Modifications to cognitive behavioural therapies for depression and anxiety in adults with neurological disorders: A qualitative analysis of intervention protocols.

Cognitive and Behavioural-based Therapies (CBT) can effectively manage symptoms of depression and anxiety. However, adults with neurological disorders (NDs) often face cognitive, physical, and social challenges that make it difficult to engage with traditional forms of these treatments. To address this, CBT protocols have been modified to better suit the needs of this population. This study analysed 41 randomized controlled trials with modified CBT-based protocols for treating symptoms of depression and/or anxiety in adults with a ND. It spanned 10 different NDs : stroke, epilepsy, migraine, Parkinson's disease, acquired brain injury, multiple sclerosis, and dementia. Content analysis identified seven main categories of modification. These were: (i) neurologically tailored information and skills; (ii) facilitation of learning and retention of information; (iii) cognitive compensatory strategies; (iv) tailoring intervention to individual needs; (v) multi-modal aids of delivery; (vi) caregiver involvement or training; (vii) flexibility of session delivery. These categories were broadly grouped into three main principles of modification: (1) content adaptation, (2) delivery enhancement and (3) caregiver involvement. These findings support the clinical implementation of CBT for adults with NDs and may guide best practices for managing common mental health difficulties in this population.