“I can do much more than I thought” – Participants’ journey of recovery after intensive exposure therapy for persistent post-concussion symptoms

• Explore participants’ recovery journey up to two years after intensive exposure therapy. • Understand participants’ experiences of the therapy and its mechanisms. • Using semi-structured interviews and thematic analysis, three themes were identified. • All participants benefitted from the therapy and experienced the therapy positively. • Psychological treatment for this patient group is important and useful. Persistent post-concussion symptoms, which frequently occur after mild traumatic brain injury, negatively interfere with individuals’ daily lives and societal participation. The fear-avoidance model suggests that fear and avoidance of activities can lead to disability, disuse, and depression. Two recent pilot and replication single-case experimental design studies have shown that intensive exposure therapy has efficacy in improving individuals’ subjective experiences of well-being. To inform future implementation, understanding participants’ experiences of the therapy is important. Using semi-structured interviews and self-reported measures, the present study aimed to explore the long-term recovery, and perspectives and experiences of participants who underwent intensive exposure therapy for persistent post-concussion symptoms. Interviews were conducted up to two years post therapy via video conferencing with seven individuals who partook in the previous pilot or replication studies. Interviews were analysed using inductive thematic analysis and self-reported measures were reported descriptively. Three main themes were identified: 1) recovery journey, 2) therapy experiences, and 3) therapy mechanisms. Findings showed that all participants benefitted from the therapy and experienced the therapy as intensive but positive. Key mechanisms participants noted were completing the therapy as part of a group, confronting their fears, and performing the exposure together with different therapists. These findings confirm the efficacy of the therapy. Patient experiences are added to the therapy protocol to stimulate clinical effectiveness and implementation in clinical practice.