problem-solving training for concussion

Conditions: Brain Concussion

Summary: mild traumatic brain injury (mtbi), also known as concussion, is a common injury sustained by veterans. while most individuals who sustain mtbi experience a complete recovery within several weeks of injury, many veterans with history of mtbi report frequent and long-lasting neurobehavioral complaints and functional impairment. though research suggests that these outcomes are strongly influenced by co-occurring conditions such as post-traumatic stress disorder, depression, and chronic pain, evidence-based interventions capable of addressing this wide array of concerns are lacking. this study seeks to address this gap by evaluating the effectiveness of a brief and flexible behavioral health treatment (problem-solving training for concussion, or pst-concussion), which was designed to be delivered by generalist providers working in va primary care settings. if pst-concussion is shown to be effective, this skills-focused intervention may help improve veterans' recovery experience following mtbi.

this study will be a longitudinal randomized two-arm parallel group clinical trial. participants will be randomized 1:1 to either pst-concussion or treatment as usual (tau). participants assigned to pst-concussion will receive six, approximately 30-minute telehealth treatment sessions. assessments will include standard self-report and cognitive measures that will be administered at baseline, post-treatment, and three-month follow-up. the primary objective of this study will be to evaluate the effectiveness of pst-concussion in reducing psychological distress compared to tau. secondary and tertiary objectives will be to evaluate whether pst-concussion is associated with appreciable change in subjective neurocognitive functioning, objective neurocognitive functioning, psychosocial functioning, and disability and quality of life. multi-level modeling will be used to evaluate treatment effects at post-treatment and three-month follow-up. a test of non-inferiority will be conducted to evaluate the potential durability of observed treatment effects from post-test to follow-up. a portion of participants assigned to pst-concussion will also be interviewed at post-treatment or follow-up to gain insight into the practical impact of intervention on psychosocial functioning and quality of life.

Eligibility criteria:
inclusion criteria: * english-speaking veteran enrolled in vha care; * history of concussion (mild traumatic brain injury or mtbi); * current psychological distress; * subjective neurocognitive symptoms of \>= 3 months. exclusion criteria: * moderate to severe tbi or other major neurocognitive disorder; * psychotic disorder (e.g., schizophrenia spectrum disorder, delusional disorder, bipolar or depressive disorder with psychotic features); * acute suicidal ideation; * inpatient psychiatric hospitalization within the past 12 months; * other illness/ condition that would preclude or predictably influence ability to engage in study visits, as determined by the study team.

Keywords: mild traumatic brain injury concussion, mild veterans neurobehavioral manifestations psychological distress