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Cognitive Behavioural Therapy

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In the SCI population, the application of CBT approaches to aid in the management of anxiety and depression is described as a prudent choice given its demonstrated effectiveness in a wide range of disorders (Craig et al. 1997). CBT strategies can include addressing “irrational” or negative thoughts, increasing opportunities for participating in rewarding activities, and instruction in relaxation, among others. Within this context, issues of assertiveness, social skills and discussions of sexuality have also at times been included to address the unique concerns of individuals with SCI. Employing a group setting to provide CBT can also be a cost-effective opportunity for peer support, practice of social skills and the opportunity for gaining additional viewpoints. Several authors have described the effects of group CBT interventions for individuals following SCI to reduce psychological distress and/or provide “immunization” against future difficulties.

Table 2 Cognitive Behavioural Therapy Group Interventions

Discussion

Several studies examined the effect of group CBT targeting mood among persons with SCI. Three studies found it was effective at reducing depressive symptoms post intervention compared to control groups (Kennedy et al. 2003, King & Kennedy 1999, Li et al. 2019); while three studies found no significant difference in mood (Craig et al. 1997, Craig et al. 1998a) (Coker et al.,2019;;. Craig et al.,(1997, 1998a, 1998b) (; 1999) found only a subgroup of participants with Beck Depression Inventory scores greater than 14 experienced a significant reduction in depressive symptoms. Among this subgroup, decreased scores were maintained at 1 and 2 year follow-ups (Craig et al. 1998a).

Several studies found significant improvement in depressive symptoms among individuals receiving CBT post intervention (Dorstyn et al. 2011, Duchnick et al. 2009, Feng & Li 2017, Norrbrink Budh et al. 2006, Perry et al. 2010). Duchinick et al.,(2009) and Dorstyn et al.,(2011) found that the effect was not maintained at 3 month follow-up; Perry (2010) found the effect was not maintained at 8 month follow-up.

Four studies examined the effect of CBT targeting pain intervention on mood compared at usual care control group (Blake et al. 2018, Heutink et al. 2014, Heutink et al. 2012, Norrbrink Budh et al. 2006, Perry et al. 2010). Only one study which provided online CBT found significant improvement in depressive symptoms between the intervention and control group (Dear et al. 2018).

One study examined the effect of telecounselling CBT programs on mood and adjustment amongst persons with SCI (Dorstyn et al. 2012). Dorstyn et al.,(2012) reported symptoms were maintained over the follow-up period. Four studies examined the role of online CBT targeting mood resulting in significant reduction in depressive symptoms post intervention (Migliorini et al. 2016, Migliorini et al. 2011). Burke and colleagues (2019) found no significant difference in depressive symptoms in the intervention group compared to the control group post intervention; however, significant decrease in depressive symptoms were seen in the treatment group at 3 month follow-up. Verwer et al.,(2016) found no significant difference in depressive symptoms through a self-directed online CBT program.

Schulz et al.,(2009) conducted a CBT trial targeting both persons with SCI and their caregivers. The study found that the dual targeted group both the persons with SCI and caregivers had the greatest reduction in depressive symptoms compared to the group targeting only persons with SCI and information only control group.

Conclusion

There is level 2 evidence (Craig et al. 1997, Craig et al. 1998a, Craig et al. 1999, Craig et al. 1998b, Kennedy & Rogers 2000, King & Kennedy 1999) to support the use group CBT intervention targeting mood to decrease depressive symptoms following SCI among those with elevated depressive symptoms.

There is level 1 evidence (Duchnick et al. 2009, Feng & Li 2017) that CBT is effective in improving depressive symptoms post intervention.

There is conflicting evidence that CBT intervention results in maintained affective improvement at follow up.

There is level 1b evidence (Schulz et al. 2009) that providing CBT to caregivers and care receivers results in improved depressive symptoms in care receivers.

There is level 1 evidence (Dear et al. 2018, Dorstyn et al. 2011, Migliorini et al. 2011) that telerehabilitation or online based CBT improves symptoms of depression post SCI.

  • Individual based CBT is effective in reducing symptoms of depression post SCI; however the results may not be maintained at follow-up.

    Cognitive behavioural interventions provided in a group setting appear helpful in reducing post-SCI depression among those with elevated symptoms of depression.

    CBT interventions aimed at both caregivers and care receivers may be effective in reducing symptoms of depression post SCI.

    Telerehabilitation or online CBT improves symptoms of depression post SCI.