Intensive exposure therapy for individuals with persistent concussion symptoms following concussion: a replicated single-case experimental design (SCED) study

Abstract

Introduction: Persistent concussion symptoms (PCS) after mild traumatic brain injury (mTBI) interfere with daily functioning. The study aimed to replicate findings of our previous work showing the efficacy of an intensive exposure therapy for PCS. Method: A replication was conducted with four participants (age M = 25.5, time-since-injury M = 13.25), using a multiple-baseline multi-phase (A-B-C-D-E) single-case experimental design. A randomly assigned baseline (A) preceded the 4-week exposure intervention (B–exploration, C–active exposure, D–booster) conducted by psychologists, with a 4-week follow-up (E). The primary measures, including active avoidance, believability, satisfaction, and symptom experience, were assessed daily on visual analogue scales. Secondary measures of symptom severity, catastrophizing, activity avoidance, anxiety, depression, societal participation and therapeutic alliance were measured across four time points. Results: Significant effects were shown in visual and Tau-U analysis for all participants on all primary measures comparing baseline and intervention phases. For all primary measures, the pooled standardized mean difference (PSMD) was high. Clear improvements were seen on all secondary measures except anxiety. Conclusions: The findings of this study further confirmed the efficacy for this intensive exposure therapy for PCS, adding further evidence for exposure therapy in this patient population. Replication in other samples is needed.