Adapting Cognitive Behavioral Therapy for Depression After Traumatic Brain Injury: A Case Study

Abstract

This case study describes a cognitive-behavioral treatment for depression adapted for individuals with traumatic brain injury (CBT-TBI) and provides a case description of a patient who experienced meaningful symptom reduction. CBT-TBI includes several adaptations to traditional CBT for depression structure, content and process aimed at meeting the unique needs of individuals with TBI sequelae. The patient, a single, White, college-educated, cisgender female in her late 30s who sustained a complicated mild TBI and endorsed symptoms of depression, anxiety, and persistent post-concussive symptoms, completed 12 individual, in-person sessions of CBT-TBI in the context of a randomized, waitlist-controlled trial. Clinician and self-rated measures, as well as neuropsychological assessments, were completed at baseline and posttreatment, and depressive symptoms were assessed weekly by self-report (Beck Depression Inventory-II). Symptom improvement was analyzed using the Reliable Change Index (RCI) and demonstrated a clinically significant reduction in depression and anxiety symptoms, as well as improvement in coping abilities and adaptive thinking. In addition to the adapted content of the intervention, this case example highlights the importance of therapist flexibility, continual assessment, collaboration, and elicitation of feedback in the delivery of CBT for depression for individuals with TBI.