LONG-TERM PSYCHOLOGICAL OUTCOMES IN SPINAL-CORD INJURED PERSONS - RESULTS OF A CONTROLLED TRIAL USING COGNITIVE-BEHAVIOR THERAPY

Objective: Although there are many anecdotal reports that psychologica l intervention is effective in enhancing adjustment to spinal cord inj ury (SCI), there are little data to support this assertion. To date, r eports of few longitudinal-based controlled trials that assessed psych ological outcomes for SCI persons have been published. This study was conducted to determine long-term efficacy of cognitive behavior therap y during rehabilitation. Design: The study employed a nonrandomized co ntrolled trial, and measures were taken on three occasions: before, im mediately after, and 12 months after treatment. Setting, Outcome Measu res, and Intervention: Anxiety, depressive mood, and self-esteem were assessed in 28 SCI persons consecutively selected on admission to hosp ital, who participated in specialized group cognitive behavior therapy (CBT) during rehabilitation. Controls: The intervention group's respo nses on the measures were compared with a control group of 41 SCI pers ons who only received traditional rehabilitation services during their hospitalization. Results: There were no overall group differences on anxiety, depressive mood, and self-esteem, although there was a trend for the treatment group to have greater levels of improvement in depre ssion scores across time in comparison to the control group. However, those in the treatment group who reported high levels of depressive mo od before the CBT treatment were significantly less depressed 1 year a fter injury, compared to similar persons in the control group. Conclus ions: While it appears not everyone who experiences SCI needs CBT, at least in the hospital phase of their rehabilitation, those who report high levels of depressive mood benefited greatly from CBT. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Aca demy of Physical Medicine and Rehabilitation