Life Improvement Following Traumatic Brain Injury

NCT ID: NCT00878150

Last Updated: 2013-10-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-09-30

Study Completion Date

2013-09-30

Brief Summary

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The purpose of this study is to test the effectiveness of a telephone-based and in-person Cognitive Behavioral Therapy (CBT) intervention for treating Major Depressive Disorder (MDD) following Traumatic Brain Injury. Participants are randomly assigned to receive one of the following: 1) Telephone-based CBT, 2) In-person CBT, or 3) Usual care (control).

Detailed Description

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Major Depressive Disorder (MDD) is the most prevalent psychiatric disorder in persons with traumatic brain injury (TBI) and is most common during the first several years after injury. MDD following TBI is associated with poor behavioral, health, and functional outcomes. While neurological factors contribute somewhat to the development of MDD in this population, there is evidence that numerous psychological, social and vocational factors also contribute.

There are also multiple barriers to effective treatment of MDD in persons with TBI, including:

* under-diagnosis and under-treatment 20lack of access to care due to mobility, transportation and health care benefit limitations
* TBI neurocognitive impairments
* comorbid medical and psychiatric problems, including substance abuse
* stressors such as lack of social support and work instability
* inaccurate beliefs about depression and its treatment among TBI survivors.

The investigators are conducting a three arm trial of Cognitive Behavioral Therapy (CBT) to treat Major Depression Disorder (MDD) that emerges within the first 10 years after complicated mild to severe traumatic brain injury (TBI). The overall objective of the study is to develop a 12-session telephone-based and in-person CBT program for people with TBI (CBT-TBI), and to evaluate its feasibility, acceptability, and effectiveness.

The investigators project aims are to

1. develop CBT for for Major Depression Disorder (MDD) in persons with TBI that can be delivered in-person or via the telephone
2. conduct a trial of CBT-TBI delivered either in-person or via telephone versus care as usual
3. refine the intervention and plan a definitive RCT of CBT-TBI if response rate is sufficient.

Participants are randomized to one of three groups: (1) 12 semi-weekly sessions of telephone-based CBT for depression provided by a study therapist, (2) 12 semi-weekly sessions of in-person CBT for depression provided by a study therapist, or (3) Usual Care (control). Randomization is stratified by injury severity to ensure equal proportions in each treatment group. Participants choose one of three randomization options that includes the groups to which he/she would like to be randomized:

* Option 1: Telephone counseling verses usual care
* Option 2: In-person counseling verses usual care
* Option 3: In-person counseling verses Telephone counseling verses usual care

Outcomes are assessed by a blinded research assistant at 8, 16, and 24 weeks after baseline.

Conditions

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Traumatic Brain Injury Depression

Keywords

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traumatic brain injury TBI head injury brain injury depression major depressive disorder cognitive behavioral therapy CBT counseling

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Telephone-based CBT

\- 12 counseling sessions over 16 weeks over the telephone

Group Type EXPERIMENTAL

Telephone Cognitive Behavioral Therapy

Intervention Type BEHAVIORAL

12 sessions of telephone-based CBT over 16 weeks

In-person CBT

\- 12 counseling sessions over 16 weeks at either Harborview Medical Center or the University of Washington Medical Center in Seattle, WA

Group Type EXPERIMENTAL

In-person Cognitive Behavioral Therapy

Intervention Type BEHAVIORAL

12 sessions of CBT delivered in-person over 16 weeks

3: Usual care

\- No counseling sessions as part of this study, however you are free to pursue regular medical care and counseling outside of this study

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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In-person Cognitive Behavioral Therapy

12 sessions of CBT delivered in-person over 16 weeks

Intervention Type BEHAVIORAL

Telephone Cognitive Behavioral Therapy

12 sessions of telephone-based CBT over 16 weeks

Intervention Type BEHAVIORAL

Other Intervention Names

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In-person CBT Counseling CBT Telephone CBT CBT Counseling

Eligibility Criteria

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Inclusion Criteria

* hospitalized for TBI within the last 10 years, and at least one month post-injury
* sustained a complicated mild to severe TBI as indicated by Glasgow Coma Scale score of 3-12 or had documented intracranial abnormalities on CT scan or had post-traumatic amnesia (PTA) of at least 7 days
* meet screening criteria for major depression
* speak English fluently
* resides in any of the the 50 United States

Exclusion Criteria

* does not have a telephone
* does not have a stable address
* history of bipolar disorder or schizophrenia, or current psychosis or suicidal intent
* current alcohol or substance dependence (within last month)
* evidence of significant cognitive impairment on neuropsychological testing
* started on an antidepressant medication within 6 weeks or planning to start on an antidepressant within the 16-week study
* currently in psychotherapy for depression or plan to start psychotherapy for depression within the 16-week study period
* refusal to participate
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institutes of Health (NIH)

NIH

Sponsor Role collaborator

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role collaborator

U.S. Department of Education

FED

Sponsor Role collaborator

University of Washington

OTHER

Sponsor Role lead

Responsible Party

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Jesse Fann

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jesse R Fann, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of Washington School of Medicine, Departments of Psychiatry & Behavioral Sciences and Rehabilitation Medicine

Charles H. Bombardier, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Washington School of Medicine, Department of Rehabilitation Medicine

Locations

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University of Washington School of Medicine

Seattle, Washington, United States

Site Status

Countries

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United States

References

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Dyer JR, Williams R, Bombardier CH, Vannoy S, Fann JR. Evaluating the Psychometric Properties of 3 Depression Measures in a Sample of Persons With Traumatic Brain Injury and Major Depressive Disorder. J Head Trauma Rehabil. 2016 May-Jun;31(3):225-32. doi: 10.1097/HTR.0000000000000177.

Reference Type DERIVED
PMID: 26291629 (View on PubMed)

Fann JR, Bombardier CH, Vannoy S, Dyer J, Ludman E, Dikmen S, Marshall K, Barber J, Temkin N. Telephone and in-person cognitive behavioral therapy for major depression after traumatic brain injury: a randomized controlled trial. J Neurotrauma. 2015 Jan 1;32(1):45-57. doi: 10.1089/neu.2014.3423.

Reference Type DERIVED
PMID: 25072405 (View on PubMed)

Other Identifiers

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1R21HD053736-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

H133G070016

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

40378 G

Identifier Type: -

Identifier Source: org_study_id