Metacognitive therapy for people experiencing persistent post-concussion symptoms following mild traumatic brain injury: a preliminary multiple case-series study

After mild traumatic brain injury (mTBI), a subgroup of individuals experiences persistent post-concussion symptoms (PPCS) that include headaches, cognitive difficulties, and fatigue. The aim of this preliminary study was to investigate possible effects associated with Metacognitive Therapy (MCT) on PPCS, maladaptive coping strategies, and positive- and negative metacognitive beliefs, following mTBI. A pre-post design supplemented with single case series repeated measurement of potential mechanisms using an A-B replication was used. From the nine participants who received MCT, all experienced a decrease in PPCS, which constituted a reliable improvement for eight participants. For eight participants (we could calculate effect sizes for eight out of nine participants) moderate to very large decreases in maladaptive coping styles and positive- and negative metacognitive beliefs were observed. However, based on visual analyses participants 6, 8, and 9 show a downward baseline trend regarding MCT mechanisms that may have persisted into the intervention phase. No adverse events were reported. In conclusion, MCT was associated with improvements in PPCS and unhelpful psychological mechanisms, but caution is required in interpreting this association. Future research, using formal single-case replication on symptom measures and randomized controlled trials appears to be justified.