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Psychological approaches to treatment of postconcussion syndrome: a systematic review
  1. Amal Al Sayegh1,
  2. David Sandford2,
  3. Alan J Carson3
  1. 1Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, UK
  2. 2Lancashire Traumatic Stress Service, Lancashire NHS Foundation Trust, Chorley, UK
  3. 3Department of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
  1. Correspondence to Dr Amal Al Sayegh, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh EH10 5HF, UK; amal.alsayegh{at}nhs.net

Abstract

Background and aim Postconcussion syndrome (PCS) is a term used to describe the complex, and controversial, constellation of physical, cognitive and emotional symptoms associated with mild brain injury. At the current time, there is a lack of clear, evidence-based treatment strategies. In this systematic review, the authors aimed to evaluate the potential efficacy of cognitive behavioural therapy (CBT) and other psychological treatments in postconcussion symptoms.

Methods Four electronic databases were searched up to November 2008 for studies of psychological approaches to treatment or prevention of postconcussion syndrome or symptoms.

Results The search identified 7763 citations, and 42 studies were included. This paper reports the results of 17 randomised controlled trials for psychological interventions which fell into four categories: CBT for PCS or specific PCS symptoms; information, reassurance and education; rehabilitation with a psychotherapeutic element and mindfulness/relaxation. Due to heterogeneity of methodology and outcome measures, a meta-analysis was not possible. The largest limitation to our findings was the lack of high-quality studies.

Conclusion There was evidence that CBT may be effective in the treatment of PCS. Information, education and reassurance alone may not be as beneficial as previously thought. There was limited evidence that multifaceted rehabilitation programmes that include a psychotherapeutic element or mindfulness/relaxation benefit those with persisting symptoms. Further, more rigorous trials of CBT for postconcussion symptoms are required.

  • Postconcussion syndrome
  • brain injury
  • cognitive behavioural therapy
  • psychotherapy
  • psychological treatment
  • head injury
  • psychiatry
  • psychology
  • Received 1 June 2009
  • Revised 23 December 2009
  • Accepted 16 January 2010

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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