Cognitive Behavioural Interventions
Acceptance and commitment therapy (ACT) is a mindfulness-based intervention to help improve symptoms of depression and anxiety. It includes CBT based processes such as mindfulness and acceptance that result in behaviour change and psychological flexibility (Hayes et al. 2012).
Discussion
Several studies examined the effect of in person group CBT related programs compared to standard care on improvement of anxiety symptoms for persons with SCI (Craig et al. 1997; Kennedy et al. 2003; King & Kennedy 1999; Li et al. 2019). Three of these studies found significant improvement in anxiety symptoms among those in the CBT group compared to the standard care group (Kennedy et al. 2003; King & Kennedy 1999; Li et al. 2019). Coker et al. (2019) found no significant effect of group-based CBT on anxiety symptoms. Craig et al. (1997) found no improvement in anxiety symptoms among the participants overall. However, a subgroup of participants with high levels of anxiety experienced significant improvement in their anxiety symptoms (Craig et al. 1998b).
One study examined the effect of telerehabilitation based CBT for managing anxiety symptoms. Dorstyn et al. (2012), in an RCT, reported small effects of telecounselling in improving anxiety symptoms compared to standard care. Migliorini et al. (2011) reported improvement in anxiety scores after an online CBT program for persons with SCI. Burke and colleagues (2019) found no significant difference in anxiety symptoms in the intervention group compared to the control group post intervention. However, significant decrease in anxiety symptoms were seen in the treatment group at 3 month follow-up.
Four studies examined the effect of CBT program among persons with SCI and chronic pain (Blake et al. 2018; Heutink et al. 2014; Heutink et al. 2012; Norrbrink Budh et al. 2006; Perry et al. 2010). Blake et al. (2018) provided a guided 8 week online CBT program and found significant improvement in anxiety symptoms post intervention. In an RCT, Heutnick et al. (2012) found significant improvement in anxiety symptoms in the intervention group compared to the wait list control group; these results were maintained at 1 year follow up (Heutink et al. 2014). Perry et al. (2010) also found a multidisciplinary CBT program resulted in improvements in anxiety over time. However, Norrbrink Budh et al. (2006) found no significant reduction in anxiety symptoms among those in the CBT group compared to the no treatment group.
Duchnick et al. (2009) evaluated the effectiveness of a CBT training intervention compared to a supportive group program. The study reported significant decrease in anxiety scores among both groups and no group effect.
Dorstyn et al. (2011) compared CBT combined with low dose amitriptyline to a standard care group and found those in the combined CBT and amitriptyline group had a significantly greater reduction in anxiety symptoms compared to the standard care group. However, this was not maintained at follow-up.
Two cluster randomized trials evaluated the efficacy of a coping oriented supportive programme (COSP) on anxiety in an inpatient SCI rehabilitation unit. Li et al. (2020) found significant improvement in symptoms of anxiety post-treatment as well as at 4-week and 12- week follow-up compared to brief education on personal care, while Li et al. (2019) found no difference in anxiety outcomes between COSP and traditional rehabilitation.
Conclusion
There is level 2 evidence (Craig et al. 1997; Craig et al. 1998a; Craig et al. 1999; Craig et al. 1998b; Kennedy et al. 2003; King & Kennedy 1999) that in person CBT may improve anxiety symptoms compared to standard treatment among those with elevated symptoms.
There is level 1b evidence (Dear et al. 2018; Dorstyn et al. 2011) Miglorini et al. 2016), that telerehabilitation based CBT improves symptoms of anxiety among persons with SCI.
There is level 1 evidence (Duchnick et al. 2009; Feng & Li 2017) that CBT is effective in improving anxiety symptoms post intervention.
There is conflicting level 2 evidence (Li et al. 2019; 2020) for the effectiveness of coping oriented supportive programme on improving symptoms of anxiety post SCI.
There is level 4 evidence (Han et al. 2022) that guided videoconferencing ACT may reduce symptoms of anxiety post SCI.
