Anxiety and adjustment following SCI: a transdiagnostic psychological intervention combining Cognitive Behavioural Therapy (CBT) and Coping Effectiveness Training (CET).

Abstract

Introduction: Spinal cord injury (SCI) is a life-changing experience which can result in a substantial range of psychological challenges. Although anxiety is elevated following SCI, evidence suggests that it is underreported and underdiagnosed, with consequences for long-term physical and mental health. In the UK, Cognitive Behavioural Therapy (CBT) is recommended as the first-line intervention for anxiety. However, people with SCI often face additional and complex challenges, which can limit the efficacy of protocol-delivered CBT. Pre-injury vulnerabilities can compound psychological challenges by influencing primary and secondary appraisals and perceived manageability of injury, resulting in poorer mental health and rehabilitation outcomes.

Case presentation: A transdiagnostic treatment intervention using a SCI-specific adjustment model alongside CBT and Coping Effectiveness Training (CET) of an adult with post-injury anxiety and adjustment difficulties (as measured by the GAD-7 and the ADAPSS), and history of depression (as measured by the PHQ-9). Individual psychological treatment for anxiety maintenance cycles, low mood and reduction of threat appraisals are reported, alongside multidisciplinary collaboration to enhance engagement. Outcomes included improved symptoms of anxiety, reduction of loss appraisals and development of resilience appraisals.

Discussion: Case studies of psychological treatment are sparse within the SCI literature. This case provides a detailed application of one of the most recognised psychological treatment modalities - CBT - and its integration with CET within an adjustment model for SCI. This study also highlights the importance of providing psychological support, psychoeducation and self-management strategies for all individuals with SCI, that is not dependent upon the degree of psychological morbidity.