1. Development of Internet-Based Cognitive Behavioural Therapy for Persistent Postconcussional Syndrome Kirsten V. Smith1, Richard G. Brown2, Rona Moss-Morris2, & Seb Potter1 1Lishman Brain Injury Unit, Maudsley Hospital, London, UK 2Institute of Psychiatry, London, UK
Why internet-based cognitive behavioural therapy (CBT)?
Face-to-face CBT can adapted for individuals with persistent postconcussional symptoms and be an effective in reducing symptoms and improving quality of life (PCS) (Potter & Brown, 2012; Potter, Brown & Fleminger, under revision).
A degree of expertise in offering this therapy may be preferred due to the heterogeneity of symptoms and relative lack of symptom specificity, overlap with other diagnoses, and debate about the role of mild TBI in the evolution and maintenance of persistent PCS.
However access to specialist resources may be geographically limited making regular weekly/fortnightly appointments for traditional face-to-face therapy more difficult.
Nonetheless there is a growing evidence base for the effectiveness of CBT in other clinical conditions for remotely-accessed therapy (e.g. via the telephone or internet), with different degrees and levels of therapist involvement (Andersson, 2009).
Objective
To develop the first internet-based but therapist-supported program of CBT for persistent PCS after a mild-moderate traumatic brain injury.
 Methods
The CBT program developed at the Lishman Brain Injury Unit focuses on the vicious cycles set up in the aftermath of a TBI that lead to an unintentional maintenance of distressing symptoms. There is a focus on cognitive attributions and the interpretation of symptoms as well as more traditional behavioural activation and challenging of negative automatic thoughts.
Platform (Lifeguide Online)
Provides secure data storage.
Delivers automated reminders via s and text messages
Cost effective.
Allows for interactive personal formulations to be produced.
Allows for built in client interactivity to maximise adherence and minimise drop-out.
Planning
Focus on identifying and breaking “vicious cycles” as a transdiagnostic approach to PCS.
Content split into 8 topics
Flexible order depending on symptom severity and priority.
Therapist supported programme– weekly sessions via Skype or telephone.
Topics
Introduction to the Symptoms of PCS
Understanding Physical Symptoms [e.g. headaches, light/noise sensitivity]
Understanding Emotional Symptoms: Focussing on Activity [behavioural approaches to address low mood, stress & irritability]
Understanding Emotional Symptoms: Focussing on Thoughts [cognitive-behavioural approaches such as identifying negative automatic thoughts]
Memory and Concentration Problems
Sleep & Fatigue
“Getting Things Done” [tackling perfectionism and procrastination]
Relapse Prevention
Challenges encountered
Skill mix: the project team is solely made up of psychologists, with the lead researcher taking on the majority of the software development and graphic design. Identifying readily-accessible technical support from software developers or computer programmers to assist with website development has not been straight-forward.
Balancing interactivity and providing a professional feel to the website against time and budget constraints
Distilling a relatively flexible transdiagnostic approach for heterogeneous symptoms around fixed website materials – how independent can materials for different topics be?
Presenting a rationale for a talking therapy to persistent PCS to individuals who may be potentially sceptical about such an approach
Next stages
Usability Testing: refining website materials
Pilot Phase: integrating with remote therapy
References
Potter, SDS., & Brown, R. G. (2012). Cognitive behavioural therapy and persistent post-concussional symptoms: Integrating conceptual issues and practical aspects in treatment. Neuropsychological rehabilitation, 22(1), 1-25.
Potter, SDS., Brown, R. G., Fleminger, S (Under revision). A randomised, waiting list controlled trial of cognitive-behavioural therapy for persistent postconcussional symptoms. Archives of Physical Medicine and Rehabilitation.
Andersson, G. (2009). Using the Internet to provide cognitive behaviour therapy.Behaviour research and therapy, 47(3),