Experience of Acceptance and Commitment Therapy for Those with Mild Traumatic Brain Injury (ACTion MTBI): A Qualitative Descriptive Study

Overview

Journal PLoS One

Date 2025 Jan 30

PMID 39883645

Authors

Josh W Faulkner

Jason Chua

Amabelle Voice-Powell

Deborah L Snell

Maree Roche

John Moffat

Suzanne Barker-Collo

Alice Theadom

Affiliations

Soon will be listed here.

Abstract

Psychological interventions may make a valuable contribution to recovery following a mild traumatic brain injury (mTBI) and have been advocated for in treatment consensus guidelines. Acceptance and Commitment Therapy (ACT) is a more recently developed therapeutic option that may offer an effective approach. Consequently, we developed ACTion mTBI, a 5-session ACT-informed intervention protocol. To establish the feasibility of this intervention, we wanted to understand participants' experiences of ACTion mTBI, determine acceptability and identify any refinements needed to inform a full-scale effectiveness trial. We recruited adults (≥16 years of age) diagnosed with mTBI who were engaged in community-based multidisciplinary rehabilitation. After completing the ACTion mTBI sessions, 23/27 (85.2%) participants (mean time post-injury: 28.0 weeks) completed a semi-structured interview about their experience of the intervention. Interviews were audio-recorded, transcribed verbatim and analysed using a qualitative description approach. There were two overarching themes 1) attacking the concussion from a different direction and 2) positive impact on recovery which depicted participants' overall experiences of the intervention. Within these overarching themes, our analysis also identified two subthemes: 1) helpful aspects of the intervention which included education and ACT processes (i.e., being present and being able to step back) and 2) "contextual factors that enabled intervention effectiveness" which included being equipped with tools, cultural and spiritual responsiveness, the therapeutic connection, and the intervention having a structured yet flexible approach to order of delivery to meet individual needs. Participants' experiences support acceptability, cultural and spiritual responsibility of ACTion mTBI. Suggested refinements included enabling access to intervention over time, not just at one point during recovery and the addition of a brief check-in follow-up.

Citing Articles

Acceptance and commitment therapy for mild traumatic brain injury (ACTion-mTBI): a quasiexperimental feasibility study.

Faulkner J, Prouty D, Devlin L, Appleton D, Roche M, Below K BMJ Open. 2025; 15(2):e089727.

PMID: 39956598 PMC: 11831269. DOI: 10.1136/bmjopen-2024-089727.

References

Marshall S, Bayley M, McCullagh S, Velikonja D, Berrigan L, Ouchterlony D . Updated clinical practice guidelines for concussion/mild traumatic brain injury and persistent symptoms. Brain Inj. 2015; 29(6):688-700. DOI: 10.3109/02699052.2015.1004755. View

Broshek D, De Marco A, Freeman J . A review of post-concussion syndrome and psychological factors associated with concussion. Brain Inj. 2014; 29(2):228-37. DOI: 10.3109/02699052.2014.974674. View

Whiting D, Deane F, McLeod H, Ciarrochi J, Simpson G . Can acceptance and commitment therapy facilitate psychological adjustment after a severe traumatic brain injury? A pilot randomized controlled trial. Neuropsychol Rehabil. 2019; 30(7):1348-1371. DOI: 10.1080/09602011.2019.1583582. View

Sandelowski M . Whatever happened to qualitative description?. Res Nurs Health. 2000; 23(4):334-40. DOI: 10.1002/1098-240x(200008)23:4<334::aid-nur9>3.0.co;2-g. View

Roche L . An acceptance and commitment therapy-based intervention for PTSD following traumatic brain injury: a case study. Brain Inj. 2019; 34(2):290-297. DOI: 10.1080/02699052.2019.1683896. View

Sullivan-Bolyai S, Bova C, Harper D . Developing and refining interventions in persons with health disparities: the use of qualitative description. Nurs Outlook. 2005; 53(3):127-33. DOI: 10.1016/j.outlook.2005.03.005. View

Sheldrake E, Al-Hakeem H, Lam B, Goldstein B, Wheeler A, Burke M . Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review. Front Neurol. 2022; 13:850590. PMC: 9035995. DOI: 10.3389/fneur.2022.850590. View

Mah K, Hickling A, Reed N . Perceptions of mild traumatic brain injury in adults: a scoping review. Disabil Rehabil. 2017; 40(8):960-973. DOI: 10.1080/09638288.2016.1277402. View

Faulkner J, Snell D . A Framework for Understanding the Contribution of Psychosocial Factors in Biopsychosocial Explanatory Models of Persistent Postconcussion Symptoms. Phys Ther. 2023; 103(2). DOI: 10.1093/ptj/pzac156. View

10.

Voormolen D, Polinder S, Steinbuechel N, Vos P, Cnossen M, Haagsma J . The association between post-concussion symptoms and health-related quality of life in patients with mild traumatic brain injury. Injury. 2018; 50(5):1068-1074. DOI: 10.1016/j.injury.2018.12.002. View

11.

Silverberg N, Iaccarino M, Panenka W, Iverson G, McCulloch K, Dams-OConnor K . Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines. Arch Phys Med Rehabil. 2019; 101(2):382-393. DOI: 10.1016/j.apmr.2019.10.179. View

12.

Cherry K, Hoeven E, Patterson T, Lumley M . Defining and measuring "psychological flexibility": A narrative scoping review of diverse flexibility and rigidity constructs and perspectives. Clin Psychol Rev. 2021; 84:101973. DOI: 10.1016/j.cpr.2021.101973. View

13.

Polinder S, Cnossen M, Real R, Covic A, Gorbunova A, Voormolen D . A Multidimensional Approach to Post-concussion Symptoms in Mild Traumatic Brain Injury. Front Neurol. 2019; 9:1113. PMC: 6306025. DOI: 10.3389/fneur.2018.01113. View

14.

Silverberg N, Gardner A, Brubacher J, Panenka W, Li J, Iverson G . Systematic review of multivariable prognostic models for mild traumatic brain injury. J Neurotrauma. 2014; 32(8):517-26. DOI: 10.1089/neu.2014.3600. View

15.

Gonzalez-Fernandez S, Fernandez-Rodriguez C . Acceptance and Commitment Therapy in Cancer: Review of Applications and Findings. Behav Med. 2018; 45(3):255-269. DOI: 10.1080/08964289.2018.1452713. View

16.

Ruggiero G, Spada M, Caselli G, Sassaroli S . A Historical and Theoretical Review of Cognitive Behavioral Therapies: From Structural Self-Knowledge to Functional Processes. J Ration Emot Cogn Behav Ther. 2018; 36(4):378-403. PMC: 6208646. DOI: 10.1007/s10942-018-0292-8. View

17.

Rickards T, Cranston C, McWhorter J . Persistent post-concussive symptoms: A model of predisposing, precipitating, and perpetuating factors. Appl Neuropsychol Adult. 2020; 29(2):284-294. DOI: 10.1080/23279095.2020.1748032. View

18.

Beck A, Dozois D . Cognitive therapy: current status and future directions. Annu Rev Med. 2010; 62:397-409. DOI: 10.1146/annurev-med-052209-100032. View

19.

Trindade I, Guiomar R, Carvalho S, Duarte J, Lapa T, Menezes P . Efficacy of Online-Based Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-Analysis. J Pain. 2021; 22(11):1328-1342. DOI: 10.1016/j.jpain.2021.04.003. View

20.

Theadom A, Barker-Collo S, Jones K, Kahan M, Te Ao B, McPherson K . Work Limitations 4 Years After Mild Traumatic Brain Injury: A Cohort Study. Arch Phys Med Rehabil. 2017; 98(8):1560-1566. DOI: 10.1016/j.apmr.2017.01.010. View