Predictors of Anxiety and Depression Symptom Improvement in CBT Adapted for Traumatic Brain Injury: Pre/Post-Injury and Therapy Process Factors

Leah M. Zelencich, Dana Wong, Nikolaos Kazantzis, Dean P. McKenzie, Marina Downing, Jennie L. Ponsford

Research output: Contribution to journalArticleResearchpeer-review

10 Citations (Scopus)


OBJECTIVES: The current study examined the association of demographic/preinjury, injury-related, and cognitive behavior therapy (CBT) process variables, with anxiety and depression symptom change in traumatic brain injury (TBI)-adapted CBT (CBT-ABI). METHODS: The audio recordings of 177 CBT-ABI sessions representing 31 therapist-client dyads were assessed from the independent observer perspective on measures of working alliance, homework engagement, and therapist competency in using homework. RESULTS: Linear regressions showed that older client age, longer post-TBI recovery period, better executive functioning, higher levels of client homework engagement, as well as higher levels of therapist competence in reviewing homework were associated with greater improvement in anxiety and/or depression symptoms. CONCLUSIONS: CBT-ABI is a promising treatment for post-TBI depression and anxiety. The current study highlights how therapists can enhance CBT-ABI effectiveness, specifically: comprehensive facilitation of client homework engagement with emphasis on homework review, and accommodation of executive deficits. The current study also suggests that the role of client age and the length of post-TBI recovery period require further investigation.

Original languageEnglish
Pages (from-to)97-107
Number of pages11
JournalJournal of the International Neuropsychological Society
Issue number1
Publication statusPublished - Jan 2020


  • Head injury
  • Homework
  • Mood disorders
  • Psychotherapeutic processes
  • Therapist competence
  • Treatment outcome
  • Working alliance

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