Interventions to enhance coping after traumatic brain injury: A systematic review

Background/Aims: The aim of this study was to identify effective psychosocial interventions to enhance coping in people who have experienced a traumatic brain injury, in order to inform clinical practice and articulate future research directions. Methods: Five electronic databases (CINAHL, Medline, EMBASE, PsycINFO, and Cochrane Library) were searched. Titles and abstracts were independently screened by two of the authors and selected for inclusion. The full text of all potentially relevant studies were retrieved and assessed for eligibility, reporting and methodological quality, and risk of bias. Findings: Eight included studies were very heterogeneous in terms of study design, type of intervention, the population studied and instruments used to evaluate coping. All studies were judged to have a moderately high risk of bias. Six studies used cognitive behavioural therapy-based interventions. Two interventions (a peer-mentoring programme and cognitive behavioural therapy combined with motivational interviewing) showed significant treatment effects on maladaptive coping. Two cognitive behavioural therapy-based group programmes improved adaptive coping, but increases were either not sustained over time or no longer significant when compared to an active control. Conclusions: There is insufficient evidence to support practice recommendations strongly. Targeting specific subgroups of people who have experienced traumatic brain injury might allow the development of more effective coping interventions. Further, a more unified concept of coping in traumatic brain injury needs to be articulated allowing larger scale evaluations