significantly decrease depressive symptoms and increase walking frequency in patients who have diabetes and depression, although failing to result in better glucose control (Piette et al., 2011). Despite recent interest in research using telephone-based and mobile-deviceYbased counseling methods for obesity in treatment in individuals with binge eating disorder and first-episode psychosis (Castelnuovo et al., 2011; Killackey et al., 2011), telephonic interventions in the mental health field have been largely limited to the treatment of substance use disorders and depression (Bombardier et al., 2009; McKay et al., 2004). Consequently , there remains a paucity of data on telephone-based interventions for weight reduction in persons with SMI. "
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ABSTRACT: Obesity and metabolic disturbances frequently occur in individuals with psychiatric disorders. This study evaluates a telephonically delivered lifestyle coaching intervention aimed at weight reduction and wellness improvement in psychiatric outpatients. A cohort of 761 participants was prospectively followed up for a period of 12 months. Lifestyle coaching was administered telephonically on a weekly basis for the first 3 months and monthly thereafter. During the study period, there was a significant reduction in weight and waist circumference as well as a significant increase in general health in the completer group. A total of 46% of the participants lost 5% or more of their baseline weight. Significant predictors of attrition at baseline were the presence of metabolic syndrome, younger age, chronic illness, and the diagnosis of a mood disorder. Dropout was significantly less in those participants who received support from a nominated caregiver. Telephonic lifestyle coaching is feasible in this population.
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