A comparison of cognitive behavioral therapy and acceptance and commitment therapy received by patients with major depressive disorder following traumatic brain injury for emotional status and quality of life of their caregivers: A randomized controlled trial

Introduction: Caregivers of individuals who sustained a traumatic brain injury (TBI) experience psychological problems that are linked to emotional status of their injured relatives. This study intends to compare the effect of cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) received by depressed TBI survivors on their caregivers. Methods: This was a single-blind, parallel-group, randomized controlled trial conducted between September 2018 and June 2019 at a teaching hospital in Iran. Participants were the 20–60-year-old persons who provide care to TBI survivors for 1–4 years. The survivors were randomized to receive either CBT (n = 24) or ACT (n = 24), or to stay on the waiting list (WL, n = 24). The family caregivers completed Depression Anxiety Stress Scale-21 (DASS-21) and 12-Item Short-Form Health Survey (physical, SF12-PCS; mental, SF12-MCS) before, after, and 3 months following the treatments. Results: All caregivers were analyzed (completers = 83.33%). Between-group differences were not significant (Ps > 0.5; small effect sizes) except at follow-up, where the differences on DASS21-Depression (P < 0.05; Glass's Δ = −0.635; 95% confidence interval [CI]: −0.729, 0.296) and SF12-MCS (P < 0.05; Glass's Δ = 0.751; 95% CI: −0.36, 0.807) were significant between caregivers of CBT recipients and WL. Moreover, a medium effect size on SF12-PCS (P > 0.5; Glass's Δ = 0.538; 95% CI: −0.416, 0.731) and SF12-MCS (P > 0.05; Glass's Δ = 0.507; 95% CI: −0.425, 0.772) was observed between caregivers of ACT recipients and WL at follow-up. Conclusion: Treating depression in TBI survivors can affect psychological status of their family caregivers. CBT received by TBI survivors is effective for improving caregivers' depression and mental quality of life.