Effects of cognitive behavioral therapy for adults with post-concussion syndrome: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE

Although the mechanism of post-concussion syndrome remains unclear, psychological factors are thought to be associated with its development. Cognitive behavioral therapy is the gold standard for psychological disorders; however, its effects on post-concussion syndrome remain unclear. Through this meta-analysis, we assessed the effects of cognitive behavioral therapy on post-concussion syndrome following traumatic brain injury.

METHODS

Six electronic databases were searched from inception to September 15, 2019, for randomized controlled trials evaluating the effects of cognitive behavioral therapy for adults with post-concussion syndrome. Primary outcomes included the severity of symptoms of post-concussion syndrome, depression, anxiety, and social integration. Secondary outcomes were fatigue, cognitive function, and quality of life. Effects were estimated through the calculation of Hedge's g and 95% confidence interval using a random effects model. Sensitivity analyses were conducted by excluding studies in which an intention-to-treat analysis was not employed.

RESULTS

In total, 24 studies were included. Most studies had risk of bias. Significant effects were found for most outcomes, except for severity of symptoms of post-concussion syndrome, fatigue, executive function, and problem solving. After sensitivity analyses, the effects of cognitive behavioral therapy remained significant for immediate and mid-term effects on depression, anxiety, and social integration.

CONCLUSIONS

This study does not support the effectiveness of cognitive behavioral therapy for severity of symptoms of post-concussion syndrome; however, it might be an effective treatment option for improving depression, anxiety, and social integration in individuals with traumatic brain injury.