An Evidence-Based Review of the Effectiveness of Cognitive Behavioral Therapy for Psychosocial Issues Post Spinal Cord Injury

Rehabil Psychol, 2011 · DOI: 10.1037/a0022743 · Published: February 1, 2011

Simple Explanation

Following a spinal cord injury (SCI), individuals may face emotional difficulties, pain, and reliance on others, affecting their overall well-being. Therefore, addressing psychological issues is important in the rehabilitation process to help individuals cope effectively post-SCI. CBT incorporates techniques such as cognitive restructuring, promoting rewarding activities, relaxation, problem-solving, and coping skills training. Cognitive restructuring aims to alleviate distress by reassessing distorted cognitions contributing to depression and anxiety. This review examines the effectiveness of CBT in improving depressive and anxiety symptoms in individuals with SCI, as well as addressing coping and adjustment issues post-SCI.

Study Duration

Not specified

Participants

Nine studies, sample sizes ranged from 18 to 296

Evidence Level

Level 1 and Level 2

Key Findings

1
CBT is effective in reducing the incidence of major depressive disorder and maintaining the reduction in persons with SCI.
2
CBT was found to produce small effects in reducing anxiety in three studies.
3
CBT intervention may positively affect adjustment for both inpatients and outpatients and in both group and individual interventions.

Research Summary

This review of CBT interventions post SCI found Level 1 and Level 2 evidence supporting the effectiveness of CBT on significantly decreasing depressive symptoms after SCI. Conflicting Level 2 evidence suggests that CBT may be effective in decreasing symptoms of anxiety. There was only Level 2 evidence that CBT positively impacts coping styles and adjustment post-SCI.

Practical Implications

Clinical Practice

CBT can be delivered in various formats like internet, videoconferencing and telephone counseling, making it accessible for persons with SCI who have transportation or access issues.

Research

Future studies should focus on selecting participants with more severe depressive symptoms, ideally meeting strict clinical diagnostic criteria, to increase the likelihood of detecting improvements following CBT.

Treatment Design

CBT sessions should directly address anxiety issues to be more effective at reducing anxiety post-SCI, as interventions geared towards depressive symptoms may not sufficiently address anxiety.

Study Limitations

1
Small sample sizes were a limitation in many studies.
2
Some studies had ineffective inclusion criteria, including patients without depressive symptomatology.
3
Lack of long term follow up with participants.

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