Metacognitive Therapy for People Experiencing Persistent Post-Concussion Symptoms Following Mild Traumatic Brain Injury: A Preliminary Multiple Case-Series Study

doi:10.1089/neur.2024.0076

. 2024 Oct 14;5(1):890-902.

doi: 10.1089/neur.2024.0076. eCollection 2024.

Metacognitive Therapy for People Experiencing Persistent Post-Concussion Symptoms Following Mild Traumatic Brain Injury: A Preliminary Multiple Case-Series Study

Johanne C C Rauwenhoff^{1

2}, Roger Hagen^{1

3

4}, Migle Karaliute^{1

5}, Odin Hjemdal^{1

6}, Leif Edward Ottesen Kennair¹, Stian Solem¹, Robert F Asarnow^{7

8

9}, Cathrine Einarsen^{10

11}, Joar Øveraas Halvorsen^{1

12}, Stephanie Paoli^{1

10}, Simen Berg Saksvik^{11

13}, Hanne Smevik^{1

2

11}, Gøril Storvig^{1

2

11}, Adrian Wells^{1

14

15}, Toril Skandsen^{2

9

11}, Alexander Olsen^{1

2

11}

Affiliations

¹ Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
² NorHead-Norwegian Centre for Headache Research, Norwegian University of Science and Technology, Trondheim, Norway.
³ Department of Psychology, University of Oslo, Oslo, Norway.
⁴ Research Institute, Modum Bad, Vikersund, Norway.
⁵ Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁶ Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Oslo, Norway.
⁷ Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
⁸ Department of Psychology, UCLA School of Medicine, UCLA, Los Angeles, California, USA.
⁹ Brain Research Institute, UCLA, Los Angeles, California, USA.
¹⁰ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
¹¹ Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
¹² Nidaros District Psychiatric Hospital, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
¹³ Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
¹⁴ Division of Psychology and Mental Health, School of Psychological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
¹⁵ Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.

PMID: 39440149
PMCID: PMC11491585 (available on 2025-10-14)
DOI: 10.1089/neur.2024.0076

Metacognitive Therapy for People Experiencing Persistent Post-Concussion Symptoms Following Mild Traumatic Brain Injury: A Preliminary Multiple Case-Series Study

Johanne C C Rauwenhoff et al. Neurotrauma Rep. 2024.

. 2024 Oct 14;5(1):890-902.

doi: 10.1089/neur.2024.0076. eCollection 2024.

Authors

Affiliations

¹ Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
² NorHead-Norwegian Centre for Headache Research, Norwegian University of Science and Technology, Trondheim, Norway.
³ Department of Psychology, University of Oslo, Oslo, Norway.
⁴ Research Institute, Modum Bad, Vikersund, Norway.
⁵ Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁶ Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Oslo, Norway.
⁷ Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
⁸ Department of Psychology, UCLA School of Medicine, UCLA, Los Angeles, California, USA.
⁹ Brain Research Institute, UCLA, Los Angeles, California, USA.
¹⁰ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
¹¹ Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
¹² Nidaros District Psychiatric Hospital, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
¹³ Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
¹⁴ Division of Psychology and Mental Health, School of Psychological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
¹⁵ Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.

PMID: 39440149
PMCID: PMC11491585 (available on 2025-10-14)
DOI: 10.1089/neur.2024.0076

Abstract

After mild traumatic brain injury (mTBI), a subgroup of individuals experience 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 A-B replication series to assess potential MCT mechanisms was used. Of 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.

Keywords: metacognitions; metacognitive therapy; mild traumatic brain injury; post-concussion symptoms.

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References

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1. de Koning ME, Scheenen ME, van der Horn HJ, et al. . Non-hospitalized patients with mild traumatic brain injury: The forgotten minority. J Neurotrauma 2017;34(1):257–261; doi: 10.1089/neu.2015.4377 - DOI - PubMed
1. Nelson LD, Temkin NR, Dikmen S, et al. and the TRACK-TBI Investigators . Recovery after mild traumatic brain injury in patients presenting to US level i trauma centers: A transforming research and clinical knowledge in traumatic brain injury (TRACK-TBI) study. JAMA Neurol 2019;76(9):1049–1059; doi: 10.1001/jamaneurol.2019.1313 - DOI - PMC - PubMed
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1. Voormolen DC, Polinder S, von Steinbuechel N, et al. . The association between post-concussion symptoms and health-related quality of life in patients with mild traumatic brain injury. Injury 2019;50(5):1068–1074; doi: 10.1016/j.injury.2018.12.002 - DOI - PubMed

[1] Levin HS, Diaz-Arrastia RR. Diagnosis, prognosis, and clinical management of mild traumatic brain injury. Lancet Neurol 2015;14(5):506–517; doi: 10.1016/S1474-4422(15)00002-2 - DOI - PubMed

[2] Levin HS, Diaz-Arrastia RR. Diagnosis, prognosis, and clinical management of mild traumatic brain injury. Lancet Neurol 2015;14(5):506–517; doi: 10.1016/S1474-4422(15)00002-2 - DOI - PubMed

[3] de Koning ME, Scheenen ME, van der Horn HJ, et al. . Non-hospitalized patients with mild traumatic brain injury: The forgotten minority. J Neurotrauma 2017;34(1):257–261; doi: 10.1089/neu.2015.4377 - DOI - PubMed

[4] de Koning ME, Scheenen ME, van der Horn HJ, et al. . Non-hospitalized patients with mild traumatic brain injury: The forgotten minority. J Neurotrauma 2017;34(1):257–261; doi: 10.1089/neu.2015.4377 - DOI - PubMed

[5] Nelson LD, Temkin NR, Dikmen S, et al. and the TRACK-TBI Investigators . Recovery after mild traumatic brain injury in patients presenting to US level i trauma centers: A transforming research and clinical knowledge in traumatic brain injury (TRACK-TBI) study. JAMA Neurol 2019;76(9):1049–1059; doi: 10.1001/jamaneurol.2019.1313 - DOI - PMC - PubMed

[6] Nelson LD, Temkin NR, Dikmen S, et al. and the TRACK-TBI Investigators . Recovery after mild traumatic brain injury in patients presenting to US level i trauma centers: A transforming research and clinical knowledge in traumatic brain injury (TRACK-TBI) study. JAMA Neurol 2019;76(9):1049–1059; doi: 10.1001/jamaneurol.2019.1313 - DOI - PMC - PubMed

[7] Theadom A, Parag V, Dowell T, et al. BIONIC Research Group . Persistent problems 1 year after mild traumatic brain injury: A longitudinal population study in New Zealand. Br J Gen Pract 2016;66(642):e16–e23; doi: 10.3399/bjgp16X683161 - DOI - PMC - PubMed

[8] Theadom A, Parag V, Dowell T, et al. BIONIC Research Group . Persistent problems 1 year after mild traumatic brain injury: A longitudinal population study in New Zealand. Br J Gen Pract 2016;66(642):e16–e23; doi: 10.3399/bjgp16X683161 - DOI - PMC - PubMed

[9] Voormolen DC, Polinder S, von Steinbuechel N, et al. . The association between post-concussion symptoms and health-related quality of life in patients with mild traumatic brain injury. Injury 2019;50(5):1068–1074; doi: 10.1016/j.injury.2018.12.002 - DOI - PubMed

[10] Voormolen DC, Polinder S, von Steinbuechel N, et al. . The association between post-concussion symptoms and health-related quality of life in patients with mild traumatic brain injury. Injury 2019;50(5):1068–1074; doi: 10.1016/j.injury.2018.12.002 - DOI - PubMed

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Metacognitive Therapy for People Experiencing Persistent Post-Concussion Symptoms Following Mild Traumatic Brain Injury: A Preliminary Multiple Case-Series Study

Affiliations

Metacognitive Therapy for People Experiencing Persistent Post-Concussion Symptoms Following Mild Traumatic Brain Injury: A Preliminary Multiple Case-Series Study

Authors

Affiliations

Abstract

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