A randomized controlled trial of cognitive behavioural therapy for managing anxiety in adolescents with acquired brain injury.

The aim of this randomized controlled trial was to evaluate an adapted cognitive behavioural therapy (CBT) programme for treating anxiety in adolescents with acquired brain injury (ABI). Participants with ABI (12-19 years, N = 36) recruited from two sites were randomly allocated into either the intervention receiving 11 sessions of CBT (n = 19) or a wait-list control group (n = 17). The primary outcome was participants' anxiety and secondary outcomes were participants' depression, self-perception, and participation in daily activities, and parental stress, measured at (i) pre-intervention, (ii) immediately post-intervention, (iii) 2 months post-intervention and (iv) 6 months post-intervention. Repeated measures ANOVAs revealed significant treatment effects with the intervention group demonstrating greater improvements in self-reported anxiety, as well as self- and parent-reported depression from pre- to immediately post-treatment, compared to wait-list controls. Little evidence of treatment effects was found for the remaining outcomes (parent-reported anxiety, self-perception, daily participation, and parental stress). Significant improvement in self-reported anxiety found immediately post-treatment was maintained at two- and six-month follow-up. Findings provide support for adapted CBT as an effective means of reducing anxious and depressive symptomatology in adolescents with ABI compared to waitlist controls, and offer support for the use of these techniques to manage anxiety in this population..

Participation after acquired brain injury: clinical and psychometric considerations of the Sydney Psychosocial Reintegration Scale (SPRS).

OBJECTIVE: To examine the psychometric qualities and develop the clinical utility of the Sydney Psychosocial Reintegration Scale (SPRS) as a measure of participation in people with traumatic brain injury. DESIGN: Data generated from previous prospective studies. SUBJECTS/PATIENTS: Convenience samples of healthy community-based volunteers (n=105) and people with severe brain injury (n=510). METHODS: (i) The equivalence of a new 5-point version of the SPRS was determined vs the original 7-point version; (ii) construct validity was tested using Rasch analyses; (iii) normative and comparative data tables were produced, and data examined for floor/ceiling effects; (iv) a reliable change index score was generated. RESULTS: Patterns of psychometric properties for the 5- and 7-point versions were almost identical (e.g. total scores rs=0.98). Rasch analyses on Forms A and B found good fit to the model, for person (3.36 and 3.03, respectively) and item (7.78 and 7.25, respectively) separation; reliability coefficients were high (all ≥ 0.90). Mean infit statistics met standard criteria (between 0.7 and 1.3). No floor/ceiling effects were detected. The reliable change index value was calculated for the total score for Form A using logit scores, and a conversion table provided. CONCLUSION: The 5-point version of the SPRS demonstrates strong psychometric qualities as a measure of participation after traumatic brain injury.