Window to Hope: A Randomized Controlled Trial of a Psychological Intervention for the Treatment of Hopelessness among Veterans with Moderate to Severe Traumatic Brain Injury

Abstract

Objective: To evaluate the efficacy of a psychological intervention to reduce moderate to severe hopelessness among Veterans with moderate to severe traumatic brain injury (TBI). Design: Two-arm parallel group, controlled, randomized crossover trial, with 3-month follow-up for those initially allocated to treatment. Participants were randomly allocated in blocks of 4 on a 1:1 ratio to treatment (n = 15) or waitlist (n = 20) groups. Setting: A Veterans Affairs Medical Center. Participants: Veterans between the ages of 26 and 65 years, with a history of moderate to severe TBI, and moderate to severe hopelessness. Interventions: A 20-hour manualized small group cognitive-behavioral intervention. Main Outcome Measures: Beck Hopelessness Scale (primary), Beck Depression Inventory, and Beck Scale for Suicide Ideation. Results: A significant difference between groups was found for postintervention scores on the Beck Hopelessness Scale (P =.03). Significant decreases were maintained at follow-up. For those initially allocated to the waitlist group who completed the intervention, treatment gains were noted in decreased hopelessness (P =.01) and depression (P =.003). Conclusions: Findings from this trial provide additional support for the efficacy of this method of psychological treatment of hopelessness among individuals with moderate to severe TBI.