Acceptance and Commitment Therapy for Traumatic Brain Injury

Recruiting at 1 trial location

Overseen By Courtney Perry, MS

Age: 18 - 65

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: University of Pittsburgh

Disqualifiers: Vestibular disorder, Neurological disorder, Cervical spine injury, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

The primary objective of this multi-site randomized clinical trial (RCT) is to compare Acceptance and Commitment Therapy Integrated Vestibular Rehabilitation (ACTIVE) with usual care vestibular rehabilitation (VESTIB CONTROL) in 250 individuals with mTBI-related vestibular symptoms attributable to mild traumatic brain injury (mTBI) treated at one of two sites (1) the University of Pittsburgh Medical Center, or (2) the Intrepid Spirit Center, Carl R. Darnall Army Medical Center, Fort Cavazos, Texas. Both interventions will be delivered weekly over 4 weeks. Assessments will be administered prior to the start of treatment (Baseline) and at 4-weeks, 3- and 6-months following the completion of treatment.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Acceptance and Commitment Therapy Integrated Vestibular Rehabilitation (ACTIVE) for traumatic brain injury?

Research shows that Acceptance and Commitment Therapy (ACT) can help reduce anxiety, depression, and stress in people with traumatic brain injuries. Studies have found that ACT can lead to significant improvements in psychological distress and quality of life, suggesting it may be a promising treatment option for these conditions. ^{1 2 3 4 5}

Is Acceptance and Commitment Therapy safe for people with traumatic brain injury?

The studies reviewed do not report any specific safety concerns for Acceptance and Commitment Therapy (ACT) in people with traumatic brain injury or other conditions, suggesting it is generally safe for use in humans. ^{1 2 3 4 5}

How is the ACTIVE treatment different from other treatments for traumatic brain injury?

The ACTIVE treatment combines Acceptance and Commitment Therapy (ACT) with Vestibular Rehabilitation, which is unique because it addresses both psychological distress and physical balance issues often seen in traumatic brain injury patients. This integrated approach aims to improve psychological flexibility and reduce anxiety and depression, which are not typically the focus of standard physical rehabilitation therapies. ^{1 2 3 4 6}

Research Team

Anthony Kontos, PhD

Principal Investigator

University of Pittsburgh

Eligibility Criteria

This trial is for individuals with mild traumatic brain injury (mTBI) who are experiencing vestibular symptoms, such as dizziness or balance problems. Participants must be treated at either the University of Pittsburgh Medical Center or the Intrepid Spirit Center in Texas.

Inclusion Criteria

I am between 18 and 49 years old.

Diagnosed with mTBI per military clinical practice guidelines (CPGs) that occurred over 8 days prior to consent as determined by a multi-domain assessment performed by a licensed healthcare professional

My vision is normal or corrected to normal.

Exclusion Criteria

Exercise-induced dizziness as determined by the Physical Therapist exam

I have trouble moving my neck due to an injury.

< 8 days following current mTBI as determined by self-report

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either ACTIVE or VESTIB CONTROL interventions over 4 weeks, with weekly in-person sessions

4 weeks

4 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment at 4-week, 3-month, and 6-month intervals

6 months

3 visits (in-person)

Treatment Details

Interventions

• Acceptance and Commitment Therapy Integrated Vestibular Rehabilitation (ACTIVE) (Behavioral Intervention)

Trial Overview The study compares two treatments: usual care vestibular rehabilitation and a new approach called Acceptance and Commitment Therapy Integrated Vestibular Rehabilitation (ACTIVE). Each treatment lasts four weeks, with assessments before, after, and at 3- and 6-month follow-ups.

Participant Groups

Group I: Acceptance and Commitment Therapy Integrated Vestibular Rehabilitation (ACTIVE) Experimental Treatment 1 Intervention

The ACTIVE intervention group will receive Acceptance and Commitment Therapy (ACT) + targeted vestibular rehabilitation exercises and behavioral management during four weekly in person sessions along with daily at-home activities during the 4 week treatment period. The four ACTIVE sessions will last 90 minutes and will be divided between the vestibular rehabilitation portion (30 minutes) and the ACT portion (60 minutes). ACT component and therapy sessions will include: 1) values clarification and goal setting; 2) skills training in psychological flexibility including emotional acceptance, cognitive defusion, and present moment awareness; and 3) practice engaging these skills to overcome mental obstacles to values-driven goal attainment.

Group II: Usual Care Vestibular Rehabilitation (VESTIB CONTROL) Active Control 1 Intervention

The VESTIB CONTROL group will receive standard of care evaluations and treatments involving a holistic multidisciplinary approach, which includes vestibular rehabilitation, but will exclude any ACT components. Because usual standard of care is individualized to the patient's unique functional deficits, treatments combined with vestibular rehabilitation may focus on any one or more of the following: neuro-optometry, neuropsychology, physical and occupational therapy, or speech and language pathology, or general mental health interventions such as instruction regarding stress reduction. Participants will attend 4 weekly in-person visits for vestibular rehab, as well as any other interventions provided to them by their treating clinician.

Who Is Running the Clinical Trial?

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

United States Department of Defense

Collaborator

Trials

940

Recruited

339,000+

Findings from Research

A scoping review of 54 studies on Acceptance and Commitment Therapy (ACT) in adults with neurological conditions identified 136 measurement tools, highlighting the need for standardized measures in this area.

The most commonly used process measure was the Acceptance and Action Questionnaire, while health-related outcomes focused on quality of life, anxiety, and depression, indicating key areas of concern for patients with conditions like multiple sclerosis and stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A scoping review to identify process and outcome measures used in acceptance and commitment therapy research, with adults with acquired neurological conditions. Foote, H., Bowen, A., Cotterill, S., et al.[2023]

Acceptance and Commitment Therapy (ACT) may effectively reduce anxiety and depressive symptoms in patients with acquired brain injury (ABI), as shown by medium to large decreases in symptoms for three out of four participants in a year-long study.

Participants also reported improvements in stress and quality of life, although there were no significant changes in psychological flexibility or social participation, indicating that while ACT shows promise, further research is needed to confirm its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy for individuals with depressive and anxiety symptoms following acquired brain injury: A non-concurrent multiple baseline design across four cases. Rauwenhoff, JCC., Bol, Y., Peeters, F., et al.[2023]

Acceptance and Commitment Therapy (ACT-Adjust) showed promise in reducing psychological distress, specifically depression and stress, in individuals with severe traumatic brain injury (TBI) compared to an active control group, with significant results observed immediately post-treatment.

While the initial reductions in depression and stress were clinically significant, these benefits did not persist at the one-month follow-up, indicating that additional sessions may be necessary to maintain treatment effects and warranting further research in larger trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can acceptance and commitment therapy facilitate psychological adjustment after a severe traumatic brain injury? A pilot randomized controlled trial. Whiting, D., Deane, F., McLeod, H., et al.[2021]

Acceptance and commitment therapy combined with vestibular rehabilitation was successfully implemented in 27 patients with persistent postural-perceptual dizziness, showing significant improvement in dizziness scores 6 months post-treatment (P < .001).

40.7% of patients achieved remission and 59.3% showed a significant treatment response, indicating that this therapy may provide long-term benefits for managing dizziness symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy combined with vestibular rehabilitation for persistent postural-perceptual dizziness: A pilot study. Kuwabara, J., Kondo, M., Kabaya, K., et al.[2021]

Acceptance and Commitment Therapy (ACT) shows promising effectiveness in improving functionality and well-being for individuals with psychological disturbances or medical problems, including those with acquired brain injuries (ABI).

There is a growing body of evidence suggesting that ACT and mindfulness-based interventions could be beneficial in the rehabilitation of ABI patients, highlighting the need for further research to rigorously test their efficacy in helping these individuals lead meaningful lives despite their challenges.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is it time to act? The potential of acceptance and commitment therapy for psychological problems following acquired brain injury. Kangas, M., McDonald, S.[2021]

References

1. England pubmed.ncbi.nlm.nih.gov

A scoping review to identify process and outcome measures used in acceptance and commitment therapy research, with adults with acquired neurological conditions. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy for individuals with depressive and anxiety symptoms following acquired brain injury: A non-concurrent multiple baseline design across four cases. [2023]

3. England pubmed.ncbi.nlm.nih.gov

Can acceptance and commitment therapy facilitate psychological adjustment after a severe traumatic brain injury? A pilot randomized controlled trial. [2021]

4. England pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of acceptance and commitment therapy for psychological distress among persons with traumatic brain injury. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy combined with vestibular rehabilitation for persistent postural-perceptual dizziness: A pilot study. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Is it time to act? The potential of acceptance and commitment therapy for psychological problems following acquired brain injury. [2021]