Can Exposure Therapy Be Effective for Persistent Post-Concussion Symptoms? A Nonconcurrent Multiple Baseline Design Across 4 Cases

Lynn Hecker; Skye King; Sven Stapert; Chantal Geusgens; Marlies den Hollander; Britt Fleischeuer; Caroline van Heugten

doi:10.1097/HTR.0000000000001023

Can Exposure Therapy Be Effective for Persistent Post-Concussion Symptoms? A Nonconcurrent Multiple Baseline Design Across 4 Cases

J Head Trauma Rehabil. 2024 Nov 18. doi: 10.1097/HTR.0000000000001023. Online ahead of print.

Authors

Lynn Hecker¹, Skye King, Sven Stapert, Chantal Geusgens, Marlies den Hollander, Britt Fleischeuer, Caroline van Heugten

Affiliation

¹ Author Affiliations: Department of Clinical and Medical Psychology (Ms Hecker and Drs Stapert and Geusgens), Zuyderland Medical Centre, Sittard-Geleen, the Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (Ms King and Dr van Heugten), Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience (Ms Fleischeuer), Limburg Brain Injury Centre (Ms King and Dr van Heugten), Maastricht University, Maastricht, the Netherlands; and Adelante Zorggroep, Center of Rehabilitation Medicine, Hoensbroek, the Netherlands (Dr den Hollander).

PMID: 39616436
DOI: 10.1097/HTR.0000000000001023

Abstract

Objective: After a concussion, some patients develop persistent post-concussion symptoms, which interferes with functioning in daily life. A biopsychosocial explanation for the development and continuation of persistent post-concussion symptoms is the fear avoidance model (FAM). This study aimed to investigate the effectiveness and feasibility of an individual 14-week exposure therapy for patients with persistent symptoms after concussion.

Participants: Four participants from a medical psychology outpatient clinic participated in the study. Their age ranged between 51 and 68 years old (M = 62.8, SD = 7). The average length of time since the concussion was 10 months.

Design: A single-case experimental design (SCED) with nonconcurrent multiple baselines was used. Participants were randomly assigned to a baseline period (A phase) length between 21 and 42 days. The intervention phase (B phase) consisted of 14 treatment sessions in 14 weeks. The follow-up phase was 12 weeks.

Main measures: Participants answered questions on a visual analogue scale about their satisfaction with functioning in daily life, avoidance behavior, and symptoms experience on a daily basis during baseline and on a weekly basis during intervention and follow-up. Additional outcomes included symptom severity, catastrophizing, quality of life, participation, avoidance behavior, and feasibility interviews.

Results: Tau-U yielded significant effects (P < .05) on all measures when comparing intervention and follow-up with the baseline in 3 out of 4 participants. Satisfaction with daily life increased and avoidance behavior and post-concussion symptoms experienced decreased. Participants and therapists rated the intervention protocol with an average of 8.8 out of 10.

Conclusion: The findings suggest that exposure therapy seems effective and feasible in treating patients with persistent symptoms after concussion in a clinical setting. Larger randomized controlled trials or replication with SCED studies are advised to obtain additional evidence on the effectiveness of exposure for individuals with persistent symptoms after concussion.