Behavioral Activation With Remote Technology for Emotional Distress Following Moderate-Severe Traumatic Brain Injury: Results of a Randomized Controlled Trial.

Abstract

Objective: Examine effects of 8-week Behavioral Activation (BA)-based treatment on emotional distress in moderate-severe traumatic brain injury (msTBI).

Setting: Single TBI rehabilitation center.

Participants: Sixty community-dwelling persons with msTBI sustained ≥6 months prior, with at least mild depression and/or anxiety but no suicidal ideation/ psychiatric instability.

Design: Randomized controlled trial comparing 2 treatments: the BAT condition delivered in 8 sessions of BA (6 face-to-face, 2 phone) with ecological momentary assessment (EMA) and text reminders for increased activity; the INT condition, shown in a previous trial to be highly credible and mildly efficacious, used 1 face-to-face session plus 8 weeks of text reminders framed as implementation intentions for increased activity.

Main measures: Global Severity Index of Brief Symptom Inventory-18 (BSI-18 GSI; primary outcome); secondary outcome measures of hypothesized BA mechanisms (environmental reward, activation); participation; and quality of life assessed at baseline, post-treatment, 2-month follow-up; Patient Global Impression of Change (PGIC) measured post-treatment.

Results: Primary analysis revealed that BAT participants with higher baseline emotional distress had significantly greater improvement in distress (primary outcome) compared to INT participants at post-treatment; this response was attenuated at follow-up. Across distress levels, both measures of BA mechanism showed superior response to BAT at post-treatment and at follow-up. Other secondary outcomes did not differ significantly by treatment, although there was a trend for BAT participants to show more improved health-related quality of life. BAT participants reported significantly greater degree of meaningful change post-treatment (PGIC).

Conclusions: Findings support a growing body of research suggesting that structured, theoretically based approaches to increasing activity linked to personal values can have substantial beneficial impact for many persons with chronic msTBI and emotional distress. Promising future directions include adapting the BAT treatment to remote delivery to improve its potential reach.