One in three people who experienced moderate to severe traumatic brain injury (TBI) will be diagnosed with two or more psychiatric disorders within a year of injury. Nearly three-quarters of those will involve coexisting anxiety and depression, both of which are associated with impaired functional and social abilities. The effects of depression and anxiety can overlap with and increase common TBI symptoms, such as difficulty planning; participating in activities; and regulating thoughts, emotions, and behaviors.
Some of the more successful treatments of depression and anxiety not related to TBI focus on promoting higher levels of meaningful activity via positive reinforcement. However, these treatments have not been studied in any TBI populations and intensive programs such as these are often inaccessible due to financial and geographical barriers. This barrier in care indicates a need for mental health treatment for individuals with TBI that is both brief and can be delivered remotely.
To increase accessibility to these therapies, a research team conducted a study to assess the effectiveness of a single face-to-face therapy session followed by daily text messages. The daily text messages were sent over eight weeks to 59 participants who were randomly placed in one of two categories: text messages that were specific statements created from patient-identified goals to increase participation in rewarding and meaningful activities; or text messages focused on mood identification and regulation chosen from pre-determined list of options.
Both groups showed modest improvements in mood. Those with individualized messages had greater environmental participation, while the mood-focused message group reported more positive thinking and increased motivation. Unexpectedly, about a third of participants in both groups felt more organized and purposeful once they had received their daily text.
The study demonstrates the feasibility of frequent text messages as supportive therapy for people with TBI. While improvements were considered modest, researchers hypothesized that single face-to-face session were sufficient enough to make more significant improvements in mood and functioning. Mental health providers should focus on individual patient needs to find effective treatments, such as daily text messages, that can be sustained over time and integrate treatment into daily lives.
Hart T, Vaccaro M, Collier G, et al. Promoting mental health in a traumatic brain injury using single-session Behavioural Activation and SMS messaging: A randomized controlled trial. Neuropsychological Rehabilitation. (March 2019).